Montelukast in allergic diseases beyond asthma

Abstract

Allergic diseases include a variety of different illnesses (rhinitis, conjunctivitis, asthma, urticaria, and dermatitis) in which the physiological and pathological basis is the release of chemical mediators such as histamine; platelet-activating factor; metabolites of arachidonic acid; and chemotactic factors from mastocytes, basophils, and eosinophils. The numerous drugs used for allergy treatment now include the new pharmacologic category of cysteinyl leukotriene (LT) antagonists. LTs are released from eosinophils, mast cells, and macrophages, interacting functionally in allergic reactions against a background of an imbalance between T-cell clones and resulting in preferential cytokine production following the T-helper 2 profile. Anti-LTs also have been used successfully by some authors to control rhinitis, atopic dermatitis, and urticaria. although additional controlled testing will be required, these applications broaden the possible range of treatments for allergic disease in all its many aspects.

International Union of Basic and Clinical Pharmacology. LXXXIV: Leukotriene Receptor Nomenclature, Distribution, and Pathophysiological Functions

“…Beyond asthma and rhinitis, there are other atopic diseases in which cysteinyl LTs are considered to play a role and that normally affect adults and children with relevant human and economic burden, such as atopic dermatitis (AD) and urticaria. Although the role of cysteinyl LTs in the inflammation of AD is unclear, several reports in the literature, but not all (Veien et al, 2005), detail improvements in patients (adult and children) with moderate to severe AD with the use of LTRAs at the doses generally recommended for asthma treatment Leonardi et al, 2007;Broshtilova and Gantcheva, 2010). In support, there is also the evidence that elevated levels of LTE 4 have been found in the urine of patients with AD (Adamek-Guzik et al, 2002;Øymar and Aksnes, 2005).…”

Culture medium from TNF-α–stimulated mesenchymal stem cells attenuates allergic conjunctivitis through multiple antiallergic mechanisms

“…The current mainstay of AC therapy includes topical MC stabilizers and antihistamines and has demonstrated variable and limited clinical success, [3][4][5][6] possibly because other factors in addition to MCs and histamine, such as T cells, B cells, macrophages, platelets, dendritic cells, and neutrophils, also play important roles in AC. Therefore the simultaneous targeting of multiple inflammatory signaling mediators, cellular components, or both might represent a promising modality for the treatment of this type of allergic disease.…”

“…3,4 Additionally, with prolonged use, topical antihistamines might be irritating to the eye, and many antihistamines are known to have anticholinergic effects that can cause ocular drying through muscarinic receptor inhibition. [3][4][5][6] Therefore investigating safer and more effective treatments is necessary.…”

Allergic conjunctivitis: a comprehensive review of the literature

“…These medications do not affect other proinflammatory mediators, such as prostaglandins and leukotrienes, which remain uninhibited. A limited duration of action necessitates frequent dosing of up to 4 times per day, and topical antihistamines may be irritating to the eye, especially with prolonged use [36]. Combination treatments using decongestants with antihistamines have been shown to be more effective, and are administered to the eye as drops up to 4 times daily [37].…”