title: Metabolic considerations of drugs in the treatment of allergic diseases.
abstract: BACKGROUND
  The clinical management of allergic diseases involves a number of drugs, most of which are extensively metabolized. This review aims to analyze the metabolism and the clinical implications of altered metabolism for these drugs.
  
  
  METHODS
  The authors present an overview of current knowledge of the metabolism of: antihistamine drugs, glucocorticoids, inhaled β-2 bronchodilators, anticholinergics and other drugs used in allergic diseases, such as cromoglycate, omalizumab, montelukast and epinephrine. Polymorphic drug metabolism is relevant for chlorpheniramine, loratadine and montelukast. Inhibition of drug metabolism is relevant for loratadine, methylprednisolone, fluticasone, mometasone, triamcinolone or prednisolone. Polymorphic pre-systemic metabolism may be relevant to budesonide, fluticasone, beclomethasone, mometasone or salmeterol. The authors also discuss the current information on gene variations according to the 1,000 genomes catalog and other databases. Finally, the authors review the clinical implications of these variations with a particular regard to drugs used in the management of allergic diseases.
  
  
  CONCLUSIONS
  Most drugs used in allergic diseases are extensively metabolized. Drug interaction or adverse reactions related to altered metabolism are relevant issues that should be considered in the management of allergic diseases. However, much additional research is required before defining pharmacogenomic biomarkers for the management of drugs used in allergic diseases.
authors.affiliation: University of Extremadura, Department of Biochemistry & Molecular Biology , Avda. de la Universidad s/n, E-10071, Cáceres , Spain +34927257000 ext 89676 ; elenag@unex.es.
authors.forename: Elena
authors.initials: E
authors.lastname: García-Martín
authors.forename: Gabriela
authors.initials: G
authors.lastname: Canto
authors.forename: José A G
authors.initials: JA
authors.lastname: Agúndez
mesh_terms: D000818:Animals; D018926:Anti-Allergic Agents / Q000009:adverse effects / Q000378:metabolism*; D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000378:metabolism*; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000378:metabolism; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D014644:Genetic Variation; D005938:Glucocorticoids / Q000009:adverse effects / Q000378:metabolism; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy*
chemical_list: D018926:Anti-Allergic Agents; D018927:Anti-Asthmatic Agents; D018680:Cholinergic Antagonists; D005938:Glucocorticoids