The effect of levocetirizine and montelukast on clinical symptoms, serum level and skin expression of COX-1 and COX-2 enzymes in patients suffering from chronic autoimmune urticaria – a pilot study

Abstract

Introduction: Chronic autoimmune urticaria (CAU) lasts over 6 weeks and is characterized by circulating IgE autoantibodies or IgG against IgE or IgE receptor. Aim: To assess the clinical, laboratory and histological effects of 4-week levocetirizine and montelukast therapy in patients suffering from CAU. Material and methods: Of 296 tested patients with chronic urticaria 40 had a positive ASST test. Only 17 (16 female/1 male; medium age: 44 years) fulfilled all study inclusion/exclusion criteria. The study was designed as an open, randomized trial with two arms: levocetirizine or montelukast treatment for 4 weeks following a 2-week wash-out period. All participants completed urticaria activity score (UAS) and visual analogue scale (VAS) questionnaires before and after both therapies. Blood samples and skin bioptats were obtained before and after treatment to evaluate COX-1 and COX-2 serum concentrations and skin expression. Results: Clinical response to therapy measured with the UAS and VAS was better in the levocetirizine group. Both drugs caused a significant decrease in COX-1 and COX-2 serum level. COX-1 and COX-2 expression in epidermal and dermal inflammatory infiltration did not change significantly in either study group, but a significant decrease of COX-1 expression was observed when the groups were combined for analysis, and the decrease in COX-2 expression in the epidermis was of borderline significance. Conclusions: The effectiveness of levocetirizine and montelukast in treating CAU may be partly related to the reduction of COX-1 and COX-2 serum level and tissue expression, but further studies on a larger group of patients are needed to support this observation.

Effectiveness and Safety of Immunosuppressants and Biological Therapy for Chronic Spontaneous Urticaria: A Network Meta-Analysis

“…In total, 14 records met the inclusion criteria and were included in the NMA ( Figure 1 ) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Detailed information on all studies included in the NMA is presented in Table 1 , and Table S2 shows information of studies excluded from the NMA [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ].…”

Changes and clinical significance of serum MMP-9, TIMP-1, COX-2, and immune levels in patients with asthma

“…COX-2, one of the isoforms of COX, has been found to be abnormally elevated in the airway epithelial cells and inflammatory cells of asthma patients. 24,25 Normally, COX-2 is not expressed in the airway epithelial and smooth muscle cells under physiological conditions but is activated and expressed in response to inflammatory factors. In the airway mucosa of asthma patients, a significant infiltration of monocytes, macrophages, eosinophils, and mast cells has been reported to release substantial amount of COX-2, triggering acute asthma attacks or exacerbating asthma symptoms.…”

Successful Use of Conbercept to Treat Choroidal Neovascularization: A Case Report

“…Chronic urticaria is a skin disease characterized by activating skin mast cells with subsequent degranulation and the release of histamine and other proinflammatory mediators such as leukotriene, prostaglandin, and tumor necrosis factor-α [1] . It is clinically defined by the presence of wheals or angioedema on the skin, with daily or intermittent symptoms lasting more than 6 weeks [2] .…”