title: Efficacy of prophylactic treatment with montelukast and montelukast plus add-on loratadine for seasonal allergic rhinitis.
abstract: Cysteinyl leukotriene and leukotriene receptor occupancy have been linked to several processes in seasonal allergic rhinitis (SAR), including nasal congestion, rhinorrhea, and recruitment of inflammatory cells. We investigated whether add-on loratadine, an antihistamine, might be effective for SAR patients showing unsatisfactory control of symptoms with the leukotriene receptor antagonist (LTRA) montelukast alone. Patients with SAR caused by Japanese cedar pollen (SAR-JCP; mean age, 29.4 years) were given prophylactic montelukast for 1 month before peak JCP dispersal. Patients recorded the severity of the symptoms (sneezing, rhinorrhea, nasal congestion, and ocular symptoms) daily on visual analog scale (VAS). We selected patients with VAS scores of >50 for any of the symptoms just before the peak pollen season (March 2 to March 8) and designated them as "poorly controlled" patients. Then, in the peak JCP season (from March 9), we conducted a randomized, double-blind, placebo-controlled study to determine whether add-on loratadine might be effective for these "poorly controlled" patients. Montelukast alone was effective, as evaluated by improvement of the VAS scores, in 95 of the 137 patients (69.3%). Add-on loratadine significantly decreased the total scores for nasal symptoms (p < 0.05), sneezing (p < 0.05), and rhinorrhea (p < 0.05) when compared with placebo. The symptoms of SAR in two of three SAR-JP patients could be controlled (VAS score[s] under 50) by prophylactic treatment with montelukast alone under the condition of mild JCP dispersal. Furthermore, the effect of add-on antihistamine on sneezing and rhinorrhea was found in selected SAR-JCP patients.
authors.affiliation: Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Takechiyo
authors.initials: T
authors.lastname: Yamada
authors.forename: Masafumi
authors.initials: M
authors.lastname: Sakashita
authors.forename: Seita
authors.initials: S
authors.lastname: Kubo
authors.forename: Dai
authors.initials: D
authors.lastname: Susuki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tokunaga
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ogi
authors.forename: Yoko
authors.initials: Y
authors.lastname: Terasawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Yamashita
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kayano
authors.forename: Mikio
authors.initials: M
authors.lastname: Masada
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kimura
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Fujieda
mesh_terms: D000085:Acetates / Q000008:administration & dosage*; D000284:Administration, Oral; D000328:Adult; D018926:Anti-Allergic Agents / Q000008:administration & dosage*; D003521:Cyclopropanes; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage*; D017336:Loratadine / Q000008:administration & dosage*; D008297:Male; D010919:Placebos / Q000008:administration & dosage; D011058:Pollen / Q000009:adverse effects; D011804:Quinolines / Q000008:administration & dosage*; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy / Q000517:prevention & control*; D012912:Sneezing / Q000187:drug effects; D013440:Sulfides; D013997:Time Factors
chemical_list: D000085:Acetates; D018926:Anti-Allergic Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D010919:Placebos; D011804:Quinolines; D013440:Sulfides; D017336:Loratadine; C093875:montelukast