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

Abstract

Leukotriene 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.

Keywords

• Leukotriene antagonist, antihistamines, allergic rhinitis, asthma

Alerjik rinit ve astım komorbiditesinin tedavisinde lökotriyen antagonisti ve antistaminiklerin rolü

Öz

Yalnız başlarına veya kombinasyon şeklinde kullanıldıklarında lökotriyen reseptörleri ve antistaminikler alerjik rinit semptomlarını azaltmada etkilidir. Alerjik rinit hastalarında H1 antistaminikleri alerjene yanıtın erken ve geç dönem yanıtları olan aksırma, kaşınma, burun akması ve nazal konjestiyonu önlemekte ve geçirmektedir. Astım hastalarında H1-antistaminikleri seçilecek ilaçlar olmamalarına rağmen rinitin kontrol altına alınması aynı zamanda astımı da iyileştirecektir. Orta-ağır derecede şiddetli inatçı astımda inhale kortikosteroidin ek tedavi olarak verilemediği veya uzun etkili beta agonistin alternatif olmadığı durumlarda hafif derecede ve inatçı astımın alternatif tedavisi olarak montelukast gibi bir lökotriyen antagonistiyle monoterapi uygulanabilir. Alerjik rinitte monoterapi olarak montelukast etkili bir ilaç olmasına rağmen yaygın olarak antistamin veya intranazal kortikosteroide ek olarak önerilmektedir. Antilökotriyen ilaçlar yine pediyatrik astımın tedavisinde yaygın biçimde kullanılmaktadır. Çocuklarda kortikosteroitler inhalasyonlarıyla idame tedavisi olarak saf epizodik (viral) hışıltılı solunum (wheezing) tedavisinde etkisiz olmalarına rağmen hem devamlı hem de aralıklı olarak verilen montelukastın hem epizodik hem de birden fazla tetikleyici faktörü olan wheezingde etkili bir rolü olduğu gösterilmiştir. Ayrıca, lökotriyen reseptör antagonistlerinin prepubertal çocuklarda kısa vadede alt ekstremite gelişme hızını olumsuz etkilememesi kortikosteroit inhalasyon tedavisine göre avantajlarını oluşturmaktadır.

Anahtar Kelimeler

• Lökotrien antagonisti, antihistaminik, alerjik rinit, astma

References

1. Bousquet J, Schünemann HJ, Samolinski B, et al.; in collaboration with the World Health Organization Collaborating Center for Asthma and Rhinitis. Allergic rhinitis and its impact on asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol 2012;130:1049-62.
2. Yorgancıo¤lu A, Özdemir C, Kalaycı Ö, et al.; WHO Collaborating Center on Asthma and Rhinitis. ARIA (Allergic Rhinitis and its Impact on Asthma) achievements in 10 years and future needs. Tuberk Toraks 2012;60:92-7.
3. Canonica GW. Introduction to nasal and pulmonary allergy cas- cade. Allergy 2002;57:8-12.
4. Cingi C, Catli T. Phenotyping of allergic rhinitis. Curr Allergy Asthma Rep 2012;12:115-9.
5. Passalacqua G, Ciprandi G, Canonica GW. The nose-lung inter- action in allergic rhinitis and asthma: united airways disease. Curr Opin Allergy Clin Immunol 2001;1:7-13.
6. Settipane G, Settipane RJ, Hagy GW. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc 1994;15:21-25.
7. Kalpaklio¤lu AF, Baççio¤lu A. Evaluation of quality of life: impact of allergic rhinitis on asthma. J Investig Allergol Clin Immunol 2008;18:168-73.
8. Canonica GW, Compalati E. Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies. Clin Exp Immunol 2009;158:260-71.

