Patient Care - Allergy & Immunology - October 2007 - (Page 25)

Allergic rhinitis I once daily for 2 weeks, was superior to both placebo and montelukast, 10 mg once daily for 2 weeks, and equivalent to the combination of fexofenadine and montelukast at decreasing early and late cutaneous allergic responses in patients with AR.34 The observations from wheal-and-flare studies demonstrate minimal or no effect of montelukast on allergen-induced reactions and further question the benefits of antagonizing leukotriene receptors as a treatment option for patients with seasonal AR. The different roles of histamine and cysteinyl leukotrienes in the allergic cascade have suggested that LTRAs might be useful agents. Based on their mechanism of action, the LTRAs might be expected to improve nasal congestion, yet the studies discussed here show that montelukast offers no apparent additional benefit over antihistamines in improving that symptom. In reviewing the data on montelukast, it is clear that the smaller studies have generally been less conclusive and that large, controlled clinical studies involving 1000 patients or more are required to demonstrate statistically significant efficacy. The effects of montelukast are modest. The evidence assessing its role in seasonal AR treatment does not suggest its use either as monotherapy or in combination with a newer-generation antihistamine. Further clinical studies are warranted to appropriately position montelukast within the treatment algorithm of AR. Although not studied extensively, the one therapeutic area in which montelukast may play a unique role is the combination of mild asthma and seasonal AR.35 If montelukast is thought to be appropriate for the treating asthma in such a situation, it might also provide relief of seasonal AR symptoms as well. Thus, the rationale for investigating a single treatment under these circumstances warrants consideration. I This article was updated by Dr Kaliner and edited by Deborah Kaplan. Dr Kaliner discloses that he is a consultant for Aventis, MedPointe, GlaxoSmithKline, Abbott, Adams, Teva, Greer, Schering-Plough, Genentech, Novartis, and King, and that he is a clinical investigator for Merck and Aventis, as well as for other companies that study products used for asthma and allergy. 20. Pearlman DS, Lumry WR, Winder JA, et al. Once-daily cetirizine effective in the treatment of seasonal allergic rhinitis in children aged 6 to 11 years: a randomized, double-blind, placebo-controlled study. Clin Pediatr. 1997;36:209-215. 21. Howarth PH, Stern MA, Roi L. Double-blind, placebo-controlled study comparing the efficacy and safety of fexofenadine hydrochloride (120 and 180 mg once daily) and cetirizine in seasonal allergic rhinitis. J Allergy Clin Immunol. 1999;104:927-933. 22. Horak F, Stubner P, Zieglmayer R, et al. Controlled comparison of the efficacy and safety of cetirizine 10 mg o.d. and fexofenadine 120 mg o.d. in reducing symptoms of seasonal allergic rhinitis. Int Arch Allergy Immunol. 2001;125:73-79. 23. Hampel F, Ratner P, Mansfield L. Fexofenadine HCl 180 mg exhibits equivalent efficacy to cetirizine 10 mg with less drowsiness in patients with moderate to severe seasonal allergic rhinitis (SAR). Ann Allergy Asthma Immunol. 2003;91:354-361. 24. Triggiani M, Gentile M, Secondo A, et al. Histamine induces exocytosis and IL-6 production from human lung macrophages through interaction with H1 receptors. J Immunol. 2001;166:4083-4091. 25. Philip G, Malmstrom K, Hampel FC, et al. Montelukast for treating seasonal allergic rhinitis: a randomized, double-blind, placebo-controlled trial performed in the spring. Clin Exp Allergy. 2002;32:1020-1028. 26. van Adelsberg J, Philip G, LaForce CF, et al. Randomized controlled trial evaluating the clinical benefit of montelukast for treating spring seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2003;90:214-222. 27. Meltzer EO, Malmstrom K, Lu S, et al. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol. 2000;105:917-922. 28. Nayak AS, Philip G, Lu S, et al. Montelukast Fall Rhinitis Investigator Group. Efficacy and tolerability of montelukast alone or in combination with loratadine in seasonal allergic rhinitis: a multicenter, randomized, double-blind, placebo-controlled trial performed in the fall. Ann Allergy Asthma Immunol. 2002;88:592-600. 29. Wilson AM, Orr LC, Coutie WJ, et al. A comparison of once daily fexofenadine versus the combination of montelukast plus loratadine on domiciliary nasal peak flow and symptoms in seasonal allergic rhinitis. Clin Exp Allergy. 2002;32:126-132. 30. Kurowski M, Kuna P, Gorski P. Montelukast plus cetirizine in the prophylactic treatment of seasonal allergic rhinitis: influence on clinical symptoms and nasal allergic inflammation. Allergy. 2004;59:280-288. 31. Pullerits T, Praks L, Skoogh BE, et al. Randomized placebo-controlled study comparing a leukotriene receptor antagonist and a nasal glucocorticoid in seasonal allergic rhinitis. Am J Respir Crit Care Med. 1999;159:1814-1818. 32. Ueda T, Takeno S, Furukido K, et al. Leukotriene receptor antagonist pranlukast suppresses eosinophil infiltration and cytokine production in human nasal mucosa of perennial allergic rhinitis. Ann Otol Rhinol Laryngol. 2003;112:955-961. 33. White M, Rothrock S, Meeves, et al. Fexofenadine is superior to montelukast at suppressing seasonal-allergen-induced wheal and flare. Proc Am Coll Allergy, Asthma Immunol. 2003. Abstract P65. 34. Simons FE, Johnston L, Gu X, et al. Suppression of the early and late cutaneous allergic responses using fexofenadine and montelukast. Ann Allergy Asthma Immunol. 2001;86:44-50. 35. Baena-Cagnani CE, Berger WE, DuBuske LM, et al. Comparative effects of desloratadine versus montelukast on asthma symptoms and use of beta 2-agonists in patients with seasonal allergic rhinitis and asthma. Int Arch Allergy Immunol. 2003;130:307-313. OCTOBER 2007 PATIENT CARE ALLERGY & IMMUNOLOGY 25

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

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