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

Kaynakça

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50. gic rhinitis and asthma comorbidity. J Med Updates 2013;3(1):34-39.