Effect of combined montelukast and desloratadine on the early asthmatic response to inhaled allergen

Davis, Beth E.; Todd, D.; Cockcroft, Donald W.

doi:10.1016/j.jaci.2005.06.014

Cited by 34 publications

(19 citation statements)

References 21 publications

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“…Montelukast also inhibited the response but desloratadine alone had no effect. Early-response methodology permits the assessment of the response as a doubling-dose shift in allergen PC20 [1]. The present study now documents that a single dose of desloratadine significantly inhibits the EAR, assessed as the AUC, as does a single dose of montelukast.…”

Section: Use Of Desloratadine and Montelukast In Asthmasupporting

confidence: 62%

“…Synergistic inhibition of the EAR with the combination of an antihistamine (desloratadine) and a leukotriene receptor antagonist (montelukast) has been documented [1], and we subsequently hypothesised that this combination would also prove beneficial against the LAR, since the LAR is correlated with the EAR and allergen-induced airway inflammation, and since recent data suggest that these agents may have a role in immune and inflammatory responses.…”

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confidence: 95%

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Single-dose desloratadine and montelukast and allergen-induced late airway responses

Davis¹,

Illamperuma²,

Gauvreau³

et al. 2009

Eur Respir J

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Montelukast and desloratadine synergistically inhibit the allergen-induced early asthmatic response. Montelukast also suppresses the allergen-induced late asthmatic response, but there are no reports on the effect of desloratadine or the combination on the allergen-induced late asthmatic response.Atopic asthmatics (n510) completed a multicentric randomised double-blind crossover study comparing single-dose placebo, 5 mg desloratadine, 10 mg montelukast and the combination administered 2 h prior to allergen inhalation challenge. Methacholine challenges were performed 24 h before and after allergen challenge. Exhaled nitric oxide measurements and sputum inflammatory cell counts were also carried out.All active treatments significantly decreased the late asthmatic response area under the curve. Combination therapy provided the greatest inhibition compared to desloratadine and montelukast. Montelukast was nonsignificantly better than desloratadine but not as effective as the combination. There was a trend towards a decrease in airway responsiveness following montelukast and combination. Montelukast, but not desloratadine or the combination, decreased exhaled NO levels 24 h after allergen. The allergen-induced increase in sputum eosinophil numbers was significantly suppressed at 7 h with desloratadine and combination therapy, and at 24 h with montelukast and combination therapy.Single-dose co-administration of desloratadine and montelukast 2 h prior to allergen inhalation clinically abolished the late asthmatic response and eosinophil recruitment.

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Section: Use Of Desloratadine and Montelukast In Asthmasupporting

confidence: 62%

mentioning

confidence: 95%

Single-dose desloratadine and montelukast and allergen-induced late airway responses

Davis¹,

Illamperuma²,

Gauvreau³

et al. 2009

Eur Respir J

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“…Histamine also contributes to bronchoconstriction during the EAR. Increases in urinary histamine metabolites have been measured during the EAR [47], and combined treatment with antihistamines and LTRAs abolish the EAR [48,49].…”

Section: Mechanisms Of Allergen-induced Bronchoconstrictionmentioning

confidence: 99%

“…An elevation in the PC20 following drug treatment versus placebo treatment demonstrates a protective effect on allergen-induced bronchoconstriction. Drugs that block components of the allergic cascade, for example, by preventing crosslinking of IgE receptors by allergen (anti-IgE) [125,156] or by interfering with mediators of bronchoconstriction (CysLTs and histamine), have been shown to increase the allergen PC20 [49]. Treatment with antihistamines [52], antileukotrienes [44] or anti-IgE [95] also attenuate the fall in FEV1 during the early and late responses after allergen challenge, which suggests that events occurring during the early response are linked to the development of the late response.…”

Section: Allergen Inhalation Challenge To Study New Drugs For Asthmamentioning

confidence: 99%

Allergen-induced airway responses

2015

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Environmental allergens are an important cause of asthma and can contribute to loss of asthma control and exacerbations. Allergen inhalation challenge has been a useful clinical model to examine the mechanisms of allergen-induced airway responses and inflammation. Allergen bronchoconstrictor responses are the early response, which reaches a maximum within 30 min and resolves by 1-3 h, and late responses, when bronchoconstriction recurs after 3-4 h and reaches a maximum over 6-12 h. Late responses are followed by an increase in airway hyperresponsiveness. These responses occur when IgE on mast cells is cross-linked by an allergen, causing degranulation and the release of histamine, neutral proteases and chemotactic factors, and the production of newly formed mediators, such as cysteinyl leukotrienes and prostaglandin D 2 . Allergen-induced airway inflammation consists of an increase in airway eosinophils, basophils and, less consistently, neutrophils. These responses are mediated by the trafficking and activation of myeloid dendritic cells into the airways, probably as a result of the release of epithelial cell-derived thymic stromal lymphopoietin, and the release of pro-inflammatory cytokines from type 2 helper T-cells. Allergen inhalation challenge has also been a widely used model to study potential new therapies for asthma and has an excellent negative predictive value for this purpose. @ERSpublications Environmental allergens are an important cause of asthma

