SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
12/13/04
Additive benefit of ibuprofen in seasonal allergic rhinitis (SAR)
Summary
Background - The combinations of antihistamines (AH) such as chlorpheniramine (C-Phen) and pseudoephedrine (Ps) are very commonly marketed as OTC remedies for SAR. However, such combinations usually do not control all symptoms, particularly non-nasal symptoms such as headaches and facial pressure/pain that occur commonly in some patients with SAR episodes.
Findings - Meltzer et al of the Allergy and Asthma Medical Group and other sites carried out a 7- day randomized, placebo controlled, double blind study comparing the effect of adding ibuprofen, a popular NSAID agent in doses of either 200mg or 400mg or placebo to standard combinations of C-Phen and Ps 9 (either 60mg/4mg or 30mg/2mg). They found an incremental 33% decrease in facial pain relief and 17-22% incremental decrease in nasal symptoms when subjects took the added ibuprofen compared to added placebo. There was no significant differences in the responses to the 2 different C-Phen/Ps dosage combinations.
Reference
Ann Allergy Asthma Immunol 2004;93:452-9 Editor's Comments
These interesting findings are somewhat surprising in several respects. It is generally thought that the facial pain seen in some SAR episodes is a reflection of obstruction of the sinus ostia by the congested nasal mucosa. Previous trials of NSAID agents alone did not appear to have nasal decongestant action although there are some non-specific analgesic effects. The latter may explain some of the pain relief. What was also surprising is that there was a modest, but significant, incremental reduction in nasal symptoms when ibuprofen was added to the C-Phen/Ps treatment. Another surprise was that the combination of the relatively low dose of 2mg C-Phen and 30mg of Ps was apparently as effective as the larger 4mg/60mg dosage combination in these adult patients. If this is a consistent finding, it could allow lower dosage (with less potential for side effects) in clinical practice.
One would like to see this study repeated with ibuprofen vs placebo added to one of the newer non-sedating AH such as fexofenadine.
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