Summary Antihistaminic drugs are widely prescribed across a multitude of medical specialities such as Allergy and Dermatology. The potentially serious sedative effect of these valuable agents has previously restricted their full use and the choice of drug has been dictated more by individual patient acceptability than by any laboratory demonstrations of comparative efficacy. Unsurprisingly therefore, there is a trend towards prescribing those newer preparations which leave the central nervous system unclouded. We have studied the most frequently prescribed non‐sedating antihistamine preparations, terfenadine (Triludan, Triludan Forte), cetirizine (Zirtek) and loratadine (Clarityn) in pharmacodynamic and relative efficacy trials using a quantifiable and reproducible extension of the classic Lewis model. The results indicate that two preparations, terfenadine 120 mg (Triludan Forte) and cetirizine 10 mg (Zirtek) are superior to their immediate rivals in degree of efficacy and/or speed of action. These results should assist clinicians in the positioning of effective, rapidly acting antihistamines for the symptomatic treatment of immediate hypersensitivity reactions such as urticaria and rhinitis.
The effect of thalidomide on the metabolism of arachidonic acid by purified washed human platelets and polymorphonuclear leukocytes was examined. The drug was found to be without effect under the conditions used. The action of thalidomide cannot therefore be attributed to a direct inhibition of prostaglandin or leukotriene biosynthesis.
Ten patients with psoriasis resistant to conventional topical treatment were given dietary supplements of fish oil, providing approximately 12 g of eicosapentaenoic acid daily for a period of at least 6 weeks. In eight patients there was a modest improvement in their psoriasis, the principal effects being a diminution of erythema and scaling. The dietary treatment resulted in a substantial inhibition of leukotriene B4 production by the peripheral blood polymorphonuclear leukocytes in vitro. The discrepancy between the high degree of inhibition of leukotriene B4 synthesis and the modest therapeutic effect suggests that leukotriene B4 is not the only mediator involved in the development of the psoriatic lesion. Furthermore, the in vivo cutaneous levels of leukotriene B4 might not have been inhibited to the same extent as the polymorphonuclear leukocyte levels in vitro. Further studies on the use of fish oil supplements, both on their own and in conjunction with other forms of treatment in psoriasis are warranted. It will also be important to determine whether the altered profile of 5-lipoxygcnase products found in the blood is also seen in the skin.
Kaposi sarcoma (KS) is a tumor derived from capillary endothelial cells associated with serologically identifiable human herpesvirus (KSHV). We report a case of KS in a patient with relapsing-remitting multiple sclerosis (RRMS) who received fingolimod for 19 months. We hypothesize that fingolimod-induced immunosuppression led to the development of KS in this patient.
industry, was found to have a titre of 1 :128 in sera taken on days 20 and 33 after the onset of a 'flu-like illness in March 1978 contracted in Majorca.The illness pro- gressed to pneumonia and he was admitted to hospital in England six days after onset.Recovery was slow.By April 1979 his antibody level had dropped to < 1:16.Using class specific antiserum, it was demonstrated that only 1gM antibodies were present.No antibodies were detected against L. pneumophila strains 2, 3, or 4.While the serological results do not entirely meet the presently accepted rigid criteria, the high specific IgM titre, the negative IFAT result after 12 months, and the clinical picture all support a presumptive diagnosis of Legionnaires' disease.A third male patient, aged 63 years, became ill in December 1977 with IFAT titres of 1 :32 in two sera taken three weeks apart in March 1978 and a third serum taken a year later.The patient who works as a printer's cutter has a 13-year history of chronic bronchitis.The prevalence of Legionnaires' disease among patients with sporadic, otherwise undiagnosed, pneumonia was found in this study to be 0.6% (2/340) compared with 1*5 % (21/2023) reported in a general population study carried out in Nottingham (Macrae et al., 1979).Other workers have reported a prevalence of 1 % (Foy et al., 1979) and 4-10°,, (Renner et al., 1979;Cohen et al., 1979) in groups of otherwise undiagnosed pneumonias.
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