Premedication with montelukast reduces local reactions of allergen immunotherapy.
BACKGROUND
Local reactions (LRs) are a very frequent side effect of specific immunotherapy with allergens and can impair patients' adherence. Antihistamine pretreatment--originally introduced as a safety measure to reduce anaphylactic side effects--has been the only treatment option for LRs so far, although these swellings usually do not appear immediately but after hours. We were interested whether pretreatment with the leukotriene antagonist montelukast would be better suited for preventing those reactions than pretreatment with the antihistamine desloratadine.


METHODS
Fifteen patients with a history of severe anaphylactic reactions to hymenoptera stings were enrolled into a prospective, double-blind, randomized, placebo-controlled pilot study. We selected a rush immunotherapy protocol consisting of 19 injections of hymenoptera venom administered over 5 consecutive days, where the majority is developing LRs, and counted the number of injections until an LR of >3 cm occurred. The patients were randomized to 3 treatment groups: premedication with placebo, 10 mg montelukast and 5 mg of the antihistamine desloratadine.


RESULTS
Compared with placebo, the occurrence of LRs (>3 cm) was significantly delayed by montelukast (p < 0.01, analysis of variance) but not by desloratadine (p = 0.19). The difference between montelukast and desloratadine was close to significant (p = 0.054). Itching, recorded on a scale from 0 to 5, did not differ between the 3 groups.


CONCLUSIONS
Montelukast can be useful in the prevention of LRs after specific immunotherapy.
Wöhrl
Stefan
S
Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria. stefan.woehrl@meduniwien.ac.at
Gamper
Simon
S
Hemmer
Wolfgang
W
Heinze
Georg
G
Stingl
Georg
G
Kinaciyan
Tamar
T
D000085:Acetates / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology; D000707:Anaphylaxis / Q000188:drug therapy*; D000818:Animals; D003521:Cyclopropanes; D003888:Desensitization, Immunologic / Q000009:adverse effects*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use; D006801:Humans; D007299:Insect Bites and Stings / Q000276:immunology; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D017336:Loratadine / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011292:Premedication; D011804:Quinolines / Q000627:therapeutic use*; D013440:Sulfides; D014862:Wasp Venoms / Q000009:adverse effects* / Q000627:therapeutic use; D014863:Wasps / Q000276:immunology
D000085:Acetates; D000485:Allergens; D003521:Cyclopropanes; D039563:Histamine H1 Antagonists, Non-Sedating; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D014862:Wasp Venoms; D017336:Loratadine; C121345:desloratadine; C093875:montelukast