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“…In a randomized study of patients with mild-tomoderate atopic asthma, after 26 hours of the treatment, early response to inhaled allergen was unchanged after desloratadine therapy and partially inhibited with montelukast therapy, whereas combination of desloratadine and montelukast provided superior efficacy to either blocker administered alone. [42] Antileukotriene-antihistamine combinations when used as either monotherapy or add-on therapy to local corticosteroids have been shown to attenuate the response to adenosine monophosphate-a sensitive marker of inflammatory process in airways further reinforcing the concept of the united allergic airway. [43] The putative benefits of such combination therapy certainly become evident when looking at concomitant effects on asthma control in patients who have concomitant allergic rhinitis.…”

Section: The Role Of H1-antihistamine and Cysteinyl Leukotriene Recepmentioning

confidence: 99%

Role of leukotriene antagonists and antihistamines in treatment of allergic rhinitis and asthma comorbidity

Baççıoğlu¹

2013

J Med Updates

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Allergy is a reaction with inflammatory cell infiltration in the target organ which allergen has been found to cause the pathology. [1,2] Allergens cause an immunoglobulin (Ig) E dependent reaction characterized by an early and late phase reaction. Histamine is released after 15 min of exposure to allergen, whereas leukotriene is increased in the AbstractLeukotriene receptor antagonists and antihistamines are efficient in reducing symptoms of allergic rhinitis and asthma when used alone or in combination. In patients with allergic rhinitis, H1-antihistamines prevent and relieve the sneezing, itching, rhinorrhea, and nasal congestion that characterize the early and the late response to allergen. H1-antihistamines are not medications of choice in asthmatic patients, but controlling rhinitis will improve asthma concomitantly. Leukotriene antagonist such as montelukast may be an alternative treatment for mild persistent asthma as monotherapy where inhaled corticosteroid cannot be administered or alternative to long-acting beta agonist as an add-on therapy to ICS for moderate to severe persistent asthma. Although montelukast is an effective drug in allergic rhinitis indicated as monotherapy, but widely recommended as adjunct to antihistamine or intranasal corticosteroid. Antileukotriene agents are also widely used in the treatment of pediatric asthma. In children, maintenance treatment with inhaled corticosteroids in pure episodic (viral) wheeze was ineffective, but maintenance as well as intermittent montelukast was shown to have an efficient role in both episodic and multi trigger wheeze. Furthermore, their advantage to inhaled corticosteroids is that leukotriene receptor antagonists do not affect short-term lower leg growth rate in prepubertal children.Key words: Leukotriene antagonist; antihistamines; allergic rhinitis; asthma. ÖzetYaln›z bafllar›na veya kombinasyon fleklinde kullan›ld›klar›nda lökotri-yen reseptörleri ve antistaminikler alerjik rinit semptomlar›n› azaltmada etkilidir. Alerjik rinit hastalar›nda H1 antistaminikleri alerjene yan›-t›n erken ve geç dönem yan›tlar› olan aks›rma, kafl›nma, burun akmas› ve nazal konjestiyonu önlemekte ve geçirmektedir. Ast›m hastalar›nda H1-antistaminikleri seçilecek ilaçlar olmamalar›na ra¤men rinitin kontrol alt›na al›nmas› ayn› zamanda ast›m› da iyilefltirecektir. Orta-a¤›r derecede fliddetli inatç› ast›mda inhale kortikosteroidin ek tedavi olarak verilemedi¤i veya uzun etkili beta agonistin alternatif olmad›¤› durumlarda hafif derecede ve inatç› ast›m›n alternatif tedavisi olarak montelukast gibi bir lökotriyen antagonistiyle monoterapi uygulanabilir. Alerjik rinitte monoterapi olarak montelukast etkili bir ilaç olmas›na ra¤men yayg›n olarak antistamin veya intranazal kortikosteroide ek olarak öne-rilmektedir. Antilökotriyen ilaçlar yine pediyatrik ast›m›n tedavisinde yayg›n biçimde kullan›lmaktad›r. Çocuklarda kortikosteroitler inhalasyonlar›yla idame tedavisi olarak saf epizodik (viral) h›fl›lt›l› solunum (wheezing) tedavisinde etkisiz olmalar›na ra¤men hem deva...

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Effect of combined montelukast and desloratadine on the early asthmatic response to inhaled allergen

Cited by 34 publications

References 21 publications

Single-dose desloratadine and montelukast and allergen-induced late airway responses

Single-dose desloratadine and montelukast and allergen-induced late airway responses

Allergen-induced airway responses

Role of leukotriene antagonists and antihistamines in treatment of allergic rhinitis and asthma comorbidity

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