Rhinorrhea, cough and fatigue in patients taking sitagliptin

Sitagliptin is a dipeptidyl peptidase-4 (DPP IV, CD26) inhibitor indicated for treatment of Type II diabetes as a second line therapy after metformin. We report fifteen sitagliptin intolerant patients who developed anterior and posterior rhinorrhea, cough, dyspnea, and fatigue. Symptoms typically developed within 1 to 8 weeks of starting, and resolved within 1 week of stopping the drug. Peak expiratory flow rates increased 34% in 8 patients who stopped sitagliptin. Similar changes were found in 4 out of 5 persons who had confirmatory readministration. Chart review identified 17 patients who tolerated sitagliptin and had no symptomatic changes. The sitagliptin intolerant group had higher rates of clinically diagnosed allergic rhinitis (15/15 vs. 6/18; p = 0.00005), Fisher's Exact test) and angiotensin converting enzyme inhibitor - induced cough (6/13 vs. 1/18; p = 0.012). Nasal and inhaled glucocorticoids may control the underlying allergic inflammation and abrogate this new sitagliptin - induced pharmacological syndrome. Potential mucosal and central nervous system mechanisms include disruption of neuropeptides and/or cytokines that rely on DPP IV for activation or inactivation, and T cell dysfunction

Comparative efficacy of bilastine, levocetirizine and desloratadine updosing in chronic urticaria

Maria T Staevska Clinical Center of Allergology, Medical University, Sofia, Bulgaria As a group of allergists who treat both allergic rhinitis and urticaria patients on a daily basis, and involved in clinical research, we read with particular interest the review paper “Treatment of allergic rhinitis and urticaria: a review of the newest antihistamine drug bilastine”,1 published in your journal. Although the group of distinguished authors from the Asia Pacific Region provide an interesting insight into the burden of allergic diseases in this fast developing part of the world, no new data or insights are offered for the treatment of these diseases. Our attention was particularly drawn by Figure 9, which is partly based on data generated in a clinical study performed and published by our group.The original article article by Wang et al