• 대한임상독성학회지
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• 제8권2호
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• pp.79-87
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• 2010

Purpose: The previous studies on $H_1$ antihistamine overdose have generally been limited to cases of acute doxylamine succinate (DS) poisoning, yet there have been some studies on diphenhydramine (DPH) overdosing. But many clinicians consider the two drugs to be very similar and to have similar ingredients. The purpose of this study was to clarify the toxicologic characteristics and clinical outcomes between DS and DPH poisoning/overdose. Methods: We reviewed the medical and intensive care records of the patients with acute DS or DPH poisoning and who admitted to our emergency department from January 2008 and April 2010. We collected patient information regarding the features of the poisoning and the clinical and demographic characteristics. The patients were assessed for the clinical outcomes, the GCS, the PSS (Poisoning Severity Score) and the SOFA (Sequential Organ Failure Assessment). Results: Fifty seven patients (45 cases of DS poisoning and 12 cases of DPH poisoning) were enrolled. Compared with the DS group, the DPH group had higher incidences of intubation, serious mental change, QTc prolongation and ECG conduction abnormality (p=0.041, <0.001, 0.014 and 0.044, respectively). The DPH group had a higher PSS and a longer ICU stay. The peak CPK time and the CPK normalization time were longer for the patients with rhabdomyolysis due to DS poisoning. Conclusion: Two common $H_1$ antihistamines, doxylamine and diphenhydramine, are in the same ethanolamine-structural class, but the toxico-clinical outcomes are different according to many aspects. Therefore, clinicians could take a careful approach for the differential diagnosis and management between DS and DPH poisoning.

• Clinical and Experimental Pediatrics
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• 제64권8호
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• pp.373-383
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• 2021

Rhinitis is among the most common respiratory diseases in children. Nonallergic rhinitis, which involves nasal symptoms without evidence of systemic allergic inflammation or infection, is a heterogeneous entity with diverse manifestations and intensities. Nonallergic rhinitis accounts for 16%-89% of the chronic rhinitis cases, affecting 1%-50% (median 10%) of the total pediatric population. The clinical course of nonallergic rhinitis is generally rather mild and less likely to be associated with allergic comorbidities than allergic rhinitis. Here, we aimed to estimate the rate of coexisting comorbidities of nonallergic rhinitis. Nonallergic rhinitis is more prevalent during the first 2 years of life; however, its underestimation for children with atopic tendencies is likely due to low positive rates of specific allergic tests during early childhood. Local allergic rhinitis is a recently noted phenotype with rates similar to those in adults (median, 44%; range, 4%-67%), among patients previously diagnosed with nonallergic rhinitis. Idiopathic rhinitis, a subtype of nonallergic rhinitis, has been poorly studied in children, and its rates are known to be lower than those in adults. The prevalence of nonallergic rhinitis with eosinophilia syndrome is even lower. A correlation between nonallergic rhinitis and pollution has been suggested owing to the recent increase in nonallergic rhinitis rates in highly developing regions such as some Asian countries, but many aspects remain unknown. Conventional treatments include antihistamines, intranasal corticosteroids, and recent treatments include combination of intranasal corticosteroids with azelastin or decongestants. Here we review the prevalence, diagnosis, comorbidities, and treatment recommendations for nonallergic rhinitis versus allergic rhinitis in children.

• Journal of Rhinology
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• 제25권2호
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• pp.103-107
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• 2018

Pregnancy rhinitis is a relatively common condition. It is characterized by the presence of nasal symptoms, especially nasal congestion, not present prior to pregnancy, but typically present during the last 6 or more weeks of pregnancy, without other signs of respiratory tract infection or any known allergic causes, and disappearing completely within 2 weeks after delivery. Nasal saline irrigation, intranasal steroid spray, and oral antihistamines are usually recommended as the first line of treatment for rhinitis. However, most pregnant women refuse medical treatment for pregnancy rhinitis because of the fear of teratogenicity. Severe pregnancy rhinitis increases the risk of snoring, which has been suggested as having adverse effects on the fetus. In cases where the patients are unable to control their symptoms, pregnancy rhinitis can negatively affect the quality of life (QOL) as well as the pregnancy outcome. Therefore, special caution is required for determining the appropriate diagnosis and treatment modalities for pregnancy rhinitis. Here, we report for the first time, the successful treatment of pregnancy rhinitis that was unresponsive to conservative management and medical therapy by using microdebrider-assisted inferior turbinoplasty at the final stages of pregnancy, along with a review of the relevant literature.

