Clinical Briefs
June 15, 1999 4 minutes read
Clinical Briefs
By Louis Kuritzky, MD
Fexofenadine HCL on Quality of Life and Work, Classroom, and Daily Activity Impairment in Patients with SAR
Second generation antihistamines (2-GA) have been developed to avoid the adversities common to first generation agents (1-GA), such as sedation, drowsiness, and performance impairment. Since these 2-GA have little ability to cross the blood-brain barrier and are less lipophilic, they should be relatively free of the common 1-GA side effects. Multiple trials have demonstrated that these agents are safe and efficacious for seasonal allergic rhinitis. The current study was designed to measure the effect of fexofenadine, a 2-GA, on general health, disease-specific quality of life, and work, classroom, and daily activity impairment. Tools used for measurement of outcomes included the Rhinoconjunctivitis Quality of Life Questionnaire, the Allergy-Specific Work Productivity and Activity Impairment Questionnaire, and the SF-36.
Almost 2000 patients participated in two randomized, placebo-controlled trials that were pooled for final analysis. At baseline, substantial numbers of individuals suffered embarrassment by allergy symptoms some to all of the time (70%), and being troubled by practical problems such as having to carry tissues or rub/blow their nose repeatedly (98%); also, more than 91% of sufferers reported impairment in ability to do daily activities, work productivity, and classroom productivity.
Within one week of active treatment, patients reported significantly improved quality-of-life scores and work performance. Classroom performance and missed time from class were similarly improved with fexofenadine 60 mg bid as soon as one week into active treatment. In addition to overt symptom control, fexofenadine is effective in enhancing important life quality and performance issues for seasonal allergic rhinitis sufferers.
Tanner LA, et al. Am J Managed Care 1999;5(4):S235-S247.
Egg Consumption and Risk of Heart Disease
Common wisdom has suggested that reduction in egg consumption may be beneficial for cholesterol lowering and, hence, reduced risk of cardiovascular end points. Though widespread in its intuitive appeal, there are few data to support such an intervention. This report used two ongoing prospective cohort studies—the Health Professional Follow-up Study (1986-1994) and the Nurses Health Study (1980-1984)—to assess the relationship of egg consumption and cardiovascular end points. Combined, the population of 117,933 men and women provides more than 1000 cardiovascular end points from which to derive associations.
There was no evident increased risk for any cardiovascular end point associated with egg consumption. This lack of increased risk was true whether subjects consumed less than one egg, 2-4 eggs, 5-6 eggs, or more than eight eggs per week.
In subgroup analysis, diabetic men and women had an increased risk of CHD when they consumed more than one egg per week (RR = 1.49-2.02). The observation that diabetic men and women demonstrated modest increased risk should stimulate further evaluation in this population in particular; postulates as to the diabetic-egg-CHD relationship include aberrancies in cholesterol transport from decreased apolipoprotein E and increased apolipoprotein C-III levels in diabetic patients.
Ho and associates conclude that egg consumption as high as 1 egg daily or greater is not associated with an increased risk of cardiovascular end points.
Ho FB, et al. JAMA 1999;281: 1387-1394.
Fasting Plasma Glucose and Glycosylated Hemoglobin
The diagnoses of diabetes mellitus (DM) has important health and social implications. Recent revision of diagnostic criteria for DM suggests that persons with fasting plasma glucose 126 mg/dL or greater be diagnosed as diabetic, whereas previously the diagnostic cutoff had been 140 mg/dL. The current study evaluated whether persons with DM diagnosed by the new criteria manifest abnormal hemoglobin A-1-C levels, the diagnostic marker by which treatment is indicated and monitored.
Davidson and colleagues had data on hand from two large data sets, the National Health and Nutrition Examination Survey (NHANES III) (n = 2284), and the Meta-Analysis Research Group Data Set (MRGDS) (n = 7908), from which they were able to compare impaired fasting plasma glucose levels with hemoglobin A-1-C levels.
Less than 0.2% of persons from NHANES III with fasting plasma glucose over 126 had a hemoglobin A-1-C greater than 7.1%, the generally acknowledged demarcation level indicating necessity for treatment. Similarly, less than 2.5% of MRGDS of subjects had a hemoglobin A-1-C greater than 7.3% when fasting plasma glucose was greater than 126.
Davidson et al suggest that improved accuracy of the diagnosis of diabetes could be achieved by restricting the diagnosis to those with elevated fasting plasma glucose coupled with abnormal hemoglobin A-1-C greater than 7.7, and that individuals with less impairment of hemoglobin A-1-C should be classified as having impaired fasting glucose, treated with diet and exercise alone.
Davidson MB, et al. JAMA 1999;281: 1203-1210.
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