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Leukotriene receptor antagonism may not be effective in atopic dermatitis treatment after all

Chin WK

J Clin Pharm Ther, 2018 Feb;43(1):159-162.
PMID: 29114905 DOI: 10.1111/jcpt.12648

WHAT IS KNOWN AND OBJECTIVE: Literature evidence suggests leukotriene involvement in the pathogenesis of atopic dermatitis. This article aimed to discuss whether the off-label use of montelukast, a leukotriene receptor antagonist, is justifiable for the treatment of atopic dermatitis.
COMMENT: Most non-randomized studies supported the use of montelukast for atopic dermatitis treatment. However, evidence from these studies should be interpreted with caution as it is relatively weak due to the absence of randomization, control groups and blinding processes, subjecting the results to high risk of selection and reporting biases. The inconsistent findings across RCTs may be related to the limited number of patients, nuances in study designs, varying severity of disease and the concomitant use of steroids in some of the studies.
WHAT IS NEW AND CONCLUSION: Current literature evidence is limited to rationally support the use of montelukast in atopic dermatitis treatment. For now, the conventional treatments should be preferred in the clinical setting.

Matched MeSH terms: Leukotriene Antagonists/therapeutic use*
Fulltext Management of chronic urticaria in Asia: 2010 AADV consensus guidelines

Chow SK

Asia Pac Allergy, 2012 Apr;2(2):149-60.
PMID: 22701866 DOI: 10.5415/apallergy.2012.2.2.149

This guideline is a result of a consensus reached during the 19th Asian-Australasian Regional Conference of Dermatology by the Asian Academy of Dermatology and Venereology Study Group in collaboration with the League of Asian Dermatological Societies in 2010. Urticaria has a profound impact on the quality of life in Asia and the need for effective treatment is required. In line with the EAACI/GA(2)LEN/EDF/WAO guideline for the management of urticaria the recommended first-line treatment is new generation, non-sedating H1-antihistamines. If standard dosing is ineffective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase in dosage of non-sedating H1-antihistamines, it is recommended that therapies such as H2-antihistamine, leukotriene antagonist, and cyclosporine A should be added to the antihistamine treatment. In the choice of second-line treatment, both their costs and risk/benefit profiles are the most important considerations.

Matched MeSH terms: Leukotriene Antagonists
Fulltext Empty nose syndrome post radical turbinate surgery

Iqbal FR, Gendeh BS

Med J Malaysia, 2007 Oct;62(4):341-2.
PMID: 18551943 MyJurnal

Empty Nose Syndrome (ENS) is a rare and controversial sequelae from previous radical turbinate surgery. We report on a 50-year-old Chinese gentleman with long-standing nasal problems who has had radical turbinate surgery many years prior to presenting at the ENT clinic with mucoid nasal discharge and chronically blocked nose. His nasal cavities were ironically very patent and there were only minor remnants of his turbinates bilaterally. We treated him medically for several years with nasal steroids, antihistamines and leukotriene receptor antagonists and his nasal symptoms have reduced significantly.
Study site: ENT clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Leukotriene Antagonists/therapeutic use
A systematic review on the off-label use of montelukast in atopic dermatitis treatment

Chin WK, Lee SWH

Int J Clin Pharm, 2018 Oct;40(5):963-976.
PMID: 29777328 DOI: 10.1007/s11096-018-0655-3

Background Atopic dermatitis (AD) is the most common form of eczema. As leukotriene mediators are involved in the inflammatory phase of atopic dermatitis, montelukast has been suggested as a possible therapy. Aim of the review To evaluate the safety and efficacy of montelukast off-label use for the treatment atopic dermatitis. Method A search was performed from database inception until March 2018 in six electronic databases for randomized-controlled-trials examining the use of montelukast for AD. Results Among 301 articles screened, 11 studies met the inclusion criteria and were included in the review. The study populations consist of paediatric and adult subjects with moderate-to-severe AD. Montelukast use was shown to improve symptoms such as pruritus in four studies. Another 2 studies reported that montelukast could improve symptoms similar to the standard regimen of topical steroid and oral antihistamine. However, five studies reported that montelukast had no effects in symptoms alleviation. The use of montelukast was associated with a similar safety profile to placebo and well-tolerated with minimal adverse effects. Conclusion There is limited evidence to suggest that the off-label use of montelukast is effective in treating moderate-to-severe AD. Further research with larger study populations employing standardized endpoint measuring instrument is warranted to further investigate the off-label use of montelukast in AD treatment. Until then, the use of conventional treatments including optimal daily skin hydration should remain the mainstay in the management of atopic dermatitis. In fact, for moderate-to-severe condition, steroid sparing immune-suppressants should still be used clinically until more effective and safer alternative is discovered.

