title: Antihistamines added to an antileukotriene in treating seasonal allergic rhinitis: histamine and leukotriene antagonism.
abstract: Cysteinyl leukotrienes (CysLTs) are a key element of allergic inflammation. Thus, the antagonism of CysLTs appears a potential target of allergic rhinitis management. Antileukotrienes and antihistamines combined showed a synergistic effect in treating seasonal allergic rhinitis (SAR). This double blind, parallel group, randomized study aimed at evaluating the clinical and anti-inflammatory effects exerted by two combinations of antihistamine plus antileukotriene in patients with SAR and mild intermittent asthma. Thirty patients were treated with montelukast added to cetirizine (M-C group) or desloratadine (M-D group) for 2 weeks. The visits, including spirometry, nasal scraping and lavage, were performed in all subjects before and directly after the treatment. Evaluation parameters were: i) nasal symptoms, ii) number of eosinophils and neutrophils, and iii) IL5 and IL8 levels. Both combinations significantly reduced: nasal symptoms (p<0.001), eosinophils and neutrophils (p<0.001), IL5 (p<0.001 for M-C groupand p<0.01 for M-D group), and IL8 levels (p<0.001 for M-C group and p<0.05 for M-D group). M-C combination reduced more significantly than M-D combination: nasal symptoms (p<0.01), inflammatory cells (p<0.01), and cytokines (p<0.01). The present study demonstrates that these antileukotriene-antihistamine combinations are effective in relieving nasal symptoms in SAR. Moreover, these combinations exert additional anti-inflammatory activity as provided by reduction of inflammatory infiltrate and cytokine levels. Finally, cetirizine might exert more beneficial activity than desloratadine when added to montelukast.
authors.affiliation: Allergy & ENT Unit, Head-Neck Dpt., San Martino Hospital, Genoa, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ciprandi
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Tosca
authors.forename: Manlio
authors.initials: M
authors.lastname: Milanese
authors.forename: Guido
authors.initials: G
authors.lastname: Schenone
authors.forename: Vittorio
authors.initials: V
authors.lastname: Ricca
mesh_terms: D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D017332:Cetirizine / Q000008:administration & dosage / Q000627:therapeutic use*; D003521:Cyclopropanes; D004311:Double-Blind Method; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D005541:Forced Expiratory Volume; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D019409:Interleukin-15 / Q000032:analysis; D020382:Interleukin-18 / Q000032:analysis; D007958:Leukocyte Count; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009297:Nasal Mucosa / Q000473:pathology; D011537:Pruritus / Q000209:etiology; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy* / Q000473:pathology; D012912:Sneezing; D013440:Sulfides; D007507:Therapeutic Irrigation
chemical_list: D000085:Acetates; D003521:Cyclopropanes; D006634:Histamine H1 Antagonists; D019409:Interleukin-15; D020382:Interleukin-18; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; C093875:montelukast; D017332:Cetirizine