9. O’Mahony L, Akdis M, Akdis CA. Regulation of the immune response and inflammation by histamine and histamine receptors. J Allergy ClinImmunol 2011;128(6):1153-62.
10. Criado PR, Criado RF, Maruta CW, et al. Histamine, histamine receptors and antihistamines: new concepts. An Bras Dermatol 2010;85:195-210.
11. Kalpaklioglu F, Baccioglu A. Efficacy and safety of H1-antihist- amines: an update. Antiinflamm Antiallergy Agents Med Chem 2012;11:230-7.
12. Kalpaklioglu AF, Kavut AB. Comparison of azelastine versus tri- amcinolone nasal spray in allergic and nonallergic rhinitis. Am J Rhinol Allergy 2010;24:29-33.
13. Yamauchi K, Shikanai T, Nakamura Y, et al. Roles of histamine in the pathogenesis of bronchial asthma and reevaluation of the clini- cal usefulness of antihistamines. Yakugaka Zasshi 2011;131:185-91.
14. Roquet A, Dahlén B, Kumlin M, et al. Combined antagonism of leukotrienes and histamine produces predominant inhibition of allergen-induced early and late phase airway obstruction in asth- matics. Am J Respir Crit Care Med 1997;155:1856-63.
15. Warner JO; ETAC Study Group. Early Treatment of the Atopic Child. A double-blinded, randomized, placebo-controlled trial of cetirizine in preventing the onset of asthma in children with atopic dermatitis: 18 months’ treatment and 18 months’ posttreatment follow-up. J Allergy Clin Immunol 2001;108:929-37.
16. Bäck M, Dahlén SE, Drazen JM, et al. International Union of Basic and Clinical Pharmacology. LXXXIV: leukotriene receptor nomenclature, distribution, and pathophysiological functions. Pharmacol Rev 2011;63(3):539-84.
17. Amlani S, Nadarajah T, McIvor RA. Montelukast for the treat- ment of asthma in the adult population. Expert Opin Pharmacother 2011;12:2119-28.
18. Cingi C, Toros SZ, Gürbüz MK, et al. Effect of grapefruit juice on bioavailability of montelukast. Laryngoscope 2012. doi:10.1002/lary.23700
19. Watts K, Chavasse RJ. Leukotriene receptor antagonists in addi- tion to usual care for acute asthma in adults and children. Cochrane Database Syst Rev 2012;5:CD006100.
20. Celik P, Sakar A, Havlucu Y, et al. Short-term effects of mon- telukast in stable patients with moderate to severe COPD. Respir Med 2005;99:444-50
21. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention NIH Pub. No 02-3659, January 1995. Updated December 2011.
22. Walia M, Lodha R, Kabra SK. Montelukast in pediatric asthma management. Indian J Pediatr 2006;73:275-82.
23. Fritscher LG, Rodrigues MT, Zamel N, et al. The effect of mon- telukast on exhaled nitric oxide of alveolar and bronchial origin in inhaled corticosteroid-treated asthma. Respir Med 2009;103:296- 300.
24. Bhatt JM, Smyth AR. The management of pre-school wheeze. Paediatr Respir Rev 2011;12(1):70-7.
25. Pedersen S, Agertoft L, Williams-Herman D, et al. Placebo-con- trolled study of montelukast and budesonide on short-term growth in prepubertal asthmatic children. Pediatr Pulmonol 2007;42:838-43.
26. Hildebrand K. Exercise-induced bronchoconstriction. Pneumonol Alergol Pol 2011;79:39-47.
27. Park HS. Aspirin-sensitive asthma: recent advances in manage- ment. BioDrugs 2000;13:29-33.
28. Pinar E, Eryigit O, Oncel S, et al. Efficacy of nasal corticosteroids alone or combined with antihistamines or montelukast in treat- ment of allergic rhinitis. Auris Nasus Larynx 2008;35:61-6.
29. Cingi C, Ozlugedik S. Effects of montelukast on quality of life in patients with persistent allergic rhinitis. Otolaryngol Head Neck Surg 2010;142:654-8.
30. Alobid I, Cardelşs S, Picado C, et al. Antileukotrienes in rhinosinusi- tis and nasal polyposis. Expert Rev Clin Immunol 2008;4:331-7.
31. Cingi C, Demirbas D, Ural A. Nasal polyposis: an overview of dif- ferential diagnosis and treatment. Recent Pat Inflamm Allergy Drug Discov 2011;5:241-52.
32. Yazıcı ZM, Sayın I, Bozkurt E, et al. Effect of montelukast on quality of life in subjects with nasal polyposis accompanying bronchial asthma. Kulak Burun Bogaz Ihtis Derg 2011;21:210-4.
33. Wöhrl S, Gamper S, Hemmer W, et al. Premedication with mon- telukast reduces local reactions of allergen immunotherapy. Int Arch Allergy Immunol 2007;144:137-42.
34. Ciprandi G, Tosca MA, Milanese M, et al. Antihistamines added to an antileukotriene in treating seasonal allergic rhinitis: hista- mine and leukotriene antagonism. Eur Ann Allergy ClinImmunol 2004;36:67-70.
35. Meltzer EO, Malmstrom K, Lu S, et al. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a ran- domized, placebo-controlled clinical trial. J Allergy Clin Immunol 2000;105:917-22.
36. Kurowski M, Kuna P, Górski P. Montelukast plus cetirizine in the prophylactic treatment of seasonal allergic rhinitis: influence on clinical symptoms and nasal allergic inflammation. Allergy 2004;59:280-8.
37. Ciebiada M, Ciebiada MG, Kmiecik T, et al. Quality of life in patients with persistent allergic rhinitis treated with montelukast alone or in combination with levocetirizine or desloratadine. J Investig Allergol Clin Immunol 2008;18:343-9.
38. Wilson AM, Orr LC, Coutie WJ, et al. A comparison of once daily fexofenadine versus the combination of montelukastplus lorata- dine on domiciliary nasal peak flow and symptoms in seasonal allergic rhinitis. Clin Exp Allergy 2002;32:126-32.
39. Cingi C, Gunhan K, Gage-White L, et al. Efficacy of leukotriene antagonists as concomitant therapy in allergic rhinitis. Laryngoscope 2010;120:1718-23.
40. Pullerits T, Praks L, Ristioja V, et al. Comparison of a nasal glu- cocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. J Allergy ClinImmunol 2002;109:949-55.
41. Wilson AM. Are antihistamines useful in managing asthma? Curr Opin Allergy Clin Immunol 2002;2:53-9.
42. Davis BE, Todd DC, Cockcroft DW. Effect of combined mon- telukast and desloratadine on the early asthmatic response to inhaled allergen. J Allergy ClinImmunol 2005;116:768-72.
43. Lee DK, Togias A. Systemic cross-talk between the lung and the nose. Am J Respir Crit Care Med 2001;164:726-7.
44. Davis BE, Illamperuma C, Gauvreau GM, et al. Single-dose desloratadine and montelukast and allergen-induced late airway responses. Eur Respir J 2009;33:1302-308.
45. Currie GP, Haggart K, Lee DK, et al. Effects of mediator antag- onism on mannitol and adenosine monophosphate challenges. Clin Exp Allergy 2003;33:783-8.
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50. gic rhinitis and asthma comorbidity. J Med Updates 2013;3(1):34-39.