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      Normative Application of Xiyanping Injection: A Systematic Review of Adverse Case Reports

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          Abstract

          Purpose

          To summarize the characteristics and the relevant factors and to give references for preventing adverse drug reactions (ADRs) associated with xiyanping (XYP), we provide a systematic review of adverse case reports about XYP.

          Methods

          Seven medical databases were searched from inception to January 2018. Case reports detailing ADRs associated with XYP were included. Data were extracted independently by two reviewers. After the assessment of causality and severity, we carried out a descriptive analysis for the relevant ADRs.

          Results

          Forty-three articles involving a total number of 55 cases were included. Eight cases were off-label drug use. In the remaining 47 cases, 26 (55.3%) had probable causality and 23 (48.9%) were serious cases. XYP used in children (≤14 years old) accounted for 66.0%. Respiratory diseases (83.0%) were major primary diseases. No allergic history mentioned (55.3%) and unspecific drug combination (59.6%) were common in these reports. As for ADR types, anaphylaxis and anaphylactic shock were up to 97.9%. ADRs happened mostly when applying XYP within 30 minutes (70.2%) and the majority (95.7%) were cured when treated in time.

          Conclusions

          Clinicians and patients are supposed to obey the package insert of XYP in clinical application. Through the results of XYP, normalization of ADR reports is also worthy of attention. High-quality researches are required to improve the drug instruction and evaluate the safety of XYP in effective diseases and different age groups. Mechanism of ADRs aiming at the hypersensitivity and the drug combination should still be further identified.

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          Most cited references73

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          Identification of a mast cell specific receptor crucial for pseudo-allergic drug reactions

          Mast cells are primary effectors in allergic reactions, and may have significant roles in diseases by secreting histamine and various inflammatory and immunomodulatory substances 1,2 . While classically they are activated by IgE antibodies, a unique property of mast cells is their antibody-independent responsiveness to a range of cationic substances, collectively called basic secretagogues, including inflammatory peptides and drugs associated with allergic-type reactions 1,3 . Roles for these substances in pathology have prompted a decades-long search for their receptor(s). Here we report that basic secretagogues activate mouse mast cells in vitro and in vivo through a single receptor, MrgprB2, the orthologue of the human G-protein coupled receptor (GPCR) MrgprX2. Secretagogue-induced histamine release, inflammation, and airway contraction are abolished in MrgprB2 null mutant mice. Further, we show that most classes of FDA-approved peptidergic drugs associated with allergic-type injection-site reactions also activate MrgprB2 and MrgprX2, and that injection-site inflammation is absent in mutant mice. Finally, we determine that MrgprB2 and MrgprX2 are targets of many small molecule drugs associated with systemic pseudo-allergic, or anaphylactoid, reactions; we show that drug-induced symptoms of anaphylactoid responses are significantly reduced in knockout mice, and we identify a common chemical motif in several of these molecules that may help predict side effects of other compounds. These discoveries introduce a mouse model to study mast cell activation by basic secretagogues and identify MrgprX2 as a potential therapeutic target to reduce a subset of drug-induced adverse effects.
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            PRISMA harms checklist: improving harms reporting in systematic reviews

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              Is there a future for andrographolide to be an anti-inflammatory drug? Deciphering its major mechanisms of action.

              Andrographis paniculata has long been part of the traditional herbal medicine system in Asia and in Scandinavia. Andrographolide was isolated as a major bioactive constituent of A. paniculata in 1951, and since 1984, andrographolide and its analogs have been scrutinized with modern drug discovery approach for anti-inflammatory properties. With this accumulated wealth of pre-clinical data, it is imperative to review and consolidate different sources of information, to decipher the major anti-inflammatory mechanisms of action in inflammatory diseases, and to provide direction for future studies. Andrographolide and its analogs have been shown to provide anti-inflammatory benefits in a variety of inflammatory disease models. Among the diverse signaling pathways investigated, inhibition of NF-κB activity is the prevailing anti-inflammatory mechanism elicited by andrographolide. There is also increasing evidence supporting endogenous antioxidant defense enhancement by andrographolide through Nrf2 activation. However, the exact pathway leading to NF-κB and Nrf2 activation by andrographolide has yet to be elucidated. Validation and consensus on the major mechanistic actions of andrographolide in different inflammatory conditions are required before translating current findings into clinical settings. There are a few clinical trials conducted using andrographolide in fixed combination formulation which have shown anti-inflammatory benefits and good safety profile. A concerted effort is definitely needed to identify potent andrographolide lead compounds with improved pharmacokinetics and toxicological properties. Taken together, andrographolide and its analogs have great potential to be the next new class of anti-inflammatory agents, and more andrographolide molecules are likely moving towards clinical study stage in the near future.
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                Author and article information

                Contributors
                Journal
                Evid Based Complement Alternat Med
                Evid Based Complement Alternat Med
                ECAM
                Evidence-based Complementary and Alternative Medicine : eCAM
                Hindawi
                1741-427X
                1741-4288
                2018
                15 November 2018
                15 November 2018
                : 2018
                : 4013912
                Affiliations
                1Key Laboratory of Chinese Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
                2Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
                3Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
                Author notes

                Academic Editor: Nunziatina De Tommasi

                Author information
                http://orcid.org/0000-0001-7420-0142
                http://orcid.org/0000-0001-6628-354X
                Article
                10.1155/2018/4013912
                6276469
                27ea41d3-3180-4a93-9d4a-a4a2aa0919fc
                Copyright © 2018 Shiqi Chen et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 July 2018
                : 23 October 2018
                : 4 November 2018
                Funding
                Funded by: National Science Fund for Distinguished Young Scholars
                Award ID: 81725024
                Funded by: National High Level Talents Special Support Plan
                Award ID: W02020052
                Categories
                Review Article

                Complementary & Alternative medicine
                Complementary & Alternative medicine

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