Patient Care - Allergy & Immunology - October 2007 - (Page 24)

I Allergic rhinitis More clinical studies are required to determine the exact position of montelukast in the range of pharmacologic agents available for the treatment of seasonal allergic rhinitis. Antihistamine monotherapy Those findings are contradictory, suggesting that the benefits of combining montelukast with an oral antihistamine are unclear; some evidence suggests that antihistamines alone can provide benefits in relieving most, if not all, AR symptoms. More clinical studies are required to determine the exact position of montelukast in the range of pharmacologic agents available for the treatment of seasonal AR. It would appear, however, that montelukast is not superior to antihistamines with respect to treating nasal congestion, the one symptom thought to possibly be leukotriene mediated. Small studies have been investigating zafirlukast and pranlukast in the treatment of seasonal AR. In the first of these studies, 33 patients with seasonal AR were randomized to receive either zafirlukast, 20 mg REFERENCES 1. Bousquet J, Van Cauwenberge P, Khaltaev N; Aria Workshop Group; World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108(5 suppl):S147-S334. 2. Nathan RA, Meltzer EO, Selner JC, et al. Prevalence of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997;99(suppl):S808-S814. 3. Bousquet J, Duchateau J, Pignat JC, et al. Improvement of quality of life by treatment with cetirizine in patients with perennial allergic rhinitis as determined by a French version of the SF-36 questionnaire. J Allergy Clin Immunol. 1996;98:309-316. 4. Coste A. ENT diseases associated with allergic rhinitis: a review of the literature. Ann Otolaryngol Chir Cervicofac. 2000;117:168-173. 5. Van Cauwenberge P, Bachert C, Passalacqua G, et al. Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology. Allergy. 2000;55:116-134. 6. Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol. 1998;81(5 pt 2):478-518. 7. Levenson T, Greenberger PA. Pathophysiology and therapy for allergic and nonallergic rhinitis: an updated review. Allergy Asthma Proc. 1997;18:213-220. 8. Nathan RA. Pharmacotherapy for allergic rhinitis: a critical review of leukotriene receptor antagonists compared with other treatments. Ann Allergy Asthma Immunol. 2003;90:182-190; quiz 190-192, 232. 9. Okuda M, Watase T, Mezawa A, et al. The role of leukotriene D4 in allergic rhinitis. Ann Allergy. 1988;60:537-540. 10. Bisgaard H, Olsson P, Bende M. Effect of leukotriene D4 on nasal mucosal blood flow, nasal airway resistance and nasal secretion in humans. Clin Allergy. 1986;16:289-297. bid po; the positive control nasal beclomethasone dipropionate, 200 mcg bid; or placebo, for 3 weeks.31 Zafirlukast was no different from placebo at reducing nasal symptoms, while the positive control significantly reduced symptoms. In contrast, pranlukast improved subjective nasal symptoms.32 Larger-scale clinical trials are required to confirm the findings. Montelukast effect seen as modest Suppression of the skin wheal-and-flare response to histamine and allergens provides an objective model for evaluating pharmacodynamic differences between therapeutic agents. Recently, the pharmacologic effects of a single dose of fexofenadine, 180 mg once daily for 2 weeks, were compared with those of montelukast, 10 mg once daily for 2 weeks, in a seasonal allergen-induced wheal-and-flare skin test model in 48 allergic subjects.33 Fexofenadine was found to be significantly more effective than both placebo and montelukast at inhibiting the allergen-induced wheal-and-flare response. Similar results were reported by investigators who demonstrated that fexofenadine, 120 mg 11. Van Cauwenberge P, Juniper E, and the STAR Study Investigating Group. Comparison of the efficacy, safety, and quality of life provided by fexofenadine hydrochloride 120 mg, loratadine 10 mg, and placebo administered once daily for the treatment of seasonal allergic rhinitis. Clin Exp Allergy. 2000;30:891-899. 12. Bernstein DI, Schoenwetter WF, Nathan RA, et al. Efficacy and safety of fexofenadine hydrochloride for treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 1997;79:443-448. 13. Bronsky EA, Falliers CJ, Kaiser HB, et al. Effectiveness and safety of fexofenadine, a new nonsedating H1-receptor antagonist, in the treatment of fall allergies. Allergy Asthma Proc. 1998;19:135-141. 14. Falliers CJ, Brandon ML, Buchman E, et al. Double-blind comparison of cetirizine and placebo in the treatment of seasonal rhinitis. Ann Allergy. 1991;66:257-262. 15. Wasserman SI, Broide DH, Marquardt DL. Cetirizine therapy for seasonal allergic rhinitis: alternative dosage schedules. Clin Ther. 1991;13:707-713. 16. Wahn U, Meltzer EO, Finn AF Jr, et al. Fexofenadine is efficacious and safe in children (aged 6-11 years) with seasonal allergic rhinitis. J Allergy Clin Immunol. 2003;111:763-769. 17. Tinkelman CG, Kemp J, Mitchell DQ, et al. Treatment of seasonal allergic rhinitis in children with cetirizine or chlorpheniramine: a multicenter study. Pediatr Asthma Allergy Immunol. 1996;10:9-17. 18. Masi M, Candiani R, van de Venne H. A placebo-controlled trial of cetirizine in seasonal allergic rhinito-conjunctivitis in children aged 6 to 12 years. Pediatr Allergy Immunol. 1993;4(4 suppl):47-52. 19. Allegra L, Paupe J, Wieseman HG. Cetirizine for seasonal allergic rhinitis in children aged 2-6 years. Pediatr Allergy Immunol. 1993;4:157-161. 24 PATIENT CARE ALLERGY & IMMUNOLOGY www.patientcareonline.com http://www.patientcareonline.com

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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

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