title: Leukotriene receptor antagonists for chronic urticaria: a systematic review.
abstract: A significant proportion of patients with chronic urticaria respond inadequately to first line treatment with antihistamines. Leukotreine receptor antagonists (LTRA) are also used for chronic urticaria, although firm recommendations on their use are lacking. We performed a systematic review of randomised trials to determine the role of LTRA in treatment of chronic urticaria. A search of PUBMED, EMBASE, SCOPUS, LILACS, the Cochrane Central Register of Controlled Trials, and the Web of Science for relevant randomized control trials or cross over studies yielded 10 eligible studies. The heterogeneity of trials were high, preventing valid meta-analysis of data. Most trials indicated that LTRA are not superior to placebo or antihistamine therapy, while combination therapy of LTRA and antihistamines appear to be more efficacious compared to antihistamine alone. The side effect profile and tolerability of this group of drugs is acceptable. The use of LTRA as monotherapy cannot be recommended. LTRA are effective add-on therapy to anti-histamines, and their use in patients responding poorly to antihistamines is justifiable. Further well designed randomized controlled trials with clear and standardized outcome measures are needed to determine the role of LTRA in chronic urticaria.
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka.
authors.forename: Nipun Lakshitha
authors.initials: NL
authors.lastname: de Silva
authors.affiliation: Department of Pharmacology, Faculty of Medicine, Colombo, Sri Lanka.
authors.forename: Hasitha
authors.initials: H
authors.lastname: Damayanthi
authors.affiliation: Department of Geriatrics, Kings Mill Hospital, Sherwood Forest NHS Foundation Trust, Sutton-in-Ashfield, Nottinghamshire, UK.
authors.forename: Anoja Chamarie
authors.initials: AC
authors.lastname: Rajapakse
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka.
authors.forename: Chaturaka
authors.initials: C
authors.lastname: Rodrigo
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka.
authors.forename: Senaka
authors.initials: S
authors.lastname: Rajapakse
keywords: Antihistamines; Chronic urticaria; Leukotreine; Leukotreine receptor antagonists; Montelukast; Zafirlukast