Montelukast treatment may alter the early efficacy of immunotherapy in children with asthma

Majak, Paweł; Rychlik, Błażej; Pułaski, Łukasz; Błauż, Andrzej; Brzozowska, Agnieszka; Bobrowska-Korzeniowska, Monika; Kuna, Piotr; Stelmach, Iwona

doi:10.1016/j.jaci.2010.02.034

Cited by 22 publications

(11 citation statements)

References 27 publications

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“…However, in rush immunotherapy trials, there seems to be a benefit from using pre‐medication . Notably, one study in children with asthma demonstrated reduced efficacy in immunotherapy when Montelukast was used as pre‐medication .…”

Section: Discussionmentioning

confidence: 99%

Adverse Events During Immunotherapy Against Grass Pollen‐Induced Allergic Rhinitis – Differences Between Subcutaneous and Sublingual Treatment

Aasbjerg

Dalhoff

Backer

2015

Basic Clin Pharma Tox

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Allergic rhinitis (AR) triggered by grass pollen is a common disease, affecting millions of people worldwide. Treatment consists of symptom-alleviating drugs, such as topical corticosteroids or antihistamines. Another option is potentially curative immunotherapy, currently available as sublingual and subcutaneous treatment. We investigated the potential differences in the prevalence and severity of adverse events related to subcutaneous and sublingual immunotherapy (SLIT) against grass pollen-induced AR. A thorough literature search was performed with PubMed and EMBASE. The findings were compared with the available summaries of product characteristics (SPC) and with commercial pharmacology databases (Micromedex). The majority of available safety data originate from registered products of standardized allergens. A surprisingly large percentage of drugs, especially those used in the United States, have no systematically collected safety data. No sufficiently powered randomized trials comparing sublingual and subcutaneous immunotherapy (SCIT) were available, but general safety assessments indicate that sublingual tablet treatment is safer than subcutaneous treatment. Not all commonly used immunotherapy drugs are officially registered, and not all have systematically collected safety data. This is especially true for older drugs used in the United States. In contrast, newer drugs that have undergone extensive clinical testing have better documentation, but unified collection of safety data is still lacking. Considering the evidence available, most drugs elicit similar side effects from the same organ systems, and symptoms from the sublingual drug classes are probably less severe. However, a head-to-head comparison of safety and efficacy is lacking.Allergic rhinitis (AR) is a common disease affecting millions of people worldwide. It impairs school performance and quality of life and leads to sick leave, thus costing societies billions of dollars annually. Allergic rhinitis is a classical Type I allergic reaction characterized by the pathological production of allergen-specific IgE antibodies and subsequent immune activation and inflammation build-up upon allergen contact. Although many allergens are well characterized from a biochemical perspective, is it largely unknown why certain chemical properties provoke an allergic response. Like any IgE-mediated allergy, pollen allergy, commonly known as hayfever, can be treated either strictly symptomatically with antihistamines, topical corticosteroids and other mildly immunosuppressive drugs, or with specific immunotherapy (SIT)-the only disease-modifying and potentially curative treatment available.International guidelines suggest immunotherapy treatment in all individuals who cannot achieve adequate symptom control using antihistamines and topical corticosteroids [1,2]. Prior to starting treatment with immunotherapy, a clear disease history associated with relevant allergens and a verified sensitization (e.g. skin prick test or measurement of specific IgE) shou...

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Section: Discussionmentioning

confidence: 99%

Adverse Events During Immunotherapy Against Grass Pollen‐Induced Allergic Rhinitis – Differences Between Subcutaneous and Sublingual Treatment

Aasbjerg

Dalhoff

Backer

2015

Basic Clin Pharma Tox

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“…88 Prophylactic use of antihistamines has been shown to mitigate the frequency and severity of most reactions. As noted in the practice parameter, it is important to reiterate that unstable asthma is a contraindication to initiation of SCIT.…”

