Antileukotrienes improve naso‐ocular symptoms and biomarkers in patients with NARES and asthma

Abstract

Objective The aim of our study was to analyze the montelukast effectiveness in improving oculonasal symptoms, patient‐reported outcomes (PROs), and eosinophilic biomarkers in patients with nonallergic rhinitis eosinophilic syndrome (NARES). Methods We enrolled prospectively 80 symptomatic patients treated with 10 mg once a day of montelukast in monotherapy for 2 months. All patients were investigated before and after treatment. Nasal symptoms (nasal obstruction, rhinorrhoea, sneezing, nasal itching), ocular symptoms (redness/puffiness, watery eyes), and other PROs (olfactory dysfunction, difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening) were scored by visual analogic scale. The following clinical scores were assessed: Total Nasal Symptom Score (T4NSS), Total Ocular Symptom Score (T2OSS), Total Symptom Score of Patient‐Reported Outcomes (TSS‐PROs), and a Composite Symptoms Score (CSS). Patients were classified as responders when a reduction of at least 50% of the CSS was observed. Before and after treatment, the eosinophilic biomarkers in nasal lavage were analyzed: nasal eosinophilia (number of eosinophils per high power field), eotaxin‐1 and eotaxin‐2. Results After treatment, significant reductions were observed for all the symptom scores. Forty‐two of 78 patients were considered responders. A significant reduction of eosinophils in nasal mucosa and of levels of eotaxin‐1 and eotaxin‐2 in nasal lavage were observed after treatment in responder patients. Patients with asthma had an increased probability to be responders. Conclusion NARES patients may benefit from treatment with montelukast. In particular, the presence of concomitant asthma may be predictive of a greater efficacy. Level of Evidence 2 Laryngoscope, 129:551–557, 2019

Rhinitis 2020: A practice parameter update

“…7 In 1 uncontrolled study, montelukast 10 mg daily reduced nasal obstruction, rhinorrhea, sneezing, and nasal pruritus in subjects with NARES and asthma. 170 Intranasal cromolyn was studied and found to have no benefit in NARES. 171 To date there has not been consensus regarding the specific clinical criteria for diagnosis of NARES.…”

Predictors of Disease Control After Endoscopic Sinus Surgery Plus Long-Term Local Corticosteroids in CRSwNP

“…A number of studies 5–9 have defined clinical factors that may predict poor response to treatment in CRSwNP, and, more recently, several authors 10–15 have suggested the prognostic value of the biochemical and cytological patterns of inflammation associated with nasal polyps. The primary objective of our study was to determine if preoperative definition of type and load of inflammation by nasal cytology may predict poor disease control of CRSwNP when treated with ESS plus local corticosteroids.…”

Clinical Evidence and Biomarkers Linking Allergy and Acute or Chronic Rhinosinusitis in Children: a Systematic Review

“…AR, in fact, is typically characterized by a Th2 immune response involving IL-4, IL-5, and IL-13 which drives IgE production and recruitment of eosinophil granulocytes. It has been suggested [ 38 – 42 ] that eosinophils, by generating potent toxic agents (cationic proteins, oxygen-free radicals, and proinflammatory cytokines), may play a major role in initiating and perpetuating inflammation of sinonasal mucosa in patients with AR.…”