The Emerging Role of Leukotriene Modifiers in Allergic Rhinitis
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The Emerging Role of Leukotriene Modifiers in Allergic Rhinitis Mitchell H. Grayson1 and Phillip E. Korenblat1,2 1 2
Division of Allergy and Immunology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA The Clinical Research Center, St Louis, Missouri, USA
Abstract
Leukotriene modifiers have been shown to be efficacious in the treatment of asthma. Because of this success, and the fact that leukotrienes can be recovered not only from bronchoalveolar lavage fluid but also nasal lavage fluid, some researchers have suggested that these medications may also be useful for treating allergic rhinitis. Because the upper and lower airways are linked physically, there has been an assumption that therapy for upper and lower airway disease should be similar. This critical appraisal examines available data both supporting and refuting the emerging role of leukotriene modifiers in the treatment of allergic rhinitis. Although many studies have shown an improvement in nasal symptoms when comparing a leukotriene modifier with placebo, few studies have conclusively shown that a leukotriene modifier is any more effective in treating allergic rhinitis than an antihistamine. Results from several reported studies suggest that the addition of a leukotriene antagonist to an antihistamine is no more efficacious than antihistamine alone. However, many of these studies were small and/or primarily designed to examine the asthmatic response, with nasal symptoms being a lesser endpoint. To better understand how, where, and when leukotriene modifiers should be used in the armamentarium of therapies for allergic rhinitis, larger clinical investigations designed specifically to study allergic rhinitis need to be undertaken. We conclude that currently, the data do not support widespread use of a leukotriene modifier with or without an antihistamine in place of an intranasal corticosteroid with or without an antihistamine in the treatment of allergic rhinitis.
Allergic rhinitis is a common condition affecting nearly onefifth of the US population.[1,2] Most commonly it is associated with nasal stuffiness, fullness, sneezing, nasal and ocular itching, and post-nasal drip. These symptoms are the result of an immunoglobulin E (IgE)-mediated reaction against allergens, such as seasonal pollens or molds and perennial antigens (e.g. pet dander and dust mites). The resulting allergic inflammation is characterized by degranulation of mast cells that occurs when the specific IgE bound to the cell surface is cross-linked by an appropriate antigen. Once this occurs, various mediators are released by the mast cell; of particular significance is histamine, which leads to vasodilatation, edema, sneezing, and itch.[2] The role of histamineblocking agents in controlling symptoms of allergic rhinitis is well established.[3-7] Other inflammatory mediators are also released during an allergic event or upon activation of the mast cell and/or basop
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