Role of Leukotriene Antagonists and Antihistamines in the Treatment of Allergic Rhinitis

Abstract

Allergic rhinitis is the most common atopic disorder seen in ENT clinics. It is diagnosed by history, physical exam and objective testing. Patient education, environmental control measures, pharmacotherapy, and allergen-specific immunotherapy are the cornerstones of allergic rhinitis treatment and can significantly reduce the burden of disease. Current treatment guidelines include antihistamines, intranasal corticosteroids, oral and intranasal decongestants, intranasal anticholinergics, intranasal cromolyn, and leukotriene receptor antagonists. In the mechanism of allergic rhinitis, histamine is responsible for major allergic rhinitis symptoms such as rhinorrhea, nasal itching and sneezing. Its effect on nasal congestion is less evident. In contrast, leukotrienes result in increase in nasal airway resistance and vascular permeability. Antihistamines and leukotriene receptor antagonists are commonly used in the treatment of allergic rhinitis. The published literature about combined antihistamines and leukotriene antagonists in mono- or combination therapy is reviewed and presented.

Sublingual house dust mite immunotherapy has no impact on decrease of circulating erythrocytes upon airway allergen challenge in allergic rhinitis

“…In acute allergic rhinitis mast cell induced inflammatory mediators, such as leukotrienes and prostaglandin, cause vascular hyper-permeability, vasodilation and chemotaxis of neutrophils and eosinophils to the local inflammation site following allergen exposure 23 . The increased microvascular leakage primarily leads to plasma extravasation making an acute systemic increase in hematocrit values more likely than a decrease, as found in our study.…”

“…Upon allergen challenge circulating eosinophil numbers remained unchanged in both HDM SLIT groups but slightly decreased in the placebo group. Eosinophil recruitment from the blood circulation and their arrest on activated endothelium and extravasation has been described in allergic airway diseases 23, 35 . There are various explanations for the mechanisms of allergen immunotherapy.…”

Mammalian lipoxygenases and their biological relevance

“…The various LTs (Fig. 5) exhibit different bioactivities and preferentially act on different cells types: Peptido-LTs: The cysteinyl LTs (LTC4, LTD4, LTE4) are constituents of the slow-reacting substance of anaphylaxis and play an important role for the pathogenesis of allergic diseases, such as bronchial asthma [168], rhinitis [169] and allergic eye disease [170]. On the molar basis cysLTs are at least 1000-times more effective as bronchoconstrictor than histamine [171], and nanomolar concentrations of cys-LTs cause plasma leakage and cell adherence in postcapillary venules leading to bronchial edema [172].…”

The Use of Filariae as a Therapeutic Agent for Hypersensitivity Diseases

“…Antihistamines are medications that are readily available for over-the-counter and prescription use. The mechanism of action for antihistamines is the blockade of HR1, which prevents the inflammation and cell activation associated with histamine release (35).…”