Matched MeSH terms: Leukotriene Antagonists/therapeutic use*
Eosinophilia and musculoskeletal disease

Watts RA

Curr Opin Rheumatol, 2001 Jan;13(1):57-61.
PMID: 11148716

Eosinophilia is occasionally a feature of rheumatic disease. The differential diagnosis of eosinophilia includes parasitic infection, systemic vasculitides, eosinophilic arthritis, and myopathies, together with the idiopathic hypereosinophilic syndrome and malignancy. Careful evaluation of the patient should enable an accurate diagnosis to be made. Parasitic infection is the commonest cause of eosinophilia worldwide and can cause systemic disease, as illustrated by the report of Sarcocystis myositis in a group of military personnel in Malaysia. A persistent arthropathy associated with eosinophilia, but not with parasitic infection, has been reported from the far East. Drugs may also cause eosinophilia, and there has recently been much discussion of the relation between Churg-Strauss syndrome and the leukotriene antagonist zafirlukast. The present view is that reduction of steroid dose allows unmasking of previously undiagnosed Churg-Strauss syndrome. The idiopathic hypereosinophilic syndrome may represent a lymphoproliferative process; evidence for this comes from the demonstration that many patients have a clonally expanded population of aberrant T cells.

Matched MeSH terms: Leukotriene Antagonists
Montelukast Reduces the Risk of Dengue Shock Syndrome in Dengue Patients

Ahmad A, Waseem T, Butt NF, Randhawa FA, Malik U, Shakoori TA

Trop Biomed, 2018 Dec 01;35(4):1115-1122.
PMID: 33601858

A significant percentage of dengue patients develop Dengue Shock Syndrome (DSS) which is characterized by increased vascular permeability, circulatory failure and often death. Montelukast, a cysteinyl leukotriene receptor antagonist regulates vascular permeability and we hypothesized that it may be effective in protecting against DSS. An open label, parallel, randomized controlled trial (RCT) was thus carried out at Mayo Hospital, Department of Medicine, Lahore. A total of 200 patients of dengue fever were recruited and randomized into two groups. The group A was treated with Montelukast 10 mg once daily for 5 days along with general supportive treatment. Group B received the standard supportive treatment and served as the control group. The frequency of DSS was compared in the two groups by Chi square test. A binary logistic regression analysis was conducted to assess the effects of montelukast treatment on onset of DSS after adjusting for gender, age, white cell count, platelet count, haematocrit, serum alanine transaminase (ALT) and aspartate transaminase (AST). Relative risk (RR), absolute risk reduction (ARR), relative risk reduction (RRR) and numbers needed to treat (NNT) were calculated. Significance level was set at p0.001, Odds ratio=5.01, 95% CI=2.17-11.60) even after adjusting for confounders. Montelukast reduced the absolute risk (ARR=22%) and the relative risk (RRR=71%) of DSS in dengue fever. Numbers needed to treat were 4.55. We thus conclude that treatment with oral montelukast may protect patients of dengue fever from DSS and greatly reduce mortality.

Matched MeSH terms: Leukotriene Antagonists
Quality of life assessment in patients with moderate to severe allergic rhinitis treated with montelukast and/or intranasal steroids: a randomised, double-blind, placebo-controlled study

Goh BS, Ismail MI, Husain S

J Laryngol Otol, 2014 Mar;128(3):242-8.
PMID: 24618303 DOI: 10.1017/S002221511400036X

This study investigated improvements in quality of life associated with eight weeks of montelukast and/or intranasal steroid treatment for moderate to severe allergic rhinitis.

Matched MeSH terms: Leukotriene Antagonists/therapeutic use*