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Alopecia areata (AA) is a common chronic tissue-specific autoimmune disease, resulting in hair loss, that affects up to 2% of the general population. The exact pathobiology of AA has still remained elusive, while the common theory is the collapse of the immune privilege of the hair follicle caused by immunological mechanism. Multiple genetic and environment factors contribute to the pathogenesis of AA. There are several clinical treatments for AA, varying from one or multiple well-defined patches to more diffuse or total hair loss of the scalp (alopecia totalis) or hair loss of the entire body (alopecia universalis). The available treatments for AA, such as corticosteroids and other immunomodulators, minoxidil, and contact immunotherapy, are of limited efficacy with a high risk of adverse effects and high recurrence rates, especially for patients with severe AA. Recent insights into the pathogenesis of AA have led to the development of new treatment strategies, such as Janus kinase (JAK) inhibitors, biologics, and several small molecular agents. In addition, modern therapies for AA, including antihistamines, platelet-rich plasma (PRP) injection, and other novel therapies have been well explored. In this review, we discussed the recent advances in the pathogenesis, diagnosis, and treatment of AA.

Pages: 2 Word count: 250 (Abstract) Acknowledgement: None Introduction- Abuse of antihistamines alone or in combination with other substances have been known for decades. Antihistamine containing cough syrups, cough suppressants, pheniramine maleate (Avil) tablets and injections are available easily as over-the-counter (OTC) medications. Psychological tolerance to the sedation and physical withdrawal symptoms following pheniramine abuse have been documented but surveying literature on pheniramine dependence yielded limited case reports on the same. Hereby, we present a unique case of pheniramine dependence, which is first of its kind ever reported of such mega doses of pheniramine abuse. Case report- A 29 years old Indian male presented to the psychiatry outpatient with history of abuse of heavy doses of pheniramine with opioids parenterally subsequently developing dependence, and injecting pheniramine up to 1700 mg daily. To obtain such high doses he purchased pheniramine meant for veterinary use (Panavil). He was started on tapentadol 300 mg, pregabalin 150 mg and quetiapine 50 mg. Tapentadol was down-tapered. Clinical opiate withdrawal scale (COWS) decreased from 13 on the day of admission to 4 on discharge. The patient was started on relapse prevention therapy and was discharged on tapentadol 50 mg, pregabalin 75 mg and quetiapine 25 mg with plan to continue psychotherapy sessions on follow up. Conclusion- Our case concludes that pheniramine has a dependence potential. OTC medication abuse seem to be under-reported and could be an emerging medical concern in the ensuing years. We enunciate the need of formulation of specific rules and regulations to supervise the availability of both human and veterinary drugs.

Purpose Ramucirumab (RAM) is recommended as premedication with H 1 -receptor antagonists (H 1 RA) to prevent infusion-related reactions (IRRs). However, RAM is a human antibody with a low incidence of IRRs. We evaluated the noninferiority of non-H 1 RA (dexamethasone [DEX] alone) premedication to H 1 RA (plus DEX) premedication in terms of IRRs in patients with gastric cancer receiving RAM plus nanoparticle albumin-bound paclitaxel (nab-PTX). Methods This was a noninferiority, multicenter, retrospective trial conducted in three Japanese centers to assess the incidence of IRRs in patients receiving RAM plus nab-PTX for gastric cancer between 2018 and 2023. Patients with gastric cancer receiving RAM plus nab-PTX were divided into groups with and without H 1 RA premedication. The incidence of IRRs was compared between the two groups. Results Ninety patients were evaluated, with non-H 1 RA and H 1 RA premedications in 43 and 47 cases, respectively. After the first dose of RAM, IRRs were not observed in either group. IRRs during the overall doses were 0% for non-H 1 RA premedication and 2.1% for H 1 RA premedication (90% confidence interval (CI): –5.6%–1.3% for each comparison). The upper limit of the 90% CI (1.3%) did not exceed the noninferiority margin (Δ) of + 10% and therefore met the noninferiority criteria. Conclusion RAM plus nab-PTX for gastric cancer with DEX premedication may be possible without H 1 RA premedication.

H 1- antihistamines, the mainstay of treatment for urticaria, were developed from anticholinergic drugs more than 70 years ago. They act as inverse agonists rather than antagonists of histamine H 1 -receptors which are members of the G-protein family. The older first generation H 1- antihistamines penetrate readily into the brain to cause sedation, drowsiness, fatigue and impaired concentration and memory causing detrimental effects on learning and examination performance in children and on impairment of the ability of adults to work and drive. Their use should be discouraged. The newer second-generation H 1 -antihistamines are safer, cause less sedation and are more efficacious. Three drugs widely used for symptomatic relief in urticaria, desloratadine, levocetirizine and fexofenadine are highlighted in this review. Of these levocetirizine and fexofenadine are the most potent in humans in vivo. However, levocetirizine may cause somnolence in susceptible individuals, whereas fexofenadine has a relatively short duration of action and may be required to be given twice daily for all round daily protection. Although desloratadine is less potent, it has the advantages of rarely causing somnolence and having a long duration of action.

Allergic rhinitis is common and is often associated with asthma. Treatment includes intranasal glucocorticoids, oral and nasal antihistamines, leukotriene-receptor antagonists, and, when pharmacotherapy is not effective or produces unacceptable side effects, allergen immunotherapy. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage A 35-year-old woman has a history of nasal congestion on most days of the year, dating back to her late teens. She has chronic nasal drainage, which is clear and thick. Her congestion is worst in the late summer and early fall and again in the early spring; at these times, she also has sneezing, nasal itching, and cough. Five years ago, she had an episode of shortness of breath with wheezing on a day when her nasal symptoms were severe, but this episode resolved spontaneously and has not recurred. Her eyes do not bother her. Over-the-counter oral antihistamines . . .

Since the synthesis of histamine in 1907, new reports about its properties and role in the human body have periodically appeared. Its blood levels remain constantly low, almost undetectable, under normal physiological conditions. Increasing histamine levels lead to serious clinical symptoms, including cardiac arrest. Histamine is involved in many processes and allergic reactions. It exerts its effects by acting on receptors, of which four types have been described so far. They are found in numerous tissues, both those in direct contact with the external environment, such as the skin, gastrointestinal and respiratory mucous membranes, as well as those located in internal organs, such as the heart, the brain and on immune cells. The word “antihistamines” is most often used to refer to agents that block the type 1 receptor. These are classified as first- and second-generation antihistamines. The first generation includes non-selective hydrophobic substances that can cross the blood–brain barrier and affect many other types of receptors. Second-generation antihistamines are selective hydrophilic preparations with a long half-life, which means they can be used once daily. Due to their better safety profile, second-generation antihistamines are the treatment of choice in the chronic management of allergic diseases, such as allergic rhinitis and urticaria. First-generation drugs are only for short-term use.