No abstract available.
Eosinophils* ; Folliculitis* ; Hydroxyzine*

Antihistamines are commonly used to treat allergic disease, such as allergic rhinitis, urticaria, and angioedema. Although several previous reports describe hypersensitivity to antihistamines such as cetirizine and hydroxyzine, documented cases of chlorpheniramine hypersensitivity are extremely rare. Here, we report the case of a 45-year-old Korean woman who presented with urticaria after ingesting a cold medication. Over the previous 5 years, she had also experienced a food allergy to crab and shrimp, allergic rhinitis, and repeated urticaria after ingesting cold medication. Provocation with aspirin elicited generalized urticaria. Intravenous chlorpheniramine and methylprednisolone was injected for symptom control, but in fact appeared to aggravate urticaria. A second round of skin and provocation tests for chlorpheniramine and methylprednisolone showed positive results only for chlorpheniramine. She was diagnosed with aspirin intolerance and chlorpheniramine hypersensitivity, and was instructed to avoid these drugs. To date, this is the second of only two cases of chlorpheniramine-induced type I hypersensitivity with aspirin intolerance. Although the relationship between aspirin intolerance and chlorpheniramine-induced type I hypersensitivity is unclear, physicians should be aware of the possibility of urticaria or other allergic reactions in response to antihistamines.
Angioedema ; Aspirin ; Cetirizine ; Chlorpheniramine ; Cold Temperature ; Drug Hypersensitivity ; Female ; Food Hypersensitivity ; Histamine Antagonists ; Humans ; Hydroxyzine ; Hypersensitivity ; Hypersensitivity, Immediate ; Methylprednisolone ; Middle Aged ; Rhinitis ; Rhinitis, Allergic, Perennial ; Skin ; Urticaria

No abstract available.
Animals ; Histamine* ; Hydroxyzine* ; Rats* ; Urinary Bladder*

Fixed drug eruption is an uncommon adverse drug reaction caused by delayed cell-mediated hypersensitivity. Levocetirizine is an active (R)-enatiomer of cetirizine and there have been a few reports of fixed drug eruption related to these antihistamines. We experienced a case of levocetirizine-induced fixed drug eruption and cross-reaction with other piperazine derivatives confirmed by patch test. A 73-year-old female patient presented with recurrent generalized itching, cutaneous bullae formation, rash and multiple pigmentation at fixed sites after taking drugs for common cold. She took bepotastine besilate (Talion®) and levocetirizine (Xyzal®) as antihistamine. She took acetaminophen, pseudoephedrine 60 mg / triprolidine 2.5 mg (Actifed®), dihydrocodeinebitartrate 5 mg / di-methylephedrine hydrochloride 17.5 mg / chlorpheniramine maleate 1.5 mg / guaifenesin 50 mg (Codening®) and aluminium hydroxide 200 mg / magnesium carbonate 120 mg (Antad®) at the same time. Patch test was done with suspected drugs and the result was positive with levocetirizine. We additionally performed patch test for other antihistamines such as cetirizine, hydroxyzine, fexofenadine and loratadine. Piperazine derivatives (cetirizine and hydroxyzine) were positive, but piperidine derivatives (fexofenadine and loratadine) were negative to patch test. There was no adverse drug reaction when she was challenged with fexofenadine. We report a case of levocetirizine-induced fixed drug eruption confirmed by patch test. Cross-reactions were only observed in the piperazine derivatives and piperidine antihistamine was tolerant to the patient.
Acetaminophen ; Aged ; Carbon ; Cetirizine ; Chlorpheniramine ; Common Cold ; Drug Eruptions ; Drug-Related Side Effects and Adverse Reactions ; Exanthema ; Female ; Guaifenesin ; Histamine Antagonists ; Humans ; Hydroxyzine ; Hypersensitivity ; Loratadine ; Magnesium ; Patch Tests ; Pigmentation ; Pruritus ; Pseudoephedrine ; Triprolidine

Hydroxyzine hydrochloride, a minor tranquilizer and a ataratic, was tested clinically for effectiveness as a premedicant separate dosages of 1 and 2 mg/kg. Each 30 patients were in the physical status class 1 and 2 by A.S.A. classification, and the age distribution was from 20 to 60 years. The following results were obtained. 1) Emotionally calm response was seen in 70% in the hydroxyzine 1 mg/kg (group 1), and in 93.3%, in the 2 mg/kg (group 2). 2) Mental alertness was seen in 86. 6% in group 1, and in 66. 6% in group 2. 3) Complications after premedication were chilling and shivering, hypertension, nausea, and headache, and were not serious. Therefore this premedication was satisfactory in most cases, especially in group 2.
Age Distribution ; Classification ; Headache ; Humans ; Hydroxyzine* ; Hypertension ; Nausea ; Premedication ; Shivering

