1. Urticaria
DR.A.Asilian

2. Mechanism of Allergy
TH1
TH2
Infections
Allergy

3. Mechanism of Allergy II
Peanut antigen
TH2
B cell
Plasma cell

4. Mechanism of Allergy III
Plasma Cell
IgE

5. Mechanism of Allergy IV
Mast Cell
IgE

6. Mechanism of Allergy V
Mast Cell

7. Mechanism of Allergy VI
Peanut antigen
Exploding
Mast Cell
Histamine

8. Mechanism of Allergy VII
Urticaria

9. Urticaria Affects 20% of population Occurs across the age spectrum1
Sometimes possible to identify a trigger such as food, drug, insect sting or infection
More than 2/3 of cases are self-limiting

10. Characteristics Pruritic (most severely at night) Erythematous
Often exhibit central pallor
Blanches
Oval, round or irregular shape or plaques
Plaques “move” to different locations over minutes to hours
Last less than 24 hours
Leave no residual marks (other than those created by scratching)

15. Urticaria
Urticaria is characterized by wheals (itchy hives) and lesions that look like burns from stinging nettle.

16. Hives or angioedema
In some patients, only hives occur – in others, only angioedema. Angioedema is swelling of the skin and mucous membranes.

17. Hives and angioedema
Most patients experience both hives and angioedema.

18. Men and women
Both sexes are affected - women twice as often as men.

19. Young and elderly
Urticaria occurs most commonly in young adults. But, children and the elderly can also suffer from urticaria.

20. Classification Acute versus Chronic Urticaria
Acute episodes < 6 weeks
more likely to have an identifiable trigger
Chronic episodes last > 6 weeks
less likely to have an identifiable trigger

21. Treatment of Urticaria
H1 antihistamines
First generation:
diphenhydramine, chlorpheniramine, hydroxyzine
Second generation:
cetirizine, loratadine, fexofenadine

22. Treatment of Urticaria (cont)
First generation antihistamines:
more sedating, require more frequent dosing
Second generation antihistamines:
higher dosing than standard dosing to obtain positive effects
Can be sedating at higher dosages

23. Treatment of Urticaria (cont)
Pregnant women or those breastfeeding may use loratidine or cetirizine

24. Treatment of Urticaria (cont)
Consider use of H2 blocker as well although data is not particularly supportive
ranitidine, nizatidine, famotidine and cimetidine
(note cimetidine can increase drug levels in other medications taken concurrently)

28. Neotadin

29. Neotadin (Desloratadine)
Active & Potent metabolite of Loratadin
New Second generation H1 receptor antagonist

30. CLINICAL PHARMACOLOGY

31. Mechanism of Action
A long-acting tricyclic histamine antagonist with selective H1-receptor histamine antagonist activity
A study in guinea pigs showed that desloratadine did not readily cross the blood brain barrier.

32. Pharmacodynamics Exhibits an antihistaminic effect by 1 hour
This effect persists for as long as 24 hours.
Effects on QTc : No clinically relevant adverse events were reported

33. PHARMACOKINETICS Tmax : 3 hr Half-life : 27 hr
Absorption :
Tmax : 3 hr
Neither food nor grapefruit juice had an effect on the bioavailability (Cmax and AUC) of desloratadine
Distribution :
82% - 87% bind to plasma protein
Elimination :
Half-life : 27 hr
equally distributed in urine and feces as metabolic products

34. Seasonal Allergic Rhinitis: Perennial Allergic Rhinitis:
INDICATIONS AND USAGE:
Seasonal Allergic Rhinitis:
relief of nasal and non-nasal symptoms in patients 2 years of age and older
Perennial Allergic Rhinitis:
relief of nasal and non-nasal symptoms in patients 6 months of age and older
Chronic Idiopathic Urticaria:
symptomatic relief of pruritus, reduction in the number of hives, and size of hives in patients 6
months of age and older

35. Adults and Adolescents 12 Years of Age and Over:
DOSAGE
Adults and Adolescents 12 Years of Age and Over:
• Neotadin Tablets - one 5 mg tablet once daily or
• Neotadin Oral Solution - 2 teaspoonfuls (5 mg in 10 mL) once daily
Children 6 to 11 Years of Age:
• Neotadin Oral Solution - 1 teaspoonful (2.5 mg in 5 mL) once daily
Children 12 Months to 5 Years of Age:
• Neotadin Oral Solution - 1/2 teaspoonful (1.25 mg in 2.5 mL) once daily
Children 6 to 11 Months of Age:
• Neotadin Oral Solution - 2 mL (1 mg) once daily

36. Neotadin Oral Solution - 0.5 mg/1 mL
DOSAGE FORMS AND ADMINISTRATION
Neotadin Tablets - 5 mg
Neotadin Oral Solution mg/1 mL
Take tablet immediately after opening the blister
may be taken without regard to meals, with or without water

37. Contraindication
Hypersensitivity

38. WARNINGS AND PRECAUTIONS
Hypersensitivity reactions including rash, pruritus, urticaria,
edema, dyspnea, and anaphylaxis have been reported. In such
cases, stop Neotadin at once and consider alternative
treatments.

39. ADVERSE REACTIONS Pharyngitis, dry mouth, myalgia, fatigue,
The most common adverse reactions (reported in ≥2% of adult
and adolescent patients with allergic rhinitis and greater than
placebo) were:
Pharyngitis,
dry mouth,
myalgia,
fatigue,
somnolence,
Dysmenorrhea
With Chronic Idiopathic Urticaria:
Headache, nausea, fatigue, dizziness, pharyngitis, dyspepsia , myalgia

40. USE IN SPECIFIC POPULATIONS*
Renal impairment: dosage adjustment is recommended
Hepatic impairment: dosage adjustment is recommended
A starting dose of one 5-mg tablet every other day
Pregnancy: category C
Desloratadine was not teratogenic in animals
Desloratadin passes into breast milk
Geriatric : dose selection for an elderly patient should be cautious
*Dosing recommendation for children with liver or renal impairment cannot be made due to lack of data.

41. NO DRUG INTERACTIONS

42. Important notes: FDA approved >6 months old
No CNS suppression (selective H1 antagonist)
Limited penetration of BBB(no anticholinergic effects)
Active & potent metabolite of Loratadine
2nd generation Antihistamines : the first choice in guidelines for AR & CIU
Once daily (Half-life=27 Hours)
Absorption is unaffected by food
Not metabolized by CytP450
Excellent compliance

43. Thank You! Questions?