Choosing an antihistamine for patients with allergic diseases

The article discusses the issues of rational choice of H1-antihistamines (H1-AHs) in the treatment of allergic diseases, mainly allergic rhinitis (AR) and urticaria. Modern ideas about the pathogenetic mechanisms of allergy are described, including the role of histamine and immunoglobulin E, as well as key pathophysiological processes that determine the formation of allergic reactions. Particular attention is paid to the differentiation of H1-AHs by pharmacological properties, their effect on the central nervous system, which is of particular importance for people of certain professions and the elderly, indicating studies and data on specific aspects of this effect. The authors emphasize the need to abandon the use of first-generation sedatives in favor of modern non-sedative H1-AHs with a more favorable safety profile. As an example of a highly effective and safe H1-Ahs of the second generation, ebastine is considered: its pharmacokinetic parameters, the results of randomized clinical trials in AR and various forms of urticaria, as well as a tolerability profile characterized by a minimal risk of cognitive impairment, including long-term use and when used in doses higher than therapeutic, are presented. Arguments in favor of the validity of the use of ebastin as a first-line drug in patients over 12 years of age are presented, as well as data on the bioequivalence of the domestic drug Allergostin to the original drug. The conclusion notes that second-generation non-sedative H1-AHs, such as ebastine, have an optimal balance between efficacy and safety and are recommended for the treatment of allergic diseases in accordance with current federal and international clinical guidelines.

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