Leukotriene receptor antagonists in allergic eye disease: a systematic review and meta-analysis.
BACKGROUND
Allergic eye diseases are common and cause significant morbidity. Leukotrienes are implicated in the pathogenesis of seasonal and perennial allergic conjunctivitis (AC), commonly seen in conjunction with allergic rhinitis, and in vernal keratoconjunctivitis and atopic keratoconjunctivitis.


OBJECTIVE
To assess the available evidence for an effect of leukotriene receptor antagonists (LTRAs) on the ocular symptoms of allergic eye diseases.


METHODS
Selected studies, identified with systematic review search methods, were single/double-blind, randomized, controlled trials that compared LTRAs with other common treatments.


RESULTS
Eighteen trials, using the LTRA montelukast (in AC only), were identified. Six studies were suitable for meta-analysis, in patients with seasonal AC [treated over a 2-week period, symptoms scored 0 (mild) to 3 (severe)]. These trials were at low risk of bias without significant heterogeneity. Six trials were analyzed and showed that montelukast improved patients' ocular symptoms to a greater extent than placebo, with a difference in mean change-from-baseline score of -0.10 (95% CI, -0.14 to -0.07; P < .00001). Three trials compared montelukast with oral antihistamine. The difference in mean change-from-baseline score was 0.08 (95% CI, 0.02 to 0.14; P = .007), in favor of antihistamines. Two trials compared montelukast and oral antihistamine with placebo. The difference in mean change-from-baseline score was -0.30 (95% CI, -0.38 to -0.21; P < .00001), in favor of combination treatment.


CONCLUSIONS
In seasonal AC LTRAs are more efficacious than placebo but less efficacious than oral antihistamines in adult patients. Clinical trials should be conducted to determine whether combination treatment with LTRA and oral antihistamine has a synergistic effect. Further research is required to clarify the role of LTRAs in other allergic eye diseases.
Clinical Research Fellow, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom. Electronic address: jenniegane@doctors.org.uk.
Jennie
J
Gane
Roger
R
Buckley
D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003233:Conjunctivitis, Allergic / Q000188:drug therapy*; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D018927:Anti-Asthmatic Agents; D006633:Histamine Antagonists; D020024:Leukotriene Antagonists
AC; AKC; AR; ARC; ARIA; Allergic Rhinitis and its Impact on Asthma; Allergic conjunctivitis; Allergic keratoconjunctivitis; Allergic rhinitis; Allergic rhinoconjunctivitis; Eye diseases; LTRA; Leukotriene antagonists; Leukotriene receptor antagonist; Meta-analysis; Montelukast; PAC; PAR; Perennial allergic conjunctivitis; Perennial allergic rhinitis; RQLQ; Review; Rhinoconjunctivitis Quality of Life Questionnaire; SAC; SAR; Seasonal allergic conjunctivitis; Seasonal allergic rhinitis; VKC; Vernal keratoconjunctivitis