Section: Subcutaneous Immunotherapymentioning

confidence: 99%

Allergen Immunotherapy in Allergic Respiratory Diseases

Viswanathan

Busse

2012

Chest

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Over the past 2 decades, the prevalence of allergic respiratory diseases has increased, in part refl ecting changes in lifestyle and environment that promote a T-helper (Th) 2 cell phenotype. 1 It has been estimated that up to 20% of the US and Western Europe populations may be affl icted by allergic respiratory diseases. 2,3 A recent estimate of the total national medical expenditure attributable to adult asthma was reported as $18 billion, with the largest contributors being prescription drugs and inpatient hospitalizations. 4,5 Although allergen avoidance is an integral component and step of therapy, it is often impractical and insuffi cient. As a consequence, the mainstay of allergic disease management has been pharmacotherapy, especially antihistamines, bronchodilators, and inhaled/intranasal corticosteroids, which are targeted to regulate infl ammation of the upper and lower airways. Although these treatments are effective and, in most cases, safe, they offer no lasting benefi t once treatment is stopped and have limited intrinsic disease-modifying effects. Moreover, it has become apparent that allergic diseases are the result of immune dysregulation and refl ect an impairment in the natural tolerance that develops to allergens. 6,7 Immunotherapy has the potential to modify fundamental, underlying disease mechanisms and to have, Allergen-specifi c immunotherapy (SIT) involves the repeated administration of allergenic extracts to atopic individuals over a period of 3 to 5 years either subcutaneously (SCIT) or sublingually (SLIT) for the treatment of allergic respiratory diseases, including asthma and allergic rhinitis (AR). In studies, SCIT and SLIT have been shown to improve existing symptoms of asthma and AR and to also have the capability to cause disease-modifying changes of the underlying atopic condition so as to prevent new allergic sensitization as well as arrest progression of AR to asthma. Recent evidence suggests that immunotherapy brings about these effects through actions that use T-regulatory cells and blocking antibodies such as IgG 4 and IgA 2, which can then result in an "immune deviation" from a T-helper (Th) 2 cell pattern to a Th1 cell pattern. Numerous meta-analyses and studies have been performed to evaluate the existing data among these studies, with the consensus recommendation favoring the use of immunotherapy because of its potential to modify existing diseases. Signifi cant adverse reactions can occur with immunotherapy, including anaphylaxis and, very rarely, death. A primary factor in considering SIT is its potential to provide longlasting effects that are able to be sustained well after its discontinuation. Given the signifi cant burden these allergic diseases impose on the health-care system, SIT appears to be a cost-effective adjunctive treatment in modifying the existing disease state. CHEST 2012; 141(5):1303-1314Abbreviations: AR 5 allergic rhinitis; BHR 5 bronchial hyperresponsiveness; PEF 5 peak expiratory fl ow; SCIT 5 subcutaneous immunotherapy; SIT 5 allergen-specifi c...

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“…The aim of the study was to find out whether montelukast would provide additional benefit in combination with SCIT. The results, however, pointed in the opposite direction in that montelukast either had no beneficial effect on the response to SCIT or somehow contributed to a poorer response [Majak et al . 2010].…”

Section: Criteria For the Commencement Of Immunotherapymentioning

confidence: 99%

The role of immunotherapy in the management of childhood asthma

Hedlin

Hage

2012

Ther Adv Respir Dis

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Subcutaneous immunotherapy (SCIT) is still questioned as a safe and efficacious way of treating allergic asthma in children. In a Cochrane review published in 2010 it was, however, concluded that SCIT has significant and beneficial effects on symptoms and medication use in both children and adults with mostly mild asthma. Only a few studies have been performed to specifically study if SCIT in children with moderate asthma reduces the need for inhaled corticosteroids. There are conflicting results that illustrate the problem of the heterogeneity of the asthma disease and the fact that allergies may play different roles on the severity and symptoms of the disease. Furthermore, children with severe allergic asthma are often sensitized to multiple allergens, which makes SCIT both complicated and less safe to administer. On the other hand, if the child suffers from asthmatic symptoms despite adherence to pharmacotherapy, omalizumab or a combination of omalizumab and allergen immunotherapy might be useful. There is a need for more studies on this combination before it can be considered as an additional therapy in children with asthma and severe allergies. Sublingual immunotherapy (SLIT) has also been shown to improve asthma symptoms and medication use. SLIT is safe although its efficacy compared with SCIT has been studied very little. Another approach is to try to prevent asthma by treating children with SCIT for allergic rhinoconjunctivitis before asthma has developed. The most attractive prospect, however, is to find ways of preventing asthma by vaccination against the most common viruses, particularly rhinovirus. There is evidence that there are children at high risk of developing asthma in whom a viral infection can also enhance the risk of allergen sensitization. So far this vaccination has not been achievable although research is in progress.

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Montelukast treatment may alter the early efficacy of immunotherapy in children with asthma

Cited by 22 publications

References 27 publications

Adverse Events During Immunotherapy Against Grass Pollen‐Induced Allergic Rhinitis – Differences Between Subcutaneous and Sublingual Treatment

Adverse Events During Immunotherapy Against Grass Pollen‐Induced Allergic Rhinitis – Differences Between Subcutaneous and Sublingual Treatment

Allergen Immunotherapy in Allergic Respiratory Diseases

The role of immunotherapy in the management of childhood asthma

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