Montelukast, a leukotriene receptor antagonist, in vernal keratoconjunctivitis associated with asthma.
OBJECTIVE
To evaluate the effects on signs and symptoms of a coexisting vernal keratoconjunctivitis in patients treated with oral montelukast sodium for asthma.


METHODS
Twelve patients with vernal keratoconjunctivitis and asthma were enrolled in this pilot study. Topical eyedrops or any systemic treatment was discontinued for at least 7 days before montelukast treatment. Patients were asked to grade their ocular discomfort daily. The following signs and symptoms were also recorded and graded through medical examination at baseline,after 15 days of treatment, and 15 days after treatment discontinuation: physician-evaluated tarsal and bulbar papillae, hyperemia, secretion, and chemosis; and patient-evaluated itching, burning, tearing, photophobia, foreign body sensation, secretion, and redness. Peak expiratory flow rate at 8 AM was also recorded. Samples were collected at the same time points for enzyme-linked immunosorbent assay measurement of leukotriene B4 in tears and leukotriene E4 in urine.


RESULTS
Eight of the 10 patients evaluated reported a reduction in symptoms at the end of treatment. Montelukast treatment significantly decreased physician-rated hyperemia, secretion, and chemosis as well as patient-rated burning, tearing, photophobia, secretion, and redness. Effects persisted 15 days after discontinuation of treatment. Clinical changes were associated with a significant increase in leukotriene B4 in tears and a significant decrease in leukotriene E4 in urine after 15 days of treatment.


CONCLUSIONS
The significant and persistent reduction of ocular signs and symptoms in asthmatic patients with vernal keratoconjunctivitis treated for 15 days with montelukast strongly suggests the need for double-masked placebo-controlled trials to confirm the potential of this new treatment in vernal keratoconjunctivitis.
Interdisciplinary Research Center, University Campus Bio-Medico, Laboratory of Ophthalmology, Rome, Italy.
Alessandro
A
Lambiase
Stefano
S
Bonini
Guido
G
Rasi
Marco
M
Coassin
Alice
A
Bruscolini
Sergio
S
Bonini
D000085:Acetates / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003233:Conjunctivitis, Allergic / Q000150:complications / Q000188:drug therapy*; D003521:Cyclopropanes; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D007975:Leukotriene B4 / Q000378:metabolism; D017999:Leukotriene E4 / Q000652:urine; D008297:Male; D009883:Ophthalmic Solutions; D010366:Peak Expiratory Flow Rate; D010865:Pilot Projects; D011804:Quinolines / Q000627:therapeutic use*; D013440:Sulfides; D013666:Tears / Q000378:metabolism
D000085:Acetates; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D009883:Ophthalmic Solutions; D011804:Quinolines; D013440:Sulfides; D007975:Leukotriene B4; D017999:Leukotriene E4; C093875:montelukast