Patient Care - Allergy & Immunology - October 2007 - (Page 19)

Is there a role for leukotriene receptor antagonists in treating allergic rhinitis? This article weighs the evidence as to whether leukotriene receptor antagonists could play a role in alleviating the symptoms of the allergic cascade. CONTRIBUTOR MICHAEL KALINER, MD, Medical Director, Institute for Asthma and Allergy, Chevy Chase and Wheaton, Md. Article at a glance I I I I Oral antihistamines are considered a mainstay of treatment for allergic rhinitis (AR), and newer-generation agents are initial therapy. Current guidelines acknowledge that leukotriene receptor antagonists may have value in AR management but offer no specific recommendations. The mode of action of newergeneration antihistamines is to prevent histamine from exerting its effects during the early-phase response, and it is hypothesized that their anti-inflammatory effects may contribute to inhibition of the late-phase response. The benefits of combining montelukast with an oral antihistamine are unclear; antihistamines alone may relieve most, if not all, the AR symptoms. llergic rhinitis (AR) affects millions of individuals in the United States, and estimates of its prevalence range from 10% to 25%.1 However, those rates may be underestimated because many do not seek medical attention.2 Although AR is not life-threatening, the clinical symptoms, including nasal congestion, nasal itching, rhinorrhea, sneezing, and nasal pruritus, can significantly disrupt quality of life.3 Moreover, if left untreated, AR may exacerbate asthma, sinusitis, otitis, sleep deprivation, and other disorders.1,4 Oral antihistamines are considered a mainstay of therapy, with the newer-generation prescription agents, including fexofenadine, cetirizine, and desloratadine, being recommended as initial therapy because of their favorable risk-benefit profile and lack of sedative effects. The leukotriene receptor antagonist (LTRA) montelukast has been approved for the treatment of seasonal AR, yet available data suggest unclear additional benefits beyond those provided by newergeneration antihistamines, either as monotherapy or in combination. Effective AR management involves an accurate diagnosis and meeting the goals of therapy as outlined in the Allergic Rhinitis and Its Impact on Asthma guidelines from the World Health Organization, which recommend allergen avoidance, pharmacotherapy, immunotherapy, and patient education.1 Several classes of pharmacologic agents, including topical nasal corticosteroids and oral and intranasal antihistamines are widely available. While current guidelines acknowledge that LTRAs may have value in AR management, they do not provide specific recommendations because of a lack of available information regarding clinical efficacy.1,5,6 This article reviews the different mechanisms by which LTRAs and antihistamines modulate the underlying pathophysiology of AR and evaluates the clinical evidence for their use in AR. Although the use of several LTRAs such as montelukast, pranlukast, and zafirlukast* in the treatment of AR has been evaluated in clinical studies, this review focuses mainly on clinical studies using montelukast because of limited data on the other LTRAs. *Unlabeled use. A OCTOBER 2007 PATIENT CARE ALLERGY & IMMUNOLOGY 19

Table of Contents Feed for the Digital Edition of Patient Care - Allergy & Immunology - October 2007

Patient Care - Allergy & Immunology - October 2007 Research Digest Contents Medicine in the News When to Suspect Celiac Disease and How to Proceed From There Averting Angioedema’s Potentially Dire Consequences Is There a Role for Leukotriene Receptor Antagonists in Treating Allergic rhinitis? Clinical Clips Dermatology Case Challenge Classified Advertising

Patient Care - Allergy & Immunology - October 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.