Update on nitroglycerin use.

P Andrien; L Lemberg

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PubMed · 2492267

Update on nitroglycerin use.

P Andrien·L Lemberg

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Abstract

Tolerance to nitrates occurs when this class of drugs is administered in a continuous around-the-clock regimen. Nitrate-free intervals from 10 to 12 hours are recommended to prevent nitrate tolerance. Full response with renewed administration occurs with interrupted nitrate therapy.

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Administration, Sublingual Aged Angina Pectoris Drug Tolerance Electrocardiography Female Humans Infusions, Intravenous Nitroglycerin Case Reports Journal Article Research Support, Non-U.S. Gov't

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P Andrien, L Lemberg. 1989. Update on nitroglycerin use.. https://pubmed.ncbi.nlm.nih.gov/2492267/

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PubMed2007

Provocation of neurocardiogenic syncope during head-up tilt testing in children: comparison between isoproterenol and nitroglycerin.

OBJECTIVE: Although nitroglycerin- and isoproterenol-augmented tilt tests are of equal value in the diagnosis of neurocardiogenic syncope in adults, no data exist in children. We compared the sensitivity and specificity of the 2 tests in a pediatric population. PATIENTS AND METHODS: We studied 85 patients (33 boys; mean age: 11.6 +/- 2.9 years). Of them, 56 had a diagnostic history of neurocardiogenic syncope, whereas 29 served as controls. After a negative passive phase, they were randomly assigned to either intravenous isoproterenol or sublingual nitroglycerin, and tilt was continued for 20 minutes. RESULTS: Sensitivity was 0.78 for the isoproterenol test and 0.79 for the nitroglycerin test, but specificity was significantly higher for isoproterenol test compared with nitroglycerin test. In patients with a positive test, the duration of the recovery period was significantly longer after nitroglycerin (8.4 +/- 2.7 minutes) than after isoproterenol (5.1 +/- 1.6 minutes). CONCLUSIONS: Nitroglycerin- and isoproterenol-augmented tilt tests are associated with equal sensitivity in the diagnosis of neurocardiogenic syncope in children and adolescents. However, nitroglycerin results in more false-positive tests and produces more prolonged vasovagal symptoms. Our data do not support the routine use of nitroglycerin in the evaluation of syncope in this age group.

Administration, Sublingual↗

PubMed2007

Successful sublingual immunotherapy with birch pollen has limited effects on concomitant food allergy to apple and the immune response to the Bet v 1 homolog Mal d 1.

BACKGROUND: Cross-reactivity between the major birch pollen allergen, Bet v 1, and the apple protein, Mal d 1, frequently causes food allergy. OBJECTIVE: To investigate the effects of successful sublingual immunotherapy (SLIT) with birch pollen extract on apple allergy and the immune response to Bet v 1 and Mal d 1. METHODS: Before and after 1 year of SLIT, Bet v 1-sensitized patients with oral allergy syndrome to apple underwent nasal challenges with birch pollen and double-blind placebo-controlled food challenges with apple. Bet v 1-specific and Mal d 1-specific serum antibody levels and proliferation in PBMCs and allergen-specific T-cell lines (TCLs) were determined. Bet v 1-specific TCLs were mapped for T-cell epitopes. RESULTS: In 9 patients with improved nasal provocation scores to birch pollen, apple-induced oral allergy syndrome was not significantly reduced. Bet v 1-specific IgE and IgG(4) levels significantly increased. Bet v 1-specific T-cell responses to all epitopes and those cross-reactive with Mal d 1 significantly decreased. However, neither Mal d 1-specific IgE and IgG(4) levels nor Mal d 1-induced T-cell proliferation changed significantly. In contrast, Mal d 1-specific TCLs showed increased responses to Mal d 1 after 1 year of SLIT. CONCLUSION: This longitudinal study indicates that pollen SLIT does not efficiently alter the immune response to pollen-related food allergens, which may explain why pollen-associated food allergy is frequently not ameliorated by pollen immunotherapy even if respiratory symptoms significantly improve. CLINICAL IMPLICATIONS: SLIT with birch pollen may have no clinical effect on associated apple allergy.

Administration, Sublingual↗

PubMed2007

Update on epinephrine for the treatment of anaphylaxis.

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Administration, Sublingual↗