Allergic Rhinitis and Asthma: The Link, The New ARIA Classificat

Leukotriene Receptor Antagonists in Allergic Rhinitis

Both histamine and cysteinyl leukotrienes are elevated in the nasal secretions of patients with allergic rhinitis. Whereas histamine induces some of the responses that typify allergic rhinitis (e.g. itching and sneezing), other mediators such as cysteinyl leukotrienes are 5000 times more potent than histamine in causing nasal congestion.

In a multicentre, double-blind trial in patients with spring seasonal allergic rhinitis, randomly assigned to once-daily montelukast (10 mg), loratadine (10 mg) or placebo, Meltzer et al..[22] demonstrated that both the daytime and nighttime nasal symptom scores were significantly (P<0.001) reduced with montelukast and loratadine compared with placebo. The quality of life was also improved with montelukast and loratadine versus placebo (P<0.005). In addition, after 2 weeks of treatment, peripheral blood eosinophil counts were significantly (P </=0.001) decreased with montelukast but not with loratadine or placebo.[21] A montelukast-induced reduction in airway eosinophilia was also reported in the sputum of patients with asthma. In another 2-week study.[22] the concomitant use of montelukast and loratadine improved the individual symptoms, composite scores and global evaluations, and rhinoconjunctivitis quality of life. Wilson et al..[23] studied the effects of an LTRA and antihistamine oral combination (montelukast plus cetirizine) in comparison with mometasone, an intranasal steroid. Intranasal steroids are known to be effective for all symptoms of allergic rhinitis. The study showed that the combination of montelukast plus cetirizine produced significant (P<0.05) improvements compared with placebo in the peak nasal expiratory flow rate, nasal oral index, nasal symptoms, nasal itch and blockage, eye symptoms and daily activity score. Importantly, there were no significant differences between mometasone and montelukast plus cetirizine. Furthermore, in a study by Price et al..[24] in patients with asthma and co-morbid allergic rhinitis, the use of montelukast with budesonide as a combination therapy was shown to be superior to doubling the dose of budesonide, both with or without the use of concomitant allergic rhinitis medications.

Therefore, oral drugs such as LTRAs that are effective for both rhinitis and asthma may be a good alternative for those patients who are not compliant with topical drugs. In fact, in the recent One Airway Survey.[8] treating both allergic rhinitis and asthma effectively was a concern raised by respondents to the survey. Almost three out of four patients (73%) responded that they found it difficult to treat both conditions effectively at the same time, and 85% noted concerns about using too many medications to treat the two conditions. The route of administration was also an important consideration among survey respondents, with nearly two-thirds (65%) reporting that they preferred to use oral medication rather than nasal sprays. Therapeutic strategies such as LTRAs thus represent a particular advance in therapy for the considerable numbers of patients with asthma and co-existing allergic rhinitis, and can increase patient compliance and improve the quality of life.

Reprint Address

Correspondence to Prof. Ruby Pawankar, MD, PhD, Department of Otolaryngology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo 113-8603, Japan Tel/fax: +81 48 597 2861; e-mail: Pawankar_Ruby/ent@nms.ac.jpAbbreviation Notes

ARIA, Allergic Rhinitis and its Impact on Asthma; ICS, inhaled corticosteroid; LTRA, leukotriene receptor antagonistPrevious PageSection 6 of 6Curr Opin Allergy Clin Immunol 4(1):1-4, 2004. © 2004 Lippincott Williams & Wilkins
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