title: Nasal eosinophilia and serum soluble intercellular adhesion molecule 1 in patients with allergic rhinitis treated with montelukast alone or in combination with desloratadine or levocetirizine.
abstract: BACKGROUND
  Because intercellular adhesion molecule (ICAM) 1 and recruitment of eosinophils are crucial in supporting allergic inflammation, their down-regulation may bring additional benefits in patients' recovery. We have assessed nasal eosinophilia and serum soluble ICAM-1 (sICAM-1) concentrations in relation to nasal symptoms in patients with persistent allergic rhinitis (AR) treated for 6 weeks with either desloratadine, levocetirizine, montelukast alone, or in combination.
  
  
  METHODS
  In this single-center, randomized, double-blind, placebo-controlled, crossover, two-arm study, 40 patients with persistent AR were randomized to receive either montelukast and/or levocetirizine or placebo (n = 20) or to receive treatment with montelukast and/or desloratadine or placebo (n = 20). Nasal eosinophilia and concentration of sICAM-1 in peripheral blood were assessed before and on the last day of each treatment period.
  
  
  RESULTS
  All active treatments in both arms of the study resulted in the decrease of sICAM-1 and nasal eosinophilia, which correlated with the severity of nasal symptoms. In the montelukast/levocetirizine arm, montelukast decreased nasal eosinophilia more significantly than levocetirizine, whereas in reduction of sICAM-1 all active treatment options were equally effective. However, in the desloratadine/montelukast arm, the resulting improvement of combination therapy of sICAM-1 and the influx of eosinophils was not statistically significant.
  
  
  CONCLUSIONS
  The improvement of nasal symptoms in patients with AR treated with antihistamines, with or without montelukast, may additionally result from the reduction of sICAM-1 and nasal eosinophilia. Because the combination therapy may bring inconclusive benefits in this area there is a strong need of further studies to find mechanisms that favor combination therapy.
authors.affiliation: Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland. maciej_ciebiada@op.pl
authors.forename: Maciej
authors.initials: M
authors.lastname: Ciebiada
authors.forename: Marcin
authors.initials: M
authors.lastname: Barylski
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Gorska Ciebiada
mesh_terms: D000085:Acetates / Q000008:administration & dosage*; D000328:Adult; D000818:Animals; D017332:Cetirizine / Q000008:administration & dosage; D003521:Cyclopropanes; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004802:Eosinophilia / Q000276:immunology; D005260:Female; D039563:Histamine H1 Antagonists, Non-Sedating / Q000008:administration & dosage; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D020024:Leukotriene Antagonists / Q000008:administration & dosage*; D017336:Loratadine / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D009666:Nose / Q000276:immunology / Q000473:pathology; D011446:Prospective Studies; D039981:Pyroglyphidae / Q000276:immunology; D011804:Quinolines / Q000008:administration & dosage*; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy* / Q000276:immunology; D013440:Sulfides
chemical_list: D000085:Acetates; D003521:Cyclopropanes; D039563:Histamine H1 Antagonists, Non-Sedating; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D018799:Intercellular Adhesion Molecule-1; C472067:levocetirizine; D017336:Loratadine; C121345:desloratadine; C093875:montelukast; D017332:Cetirizine