• 보건의료산업학회지
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• 제13권3호
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• pp.115-125
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• 2019

Objectives: Korea has been practicing the separation of dispensary from medical practice since 2000 as a national policy to prevent misuse or overuse of medicines. This study aimed to investigate prescription patterns from except pharmacies in order to determine the appropriateness of drug usage among those patients. Methods: Thirty-two pharmacies in the Yeongdong area of Gangwon Province were examined in this study. The same simulated patient complaining of cold symptoms for 3 days visited each pharmacy to obtain a prescription for medication. Results: At pharmacies prescribing medicine, steroids (53.1%) and antibiotics (50.0%) were used to treat the common cold. Duplicate prescriptions of drugs, such as antihistamines (47.0%) and decongestants (31.3%) were common. The average number of drug prescriptions was 6.59, and 53.2% of pharmacies had prescribed more than seven drugs. The average total cost of the prescriptions was 6,093 won, and the daily cost was 2,544 won. Conclusions: Steroids and antibiotics were frequently abused among patients whose medications had been prescribed by pharmacies. Also, there were a considerable number of drugs and duplicate prescriptions. The prices of the drugs were somewhat high.

• 대한중풍순환신경학회지
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• 제8권1호
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• pp.52-57
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• 2007

Drug eruption is a relatively commin dermatological disorder and may cause significant problems. The treatment is to stop using a drug that may cuase a drug eruption. In some cases, steroids and antihistamines can be used supportively. According to some reports, Onchungeum(溫淸飮) has steroid-like effects and antihistaminic effects. We administered Onchungeum(溫淸飮) a patient with severe itching because of a drug eruption. After administration of Onchungeum(溫淸飮), itching decreased to much degrees. It can be suggested that Onchungeum(溫淸飮) can be used to treat symptoms of allergic skin disease like a drug eruption.

• 대한한방내과학회지
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• 제44권4호
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• pp.757-764
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• 2023

Background: Vestibular neuritis is a common cause of acute unilateral peripheral vestibulopathy. Vestibular neuritis is the second most common disease among patients with dizziness. Clinical symptoms of vestibular neuritis include the sudden onset of vertigo with spontaneous nystagmus, unsteady gait, nausea, and vomiting that last from days to weeks. However, even after the vertigo disappears, difficulty maintaining balance while walking may persist for weeks to months. Antihistamines, serotonin receptor blockers, and benzodiazepine vestibular suppressants are widely used as symptomatic treatments to reduce the severity of symptoms that occur in the acute phase. Case Summary: A patient diagnosed with acute vestibular neuritis was treated with acupuncture, moxibustion, and herbal medicine. We used the visual analog scale (VAS) to assess each symptom and the vertigo score to observe the effect of treatment. After treatment, the VAS scores for each symptom and the vertigo score decreased, and the severity of nystagmus was reduced. Conclusion: This study suggests that Korean medicine treatments, including Samchulgunbi-tang-gagam, could be effective in improving the clinical symptoms of vestibular neuritis.

• 한국임상약학회지
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• 제30권2호
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• pp.113-119
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• 2020

Background: Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. Methods: We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. Results: The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26-3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. Conclusions: This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.

• 약학회지
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• 제34권4호
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• pp.224-237
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• 1990

A single uniform population of specific, saturable, high affinity binding site of $[^3H]QNB$ guinuclidinyl benzilate(QNB) was identified in the rat cerebral microsomes. The Kd value(37.2 pM) for $[^3H]QNB$ calculated from the kinetically derived rate constants was in agreement with the Kd value(48.9 pM) determined by analysis of saturation isotherms at various receptor concentrations. Dimenhydrinate(DMH), histamine $H_1-blocker$, increased Kd value for $[^3H]QNB$ QNB without affecting the binding site concentrations and this effect resulted from the ability of DMH to slow $[^3H]QNB-receptor$ association. Pirenzepine inhibition curve of $[^3H]QNB$ binding was shallow(nH = 0.52) indicating the presence of two receptor subtypes with high ($M_1-site$) and low($M_2-site$) affinity for pirenzepine. Analysis of these inhibition curves yielded that 68% of the total receptor populations were of the $M_1-subtype$ and the remaining 32% of the $M_2-subtype$. Ki values for the $M_1-$ and $M_2-subtypes$ were 2.42 nM and 629.3 nM, respectively. Ki values for $H_1-blockers$ that inhibited $[^3H]QNB$ binding varied with a wide range ($0.02-2.5\;{\mu}M$). The Pseudo-Hill coefficients for inhibition of $[^3H]QNB$ binding by most of $H_1-blockers$ examined except for oxomemazine inhibition of $[^3H]QNB$ binding were close to one. The inhibition curve for oxomemazine in competition with $[^3H]QNB$ was shallow(nH = 0.74) indicating the presence of two receptor populations with different affinities for this drug. The proportion of high and low affinity was 33:67. The Ki values for oxomemazine were $0.045{\pm}0.016\;{\mu}M$ for high affinity and $1.145{\pm}0.232\;{\mu}M$ for low affinity sites. These data indicate that muscarinic receptor blocking potency of $H_1-blockers$ varies widely between different drugs and that most of $H_1-blockers$ examined are nonselective antagonist for the muscarinic receptor subtypes, whereas oxomemazine might be capable of distinguishing between subclasses of muscarinic receptor.

