TY - JOUR
T1 - Middle ear fluid histamine and leukotriene B4 in acute otitis media
T2 - Effect of antihistamine or corticosteroid treatment
AU - McCormick, David P.
AU - Saeed, Kokab
AU - Uchida, Tatsuo
AU - Baldwin, Constance D.
AU - Deskin, Ronald
AU - Lett-Brown, Michael A.
AU - Heikkinen, Terho
AU - Chonmaitree, Tasnee
N1 - Funding Information:
Financial support was provided by the National Institutes of Health, Grant R01 DC 02620. The study was conducted at the General Clinical Research Center at the University of Texas Medical Branch at Galveston, funded by Grant M01 RR 00073 from the National Center for Research Resources, NIH, USPHS. We thank Dr Mary Owen and Dr Monica Thint for their invaluable input and assistance with patient evaluation; Dr Avelina Dimaandal and Dr Ralph W. Noble, UTMB ambulatory pediatric faculty and pediatric residents for patient referral; Dawn Hedgepeth, Michelle Malanga, Theresa Bette and Sarah Warnken for clinical care coordination; and Xiaoran Xia, Wen Yang and Judy Tate for technical assistance.
PY - 2003/3
Y1 - 2003/3
N2 - Objective: Two potent mediators of acute inflammation, histamine and leukotriene B4 (LTB4), have been shown to play important roles in the pathogenesis and clinical course of acute otitis media (AOM) in children. The purpose of this study was to evaluate the ability of adjuvant drugs, antihistamine and corticosteroid, in reduction of the levels of histamine and LTB4 in the middle ear and their ability to improve outcomes of AOM. Methods: Eighty children with AOM (aged 3 months to 6 years) were enrolled in a prospective, randomized, double-blind, placebo controlled study. All children received one dose of intramuscular ceftriaxone and were randomly assigned to receive either chlorpheniramine maleate (0.35 mg/kg per day) and/or prednisolone (2 mg/kg per day) or placebos three times a day for 5 days. Tympanocentesis was performed at enrollment and after 5 days of adjuvant drug treatment. MEFs were collected for bacterial and viral studies and histamine and LTB4 levels. The subjects were followed for the duration of middle ear effusion or up to 3 months. Results: Histamine or LTB4 levels in the MEF after 5 days of treatment were not significantly reduced by adjuvant drug treatment. However, subjects receiving corticosteroid had a lower rate of treatment failure during the first 2 weeks and shorter duration of middle ear effusion. Conclusions: Five day of antihistamine or corticosteroid treatment does not reduce the levels of histamine or leukotriene B4 in the MEF of children with AOM. Positive clinical outcomes of AOM cases associated with corticosteroid treatment needs to be confirmed in a larger clinical trial of children with intact tympanic membranes, who do not receive tympanocentesis.
AB - Objective: Two potent mediators of acute inflammation, histamine and leukotriene B4 (LTB4), have been shown to play important roles in the pathogenesis and clinical course of acute otitis media (AOM) in children. The purpose of this study was to evaluate the ability of adjuvant drugs, antihistamine and corticosteroid, in reduction of the levels of histamine and LTB4 in the middle ear and their ability to improve outcomes of AOM. Methods: Eighty children with AOM (aged 3 months to 6 years) were enrolled in a prospective, randomized, double-blind, placebo controlled study. All children received one dose of intramuscular ceftriaxone and were randomly assigned to receive either chlorpheniramine maleate (0.35 mg/kg per day) and/or prednisolone (2 mg/kg per day) or placebos three times a day for 5 days. Tympanocentesis was performed at enrollment and after 5 days of adjuvant drug treatment. MEFs were collected for bacterial and viral studies and histamine and LTB4 levels. The subjects were followed for the duration of middle ear effusion or up to 3 months. Results: Histamine or LTB4 levels in the MEF after 5 days of treatment were not significantly reduced by adjuvant drug treatment. However, subjects receiving corticosteroid had a lower rate of treatment failure during the first 2 weeks and shorter duration of middle ear effusion. Conclusions: Five day of antihistamine or corticosteroid treatment does not reduce the levels of histamine or leukotriene B4 in the MEF of children with AOM. Positive clinical outcomes of AOM cases associated with corticosteroid treatment needs to be confirmed in a larger clinical trial of children with intact tympanic membranes, who do not receive tympanocentesis.
KW - Acute otitis media
KW - Antihistamine
KW - Corticosteroid
KW - Histamine
KW - Leukotriene B4
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U2 - 10.1016/S0165-5876(02)00372-5
DO - 10.1016/S0165-5876(02)00372-5
M3 - Article
C2 - 12633920
AN - SCOPUS:0037334539
SN - 0165-5876
VL - 67
SP - 221
EP - 230
JO - International Journal of Pediatric Otorhinolaryngology
JF - International Journal of Pediatric Otorhinolaryngology
IS - 3
ER -