A randomized intervention of montelukast for post-bronchiolitis: effect on eosinophil degranulation.
OBJECTIVE
To investigate the effect of montelukast on eosinophil degranulation and recurrent wheezing episodes in post-respiratory syncytial virus (RSV) bronchiolitis.


METHODS
Two hundred infants (age, 6-24 months) who were hospitalized with their first episode of acute RSV bronchiolitis were randomized in a double-blind, placebo-controlled, parallel comparison of 4-mg montelukast granules (RSV-MONT group) or matching placebo (RSV-PLC group) administered for 3 months. Serum eosinophil-derived neurotoxin (EDN) levels were measured (primary outcome), and recurrent wheezing was documented (secondary outcome) for 12 months. Comparisons were made with control subjects (control group, n = 50).


RESULTS
At the end of the 3-month treatment period, the RSV-PLC group (n = 71) exhibited significantly elevated EDN levels (P < .0001), and the RSV-MONT group (n = 79) showed significantly decreased EDN levels (P < .01) when compared with the initial levels. As a result, EDN levels in the 2 RSV groups significantly differed at this point (P < .0001) and remained different for the entire 12-month follow-up period. Cumulative recurrent wheezing episodes at 12 months were significantly lower in the RSV-MONT group (P = .039).


CONCLUSIONS
Montelukast treatment reduces eosinophil degranulation and is associated with a decrease in recurrent wheezing episodes in post-RSV bronchiolitis.
Kim
Chang-Keun
CK
Department of Pediatrics and Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea.
Choi
Jungi
J
Kim
Hyo Bin
HB
Callaway
Zak
Z
Shin
Bo Moon
BM
Kim
Jin-Tack
JT
Fujisawa
Takao
T
Koh
Young Yull
YY
D000085:Acetates / Q000627:therapeutic use*; D000208:Acute Disease; D001990:Bronchiolitis, Viral / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D015550:Cell Degranulation / Q000187:drug effects; D003521:Cyclopropanes; D004311:Double-Blind Method; D047208:Eosinophil-Derived Neurotoxin / Q000097:blood; D004804:Eosinophils / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007223:Infant; D011804:Quinolines / Q000627:therapeutic use*; D012008:Recurrence; D012135:Respiratory Sounds / Q000187:drug effects; D018357:Respiratory Syncytial Virus Infections / Q000150:complications*; D013440:Sulfides
D000085:Acetates; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D047208:Eosinophil-Derived Neurotoxin; C093875:montelukast