• 한국임상수의학회지
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• 제19권2호
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• pp.186-190
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• 2002

아토피성 피부염은 면역계재성 피부질환으로 소양증이 주요 증상이며 이의 치료가 필수적이다. 따라서 개에서 제2세대 항히스타민제의 임상적용을 위해 피부에 히스타민에 의해 유발된 팽진과 발적에 대한 loratadine, cetirizine과 terfenadine의억제 효과를 비교하였다. 3종의 항히스타민제는 대조군에 비해 매우 유의하게 발적반응을 억제하였으며(p<0.01) cetirizine이 다른 제제에 비해 높은 억제효과를 보였다. 3종의 항히스타민제는 팽진 반응을 억제하는 효과를 보였으며 loratadine의 억제효과가 일정하며 지속적이었다. 따라서 제 2세대 항히스타민제인 loratadine과 cetirizine은 개에서 아토피성 피부염의 소양증 치료에 적용할 수 있는 항히스타민제로 사료된다. 특히 스테로이드제제를 대체할 수 있는 치료효과를 보일 것으로 판단된다.

• 약학회지
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• 제52권2호
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• pp.137-146
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• 2008

Even though driving under the influence of drug (DUID) is a worldwide problem, we, Korea has no regulation system yet except for alcohol, and there are little cases reported related to DUID. In order to investigate the type of abused drugs for drivers in Korea, we tried to analyze controlled and non-controlled drugs in alcohol-positive blood samples. 275 whole bloods, which were positive for alcohol on the roadside test, were collected from the police for two months ($Nov.{\sim}Dec.$ 2006). The analytical strategy was constituted of three steps: First, alcohol in blood samples were confirmed and quantified by gas chromatography. Second, controlled drugs were screened by $Evidence_{investigator}\;^{TM}$ (Randox, U.K.) as preliminary test. It was based on immunoassay by biochip array analyzer. Nine groups of drug abuse were screened: amphetamines, methamphetamines, cannabis, cocaine, opiates, barbiturates, methadone, benzodiazepines I (oxazepam) & II (lorazepam). Finally, confirmation of these drugs was performed by GC-MS. Blood samples were extracted by solid-phase extraction by $RapidTrace^{TM}$ (Zymark, U.S.A.). After trimethylsilyl (TMS) derivatization, eluates were analyzed to GC-MS. Total 49 drugs were investigated in this study including controlled drugs, antidepressants, 1st generation antihistamines, dextromethorphan, nalbuphine, ketamine, etc. For rapid detection, we developed the automated identification system. It was made up a new software, "DrugMan", modified Chemstation data analysis menu and newly developed macro modules. A series of peak selection, identification and reporting of the results were performed automatically by this system. Concentrations of alcohol in 275 blood samples were ranged from 0.011 to 0.249% (average, 0.119%). Among 149 blood samples, just six samples (4.0%) were showed positive results to the immunoassay: one methamphetamine and five benzodiazepines group I. By GC-MS confirmation, only benzodiazepines were detected and methamphetamine was not detected from immunoassay positive blood sample. Besides these drugs, 5 chlorpheniramines, dextromethorphan, diazepam, doxylamine, ibuprofen, lidocaine and topiramate were also detected in whole bloods by GC-MS. Conclusively, the frequency of drug abuse for Korean drivers was relatively low. There was none case which illegal drug was detected. However these results were limited to alcohol positive blood samples, so it is necessary to analyze more samples including alcohol negative blood.