Preoperative sedation of children is a difficult problem for the psychic trauma consequent to anticipation of surgery may be as a great hazard to the patient as his original disease. Until now, a number of sedatives have been used commonly for adequate sedation of pediatric patients, but no method has been uriversally accepted. Comparison of the efficacy and safety of ketamine HCI(2.5mg/kg), hydroxyzine HCI(2 mg/kg) and pentazocine(1mg/kg) for preoperative mediaction was conducted in each 25 cases below 10 year old children for minor day out surgery. The obtained results were as follows; 1) Preoperative sedation effect was more better ketamine and hydroxyzine than pentazociae. 2) No clinically significant changes were observed in vital signs in hydroxyzine group. 3) Adverse reaction during induction of anesthesia was unremarkable in all groups, but bradycardia was occurred in pentasocine group. 4) Recovery time was more longer in hydroxyzine group than in the other groups.
Anesthesia ; Bradycardia ; Child* ; Humans ; Hydroxyzine ; Hypnotics and Sedatives ; Ketamine ; Methods ; Vital Signs

It has been already demonstrated by Cote and his collegues that the values of crying pts gastric pH were higher than those of noncrying pts. We have previously shown that the more patients cried, the higher gastric pH they had, and speculated that this effect may be resulted from the discharged stress through the crying. The present study was performed to examine the hypothesis that parental presence and doctors conversation prior to anesthesia influence the gastric acidity and volume changes. Ninety-one ASA class I or II children, 4 to 13 years of age, were selected randomly excluded 2nd or repeated operation, gastrointestinal operation and history of disease affecting gastric acidity and volume. And divided them into two groups by their status of parental presence and doctors conversation; parents presence (G-l, N=46) or not (G-2, N=45), doctor's comforting words(G-A, N=45) or not (G-B, N=46). These patients were further analyzed by combine factors of parental presence and doctors conversation; parental presence and doctors conversation (G-IA, N=25). parental presence and no conversation (G-1B, N=21), parent not present and conversation(G-2A, N=20) and parent not present and no conversation (G-2B, N=25). Those patients who had comforting words from their doctors were further divided by their response: poor response(G-i), good response(G-ii). All patients were premedicated with glycopyrrolate and hydroxyzine. Gastric samples were obtained through nasogastric tube and measured pH values with TOA pH METER MODEL HM-5ES(TOA Electronics Ltd., Tokyo, Japan) immediately after induction. The results were as follows; 1) Gastric pH; There were no statistical significances between groups(P>0.05) in the changes of the mean pH values. 2) Gastric volume; There were no statistical differences between groups(P>0.05) in the changes of the mean gastric volume(ml/kg). 3) Gastric pH and volume of the response of doctors conversation, There were no statistical difference of gastric pH and volume between good and poor response groups of doctors comfortmg words(P>0.05). From these results, we concluded that parental presence and doctors conversation did not influence the gastric acidity and volume statistically. However, clinically, these results might somehow influence the gastric acidity because the values of gastric pH of G-l(2.32+/-0.69) and G-A(2.38+/-0.64) were higher than of G-2(2.38+/-0.64) and G-B(2.18+/-0.53), and the value of gastric pH of G-IA(2.40+/-0.68) was highest and G-2B(2.15+/-0.43) was lowest.
Anesthesia ; Child ; Crying* ; Gastric Acid* ; Glycopyrrolate ; Humans ; Hydrogen-Ion Concentration ; Hydroxyzine ; Parents* ; Pediatrics ; Pneumonia, Aspiration

