Histamine and pharmacological treatment of allergy. Antiemetics. Antiserotonic drugs. Anton Kohút

Acute allergic reaction

Allergens

omalizumab

Histamine is formed from the amino acid histidine by histidine decarboxylase.

Histamine is a basic amine, stored in mast cells and basophils (lung, skin, GIT, CNS). R e l e a s e Histamine is released during inflammatory and alergic reactions. Secretory process is initiated by a rise of intracellular calcium. Drugs increasing histamine release: morphine tubocurarin substance P

Actions of histamine

Antihistaminics (H1)

Antihistaminics (H2) Cimetidine Famotidine Nizatidine Ranitidine Treatment of gastric ulcer

Serotonin (5-HT)

5-HT neurotransmission

5HT-RActionAgonistAntagonist 1A, B neuronal inhibition, behavioural effects: sleep, feeding, anxiety, thermoregul. Buspirone, Sertindole Ergotamine Metiotepine 1Dvasoconstriction Sumatriptan Ergotamin Metiotepine 2Aneuronal excitation (increase in the number in suicides) LSD Ketanserine Cyproheptadine Nefazodone 3neuronal excitation, vomiting, anxiety  -Metyl-5- HT Ondanzetron Granizetron Tropizetron 7not knownLSD Ketanserine Cyproheptadine 5-HT-R classification and function in CNS

Serotonin has been linked to an exhausting list of conditions: - depression, -eating disorders, -schizophrenia, - premenstrual syndrome, anxiety, panic disorder, -seasonal affective disorder, -extreme violence, -hostility and aggression, -suicide, migraine,- - addiction, and more.

Actions and functions of 5–HT Actions increased GIT motiliti, smooth muscle (bronchi, uterus)- contraction mixture of vascular constriction and dilatation, increased microvascular permeability platelet aggregation, stimulation of peripheral nociceptive nerve endings excitation/inhibition of CNS neurons, Pathophysiological role in periphery: peristalsis, vomiting, platelet aggregation, inflammatory mediator, sensitisation of nociceptors and microcirculation control. in CNS: control of apetite, sleep, mood, hallucinations, pain perception and vomiting. Clinical conditions: -migraine, -carcinoid syndrome flushing, diarhoe, bronchoconstriction, hypotension), - mood disorders (depression) and anxiety, - vomiting

Drugs influencing serotoninergic function

Antiemetics

Receptors involved in vomiting

Causes of vomiting I. Drugs Anticancer drugs, cardiac glycosides, apomorphine, levodopa, bromocryptine, cholinomimetics, opiates, ergot alkaloids II. Physiological Pregnancy, head motion, weitghlesness III. Pathophysiological Uremia, endocrinopathies, alcoholism, migraine, allergies, gastric irritations IV. Toxic Food poisons, industrial poisons, radiations, infections

Grops of antiemetic drugs

Recomended antiemetic treatment

Migraine are recurrent, moderate-to-severe episodes of head pain that may be induced by a variety of triggers. A migraine headache is a form of vascular headache. Migraine headache is caused by vasodilatation that causes the release of chemicals from nerve fibers.

Pathophysiology and treatment of migraine