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Controversy exists as to the role of modern histamine H1-receptor
antagonists in the treatment of atopic asthma.
Forty-nine patients with atopic asthma were evaluated from three
randomised double-blind placebo-controlled cross-over studies assessing
the anti-inflammatory effects of desloratadine, fexofenadine, and
levocetirizine at clinically recommended doses.
Desloratadine, fexofenadine, and levocetirizine significantly
improved (p <0.05) the provocative concentration of adenosine
monophosphate producing a 20% fall in forced expiratory volume in one
second by 142% compared to placebo. There was a significant improvement (p
<0.05) of 15% in forced expiratory flow at 25% to 75% of maximal lung
volume compared to placebo with desloratadine, fexofenadine, and
levocetirizine. Fexofenadine significantly improved (p <0.05) exhaled
nitric oxide, domiciliary peak expiratory flow, and albuterol rescue use
by 27%, 4%, and 83% respectively compared to placebo. There were no
significant differences in all outcomes among the modern histamine H1-
Modern histamine H1-receptor antagonists improve airway
hyperresponsiveness, small-airways caliber, surrogate inflammatory
markers, and asthma diary outcomes in patients with atopic asthma. Further
studies are required to evaluate the effects of modern histamine H1-
receptor antagonists on asthma exacerbations.
Daniel K C Lee