I was out last week because I attended the 12th Asian Research Symposium in Rhinology and 51st Annual Philippine Society of Otolaryngology-Head and Neck Surgery at the Sofitel Plaza Hotel. Passing the diplomate board examination last 2005 and actively practicing for the last two years, I was inducted as fellow of the society. Throughout the 4-day event, among the many topics discussed, the one that caught my interest is the role of the anti-leukotrienes in the management of allergic rhinitis. I have been hearing about this before but I haven't really applied it in my clinical practice. The principles behind this were well explained during the ARSR and I was convinced to try it myself, since I have also an AR, and with my patients with similar problems.
Cysteinyl-leukotrienes (CysLTs) are endogenous mediators of inflammation and play an important role in allergic airway disease by stimulating bronchoconstriction, mucus production, mucosal edema and inflammation, airway infiltration by eosinophils, and dendritic cell maturation that prepares for future allergic response. The anti-leukotrienes (i.e.,Montelukast) inhibits these actions by blocking type 1 CysLT receptors found on immunocytes, smooth muscle and endothelium in the respiratory mucosa.
Initially developed as a treatment for asthma, studies now show that patients with allergic rhinitis treated with montelukast had significantly greater improvements in their symptoms. As monotherapy, montelukast exhibited efficacy similar to that of loratadine, but less than that of the intranasally administered corticosteroid fluticasone propionate. The use of montelukast in combination with antihistamines such as loratadine or cetirizine has generally resulted in greater efficacy than when these agents were used alone, and in some studies has produced results comparable with intranasally applied corticosteroids. In patients with allergic rhinitis comorbid with asthma, montelukast treatment has resulted in significant improvements in both. Montelukast is well tolerated and has a favourable safety profile.
Cysteinyl-leukotrienes (CysLTs) are endogenous mediators of inflammation and play an important role in allergic airway disease by stimulating bronchoconstriction, mucus production, mucosal edema and inflammation, airway infiltration by eosinophils, and dendritic cell maturation that prepares for future allergic response. The anti-leukotrienes (i.e.,Montelukast) inhibits these actions by blocking type 1 CysLT receptors found on immunocytes, smooth muscle and endothelium in the respiratory mucosa.
Initially developed as a treatment for asthma, studies now show that patients with allergic rhinitis treated with montelukast had significantly greater improvements in their symptoms. As monotherapy, montelukast exhibited efficacy similar to that of loratadine, but less than that of the intranasally administered corticosteroid fluticasone propionate. The use of montelukast in combination with antihistamines such as loratadine or cetirizine has generally resulted in greater efficacy than when these agents were used alone, and in some studies has produced results comparable with intranasally applied corticosteroids. In patients with allergic rhinitis comorbid with asthma, montelukast treatment has resulted in significant improvements in both. Montelukast is well tolerated and has a favourable safety profile.
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