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

Abstract

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...

Antileukotrienes in adenotonsillar hypertrophy: a review of the literature

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Combination treatment for allergic rhinitis: optimum solution

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Clinical Efficacy of Immunotherapy in Allergic Rhinitis

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