title: Protective effect of montelukast on lower and upper respiratory tract responses to short-term cat allergen exposure.
abstract: BACKGROUND
  Challenge with short-term exposure to airborne cat allergen in sensitized patients produces pulmonary function changes and rhinitis symptoms.
  
  
  OBJECTIVE
  To determine the benefit of montelukast, 10 mg, for patients with concomitant asthma and allergic rhinitis as demonstrated by protection against both lower and upper airway responses to cat allergen challenge.
  
  
  METHODS
  This randomized, crossover study treated patients with montelukast vs placebo during two 2-week, double-blind treatment periods, separated by a 1-week washout period. After each treatment period, patients underwent a 60-minute or less exposure to high levels of airborne cat allergen. Lower and upper airway responses were measured by spirometry and symptom scores.
  
  
  RESULTS
  Of 52 patients with data from both treatment arms, 79% of patients taking montelukast and 67% taking placebo were exposed to the full 60-minute allergen challenge. Montelukast provided significant (P < or = .001) protection against allergen challenge in the lower airway coprimary end point of area under the curve during challenge (AUC0-60min) for percentage decrease in forced expiratory volume in 1 second: mean of 10.5% per hour and 14.7% per hour for montelukast and placebo, respectively. Although the effect on the overall nasal symptoms score (NSS) coprimary end point of AUC0-60min was not statistically significance (P = .12), nasal congestion during the challenge and NSS during recovery showed statistically significant (P = .048) protection by montelukast. Additional analyses of simultaneous lower and upper airway responses showed that more patients taking montelukast (22, 43%) vs placebo (13, 26%) were protected from both asthma and rhinitis (P = .02), with an odds ratio of 2.24 (95% CI, 1.16-4.32) in favor of montelukast.
  
  
  CONCLUSIONS
  Montelukast has a protective effect against both lower and upper airway responses during exposure to high levels of cat allergen.
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Tamara T
authors.initials: TT
authors.lastname: Perry
authors.forename: Jonathan
authors.initials: J
authors.lastname: Corren
authors.forename: George
authors.initials: G
authors.lastname: Philip
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kim
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Conover-Walker
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Malice
authors.forename: Rachid
authors.initials: R
authors.lastname: Massaad
authors.forename: S Balachandra
authors.initials: SB
authors.lastname: Dass
authors.forename: Theodore F
authors.initials: TF
authors.lastname: Reiss
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wood
mesh_terms: D000085:Acetates / Q000494:pharmacology*; D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology*; D000818:Animals; D019540:Area Under Curve; D001249:Asthma / Q000276:immunology*; D002415:Cats / Q000276:immunology*; D018592:Cross-Over Studies; D003521:Cyclopropanes; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D006967:Hypersensitivity / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011804:Quinolines / Q000494:pharmacology*; D012137:Respiratory System / Q000276:immunology*; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology*; D013440:Sulfides
chemical_list: D000085:Acetates; D000485:Allergens; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; C093875:montelukast