Sedative and antiemetic effect of hydroxyzine as a premedicant were studied and results were compared with a placebo and Talwin. Two hundred and fourty patients were evaluated. These patients were divided into 6 groups. There were fourty patients in each group. Group 1: Hydroxyzine 50mg. Group 2: Hydroxyzine 100mg. Group 3: Placebo. Group 4: Talwin 20mg. Group 5: Hydroxyzine 5pmg plus Talwie 20mg. Group 6: Hydroxyzine 100mg plus Talwin 20mg. The results were as follows; 1) Satisfactory sedation was ovtained in 75% with group I, in 92.5% with group 2, in 30% with group 3, in 40% with group 4, in 82. 5% With group 5, and in 97. 5% with group 6. Better results were obtained with hydroxyzine plus Talwin group than hydroxyzine anly. 2) The incidence of postoperative nausea and vomiting in recovery room, 7. 5% wlth group 7. 5 % with group 3, 20% with group 4, 5%. with group 5. There was no case of nausea and vomiting in group 2 and group 6. We obtained a significant difference in antiemetic effect between Talwin only and the Talwin plus hydroxyzine group. 3) There was no adverse change on vital signs in all cases.
Antiemetics ; Humans ; Hydroxyzine* ; Incidence ; Nausea ; Pentazocine ; Postoperative Nausea and Vomiting ; Recovery Room ; Vital Signs ; Vomiting

It has been already demonstrated that the gastric acidity of crying pediatric surgical patients were less acidic than that of non-crying patients by Cote CJ and his collegues. Under the postulation that the changes of the gastric acidity and volume of crying patients might not be the same according to the amount of crying(duration or crying), this study was undertaken. 81 ASA physical status 1-2 children ages 1-14 for 1st elective operation except gastrointesti- nal surgery were selected randomly and divided into 2 groups and subdivided into 2 groups as follows: Group 1 (n=39~7, not cried Group 2 (n=42g cried Group A (n=14R cried in RR and OR Group B (n=28); cried in OR Subgoup B-1 (n= 11~7, cried as soon as arrived in OR Subgroup B-2 (n = 17); cried when attached monitoring and/or started IV All patients were premedicated with glycopyrrolate and hydroxyzine. Gastric samples were obtained through nasogastric tube and measured pH values with TOA PH METER MODEL HM-SES immediately after induction. The results were as follows; 1) Gastric pH In the changes of the mean pH values, there were statistical significances between groups 1 and 2(P<0.01), and between groups A and B(P<0.05), but was no statistical difference between subgroups B-1 and B-2. In comparing group A with subgroups B-1 or B-2, there was no statistcal significance between group A and subgroup B-l, but there was statistical signifi- cance between group A and subgroup B-2(P<0.05). 2) Gastric volume In the changes of the mean gastric volume(ml/kg), there were no statistical differences be- tween groups 1 and 2 and between groups A and B, but there was statistical significance be-tween subgroup B-l and B-2(P<0.05). In comparing group A with subgroups B-1 or B-2, there was no statistacal significance between group A and subgroup B-l, but there was statistically significance between group A and subgroup B-2(P<0.05). 3) Combined risk of pH and volume There were no differences in the proportion of combined risk(both gastric pH C2.5 and Ras- tric volume > or = 0.4 ml/kg) between groups 1 and 2, and between subgroups B-1 and B-2, but there were significant differences between groups A and B, and between group A and subgroup B-2 (p <0.05).
Child ; Crying* ; Gastric Acid* ; Glycopyrrolate ; Humans ; Hydrogen-Ion Concentration ; Hydroxyzine ; Pediatrics ; Pneumonia, Aspiration

The treatment of chronic spontaneous urticaria begins with antihistamines; however, the dose required typically exceeds that recommended for allergic rhinitis. Second-generation, relatively non-sedating H1-receptor blockers are typically employed up to 4 times a day. First-generation antihistamines, such as hydroxyzine or diphenhydramine (Atarax or Benadryl), were employed similarly in the past. Should high-dose antihistamines fail to control symptoms (at least 50%), omalizumab at 300 mg/month is the next step. This is effective in 70% of antihistamine-refractory patients. H₂-receptor blockers and leukotriene antagonists are no longer recommended; they add little and the literature does not support significant efficacy. For those patients who are unresponsive to both antihistamines and omalizumab, cyclosporine is recommended next. This is similarly effective in 65%–70% of patients; however, care is needed regarding possible side-effects on blood pressure and renal function. Corticosteroids should not be employed chronically due to cumulative toxicity that is dose and time dependent. Brief courses of steroid e.g., 3–10 days can be employed for severe exacerbations, but should be an infrequent occurrence. Finally, other agents, such as dapsone or sulfasalazine, can be tried for those patients unresponsive to antihistamines, omalizumab, and cyclosporine.
Adrenal Cortex Hormones ; Blood Pressure ; Cyclosporine ; Dapsone ; Diphenhydramine ; Histamine Antagonists ; Humans ; Hydroxyzine ; Leukotriene Antagonists ; Omalizumab ; Rhinitis, Allergic ; Sulfasalazine ; Urticaria*