Montelukast with desloratadine or levocetirizine for the treatment of persistent allergic rhinitis.
BACKGROUND
Montelukast sodium is approved as a treatment for intermittent and persistent allergic rhinitis (AR), but it has not been evaluated as combined therapy with antihistamines for persistent AR.


OBJECTIVE
To investigate the effects of 6 weeks of treatment of persistent AR with desloratadine, levocetirizine, or montelukast alone or in combination.


METHODS
A randomized, double-blind, placebo-controlled crossover study was performed. Patients were assigned to 2 arms: 20 received montelukast, 10 mg/d, desloratadine, 5 mg/d, or both or placebo and 20 received montelukast, levocetirizine, or both, 5 mg/d, or placebo. The treatment periods were separated by 2-week washout periods. Symptom scoring, skin prick tests, spirometry, rhinometry, and nasal lavage were performed the day before and the last days of the treatment periods. Eosinophil cationic protein levels were evaluated by means of nasal lavage.


RESULTS
The mean +/- SD total baseline nasal symptom score was 7.7 +/- 0.49 before treatment, 3.74 +/- 0.54 after desloratadine use, 3.6 +/- 0.48 after montelukast use, and 3.04 +/- 0.4 after montelukast-desloratadine use. The mean +/- SD baseline nasal symptom score was 7.95 +/- 0.68 before treatment, 3.02 +/- 0.64 after levocetirizine use, 3.44 +/- 0.55 after montelukast use, and 2.14 +/- 0.39 after montelukast-levocetirizine use. The greatest improvement in nasal symptoms occurred after combination treatment. Decreases in the level of eosinophil cationic protein were greater after the combined use of montelukast and antihistamine than after each agent given alone.


CONCLUSIONS
For persistent AR, the combination of montelukast and either desloratadine or levocetirizine is more effective than monotherapy with these agents.
Ciebiada
Maciej
M
Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland.
Górska-Ciebiada
Małgorzata
M
DuBuske
Lawrence M
LM
Górski
Paweł
P
D000085:Acetates / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D017332:Cetirizine / Q000627:therapeutic use*; D018592:Cross-Over Studies; D003521:Cyclopropanes; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D047150:Eosinophil Cationic Protein / Q000032:analysis; D005260:Female; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use; D006801:Humans; D017336:Loratadine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017817:Nasal Lavage Fluid / Q000737:chemistry; D010879:Piperazines / Q000627:therapeutic use*; D011804:Quinolines / Q000627:therapeutic use*; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy* / Q000473:pathology; D023842:Rhinometry, Acoustic; D013440:Sulfides; D016896:Treatment Outcome
D000085:Acetates; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D039563:Histamine H1 Antagonists, Non-Sedating; D010879:Piperazines; D011804:Quinolines; D013440:Sulfides; C472067:levocetirizine; D017336:Loratadine; D047150:Eosinophil Cationic Protein; C479220:RNASE3 protein, human; C121345:desloratadine; C093875:montelukast; D017332:Cetirizine