Is there a role for antileukotrienes in urticaria?

Lorenzo, Gabriele Di; Pacor, Maria Luisa; Mansueto, Pasquale; Esposito-Pellitteri, Maria; Ditta, Vito; Bianco, Claudia Lo; Leto-Barone, Maria Stefania; Fede, Gaetana Di; Rini, G. B.

doi:10.1111/j.1365-2230.2006.02127.x

Cited by 38 publications

(14 citation statements)

References 32 publications

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“…In addition, there are some case reports and small studies showing a mild effect of montelukast in treating chronic urticaria, but there are also negative studies [6, 7] and the overall evidence is limited [8, 9]. The present study does not suggest a role for montelukast in treating atopic dermatitis or urticaria in adults, as we found no effect of montelukast on these skin manifestations.…”

Section: Discussioncontrasting

confidence: 50%

Montelukast Is Not Effective in Controlling Allergic Symptoms Outside the Airways

Lehtimäki

Petäys²,

Haahtela³

2009

Int Arch Allergy Immunol

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Background: Subjects with atopic syndrome often perceive symptoms from various organs. A single drug that acts on all the syndrome’s manifestations would be the ideal treatment. The role of montelukast, a cysteinyl-leukotriene receptor antagonist, is established in treating allergic rhinitis and asthma, but its ability to alleviate atopic symptoms outside the airways is controversial. Our aim was to assess if montelukast could be used to treat all the various symptoms seen in subjects with atopic syndrome. Methods: A randomised, double-blind, placebo-controlled crossover study on the effect of montelukast in atopic syndrome was conducted during the 2007 pollen season. Forty-five pollen-sensitised subjects who had allergic symptoms from both the upper and lower airways and allergic symptoms outside the airways (conjunctivitis, oral symptoms, eczema and/or urticaria) were recruited. The primary outcome parameter was the allergic symptoms, which were assessed using a questionnaire. Secondary outcome parameters were lower-airway inflammation (exhaled nitric oxide) and the need for rescue medication (inhaled β₂-agonists and oral antihistamines). Results: There were no differences between montelukast and placebo treatments in allergic symptoms, in exhaled NO concentration or in the need for oral antihistamines. The need for inhaled β₂-agonists was significantly lower during montelukast treatment. Conclusions: Montelukast was not effective in treating allergic symptoms outside the airways in subjects suffering from different manifestations of the atopic syndrome. Based on the current results, montelukast should not be recommended as a general drug to treat all the symptoms of atopic syndrome, but it should be considered as a drug for asthma and rhinitis.

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Section: Discussioncontrasting

confidence: 50%

Montelukast Is Not Effective in Controlling Allergic Symptoms Outside the Airways

Lehtimäki

Petäys²,

Haahtela³

2009

Int Arch Allergy Immunol

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“…Most commonly, montelukast, a leukotriene D4 receptor antagonist, is approved for asthma therapy. Montelukast also proved clinical efficacy in urticaria and urticaria factitia (28,44,45). According to own experiences, patients suffering from aquagenic pruritus experience improvement when treated with montelukast.…”

Section: Targeting Pruritus Elicitation In the Skinmentioning

confidence: 99%

Neurophysiological and neurochemical basis of modern pruritus treatment

Ständer

Weißhaar

Luger

2007

Experimental Dermatology

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Chronic pruritus of any origin is a frequent discomfort in daily medical practice, and its therapy is challenging. Frequently, the underlying origin may not be identified and symptomatic therapy is necessary. Conventional treatment modalities such as antihistamines often lack efficacy, and hence new therapeutic strategies are necessary. The neuronal mechanisms underlying chronic pruritus have been partly identified during the past years and offer new therapeutic strategies. For example, mast cell degranulation, activation of neuroreceptors on sensory nerve fibres and neurogenic inflammation have been identified to be involved in induction and chronification of the symptom. Accordingly, controlling neuroreceptors such as cannabinoid receptors by agonists or antagonists showed high antipruritic efficacy. Pruritus is transmitted to the central nervous system by specialized nerve fibres and sensory receptors. It has been demonstrated that pruritus and pain have their own neuronal pathways with broad interactions. Accordingly, classical analgesics for neuropathic pain (gabapentin, antidepressants) also exhibit antipruritic efficacy upon clinical use. In summary, these recent developments show that highlighting the basis of pruritus offers modern neurophysiological and neurochemical therapeutic models and the possibility to treat patients with refractory itching of different origin.

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“…Moreover, the costs of treating CU are similar to those associated with bullous skin diseases [ 2• ]. Medical management is usually grounded in symptom-blocking therapies directed against histamine (via both H 1 and H 2 receptors), and sometimes cysteinyl leukotriene receptor antagonists, with variable effectiveness [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Immunomodulatory approaches to the management of chronic urticaria: An immune-mediated inflammatory disease

Bingham

2008

Curr Allergy Asthma Rep

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Although commonly encountered in clinical practice, chronic urticaria (CU) remains difficult to treat. In contrast to acute urticaria, neither exogenous triggers nor specific immunoglobulin E are identified in most chronic cases. A body of evidence suggests that CU is represented within the spectrum of immune-mediated inflammatory diseases (IMID). Our understanding of the CU disease pathogenesis now recognizes a role for T cells, B cells, and autoantibodies, and intrinsic abnormalities of histamine-releasing effector cells, thus providing new targets of intervention beyond the current mainstay of often inadequate symptomatic treatment directed against histamine receptors and steroids, with their attendant morbidities. Agents previously used to treat other autoimmune and inflammatory diseases have demonstrated efficacy in CU. Newer biologic and nonbiologic immunomodulatory agents approved for other indications and in clinical development provide potential options for this often severe disease.

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Is there a role for antileukotrienes in urticaria?

Cited by 38 publications

References 32 publications

Montelukast Is Not Effective in Controlling Allergic Symptoms Outside the Airways

Montelukast Is Not Effective in Controlling Allergic Symptoms Outside the Airways

Neurophysiological and neurochemical basis of modern pruritus treatment

Immunomodulatory approaches to the management of chronic urticaria: An immune-mediated inflammatory disease

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