Addition of fexofenadine to inhaled corticosteroid therapy to reduce inflammatory biomarkers in atopic asthma.
BACKGROUND
We previously showed that H1-antihistamines may shift the PC20 (provocation concentration that caused a decrease in forced expiratory volume in 1 second of 20%) threshold to adenosine monophosphate (AMP) challenge but may paradoxically prolong recovery.


OBJECTIVE
To measure AMP recovery using a constant predetermined AMP PC20 and to evaluate whether fexofenadine use confers add-on effects to treatment with either fluticasone propionate alone or combined fluticasone propionate-salmeterol.


METHODS
Fourteen atopic patients with mild-to-moderate asthma (forced expiratory volume in 1 second of 76%) completed a double-blind, randomized, crossover study consisting of 3-week treatment blocks of either fluticasone propionate-salmeterol, 250 microg twice daily, or fluticasone propionate alone, 250 microg twice daily, in conjunction with either fexofenadine, 180 mg once daily, or matched placebo. Recovery after a predetermined AMP PC20 challenge was measured (primary outcome), along with exhaled nitric oxide levels, plasma eosinophil cationic protein levels, peripheral eosinophil counts, pulmonary function, diary card outcomes, and quality of life (all secondary outcomes).


RESULTS
There were no differences in any of the primary or secondary outcomes when fexofenadine was added to treatment with either fluticasone propionate-salmeterol or fluticasone propionate alone. The mean AMP recovery time was 25.0 vs 23.4 minutes for fexofenadine and placebo, respectively, as add-on to fluticasone-salmeterol and 22.5 vs 23.9 minutes, respectively, as add-on to fluticasone alone.


CONCLUSIONS
Fexofenadine did not affect recovery to a fixed dose of AMP challenge or any other surrogate inflammatory markers when given as add-on therapy to corticosteroid-treatedatopic asthmatic patients.
Fardon
Tom C
TC
Asthma and Allergy Research Group, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland.
Lee
Daniel K C
DK
Hodge
Melissa R
MR
Lipworth
Brian J
BJ
D000249:Adenosine Monophosphate / Q000276:immunology; D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000420:Albuterol / Q000031:analogs & derivatives / Q000627:therapeutic use; D000730:Androstadienes / Q000627:therapeutic use; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D015415:Biomarkers; D001985:Bronchial Provocation Tests; D004359:Drug Therapy, Combination; D047150:Eosinophil Cationic Protein / Q000097:blood / Q000187:drug effects; D004804:Eosinophils / Q000187:drug effects; D005260:Female; D000068298:Fluticasone; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000188:drug therapy*; D007249:Inflammation / Q000276:immunology; D008297:Male; D009569:Nitric Oxide / Q000032:analysis; D012129:Respiratory Function Tests; D000068299:Salmeterol Xinafoate; D016593:Terfenadine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D018926:Anti-Allergic Agents; D015415:Biomarkers; D009569:Nitric Oxide; D000249:Adenosine Monophosphate; D000068299:Salmeterol Xinafoate; D016593:Terfenadine; D000068298:Fluticasone; C093230:fexofenadine; D047150:Eosinophil Cationic Protein; D000420:Albuterol