تأثيرات مضاد الهستامين الدايفنهايدرامين في السقية الحادة لمبيدات الحشرات الفوسفورية العضوية و الكارباميتية لمختلف الدراسات على الحيوانات : تحليل ميتا

الملخص EN

The H1-antihistamine diphenhydramine possesses antimuscarinic-cholinoceptors properties, which enable it to act against cholinesterase inhibiting organophosphate and carbamate pesticides in humans and animals.

Several reports on the use of diphenhydramine, in spite of some variations in its antidotal or therapeutic efficacy, specify beneficial effects of the drug in treating poisoning induced by these pesticides.

Therefore, the purpose of the present review was to identify studies that encompass effects of diphenhydramine on the acute toxicity of pesticides with meta-analysis to demonstrate statistically the benefit of the drug which is considered as an additional antidote besides the standard one atropine.

We used PRISMA and meta-analysis on the toxicity indices of pesticides in animals which were the occurrence of death, signs of poisoning and toxicity score.

The studies were identified and then included in the review after searching data bases in addition to the manual search of publications at the universities.

Two-group meta-analysis was conducted using software tools.

Open-Meta Analyst was used for the forest plot, effect size of the relative risk, heterogeneity test and leave-one-group assessment, whereas Meta-Essentials Version 1.5 was used for the funnel plot that included effect size and standard error, with Egger’s test for the statistical publication bias and trim-and-fill analysis for missing points.

Studies selected for analysis were 13, which comprised 16 reports on the effects of diphenhydramine on toxicity indices of the pesticides.

Diphenhydramine statistically significantly reduced the relative risks of the organophosphate and carbamate pesticides, which were with their 95% confidence intervals: 0.375 (0.261, 0.54) for animal death, 0.399 (0.283, 0.563) for the signs of poisoning and 0.466 (0.363, 0.597) for the toxicity score.

The % weight of the reports varied between 1.713% to 20.245% for death analysis, 1.612% to 23.062% for signs of poisoning and 4.566% to 13% for the toxicity score.

The leave-one-group assessment of the reports indicated the effect size was not affected, as the values were close to the original one.

A significant statistical heterogeneity was found related to the data of toxicity score but not related to the death and signs of poisoning data.

Publication bias was identified by the funnel plot and the trim-and-fill assessment identified the missing points.

We conclude from the present review and meta-analysis that diphenhydramine characteristically possesses effects against poisoning with cholinesterase inhibiting pesticides with a reduction of their relative risks within the toxicity indices.

It is stressed that diphenhydramine should not be considered a substitute for the standard antidote atropine.