title: In Vivo Anti-Inflammatory Effect of H1 Antihistamines in Allergic Rhinitis: A Randomized Clinical Trial.
abstract: BACKGROUND
  Allergic rhinitis is characterized by a chronic inflammation of nasal mucosa and represents a risk factor for asthma occurrence. H1 antihistamines reduce the symptoms of rhinitis, but some compounds may have anti-inflammatory properties.
  
  
  OBJECTIVE
  We evaluated the plasma level of some cytokines in patients with persistent allergic rhinitis (PAR) and their evolution after a 4-week treatment with H1 anti-histamines, as well as the risk of asthma after 1.5 years.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Eighty-five patients with PAR and 30 healthy volunteers were included in the study. The patients with PAR were randomly divided into 2 groups: 41 patients treated with 5 mg/day desloratadine and 44 patients under 5 mg/day levocetirizine for 4 weeks. The clinical and biological evaluations were performed before and after treatment and included rhinitis symptoms and total symptoms score, type of sensitization, and plasmatic levels of total IgE, IL-1β, IL-6, IL-8 and TNF-α.
  
  
  RESULTS
  IL-8 and TNF-α were significantly increased in patients with PAR compared to healthy volunteers (5.85 vs 3.12, p<0.001 and 2.32 vs 1.06, p<0.001, respectively). Both H1 antihistamines reduce all symptoms of allergic rhinitis, including nasal congestion and the plasmatic level of IL-1β, IL-6, IL-8 and TNF-α, after 4 weeks of treatment. The reduction of cytokine levels was not influenced by patients' age, sex, duration or severity of rhinitis, or type of sensitization. Levocetirizine has a superior effect compared to desloratadine in reducing the rhinitis symptoms and cytokines' level. Twenty eight (32.9%) of the patients presented asthma symptoms after 1.5 years. The occurrence of asthma was influenced by house dust sensitization (OR-14.6; CI 95% 1.8-116.3; p=0.01), but baseline values of cytokines were not predictive factors for its appearance.
  
  
  CONCLUSIONS
  Levocetirizine and desloratadine as a prolonged therapy reduce plasmatic levels of some pro-inflammatory cytokines in patients with PAR. Levocetirizine has a better effect on decreasing the symptoms and plasmatic levels of IL-1β and IL-8. (ClinicalTrials. gov Identifier: NCT02507635).
  POSDRU and University of Medicine and Pharmacy, Iuliu Haţieganu, Cluj Napoca.
authors.affiliation: Department of Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
authors.forename: Corina I
authors.initials: CI
authors.lastname: Bocşan
authors.affiliation: Department of Allergology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
authors.forename: Adriana I
authors.initials: AI
authors.lastname: Bujor
authors.affiliation: Department of Allergology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
authors.forename: Nicolae
authors.initials: N
authors.lastname: Miron
authors.affiliation: Department of Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
authors.forename: Ştefan C
authors.initials: ŞC
authors.lastname: Vesa
authors.affiliation: Department of Allergology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
authors.forename: Diana
authors.initials: D
authors.lastname: Deleanu
authors.affiliation: Department of Allergology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
authors.forename: Anca D
authors.initials: AD
authors.lastname: Buzoianu
keywords: Cytokines; allergic rhinitis; histamine H1 antagonists