title: Antileukotrienes in upper airway inflammatory diseases.
abstract: Leukotrienes (LTs) are a family of inflammatory mediators including LTA4, LTB4, LTC4, LTD4, and LTE4. By competitive binding to the cysteinyl LT1 (CysLT1) receptor, LT receptor antagonist drugs, such as montelukast, zafirlukast, and pranlukast, block the effects of CysLTs, improving the symptoms of some chronic respiratory diseases, particularly bronchial asthma and allergic rhinitis. We reviewed the efficacy of antileukotrienes in upper airway inflammatory diseases. An update on the use of antileukotrienes in upper airway diseases in children and adults is presented with a detailed literature survey. Data on LTs, antileukotrienes, and antileukotrienes in chronic rhinosinusitis and nasal polyps, asthma, and allergic rhinitis are presented. Antileukotriene drugs are classified into two groups: CysLT receptor antagonists (zafirlukast, pranlukast, and montelukast) and LT synthesis inhibitors (5-lipoxygenase inhibitors such as zileuton, ZD2138, Bay X 1005, and MK-0591). CysLTs have important proinflammatory and profibrotic effects that contribute to the extensive hyperplastic rhinosinusitis and nasal polyposis (NP) that characterise these disorders. Patients who receive zafirlukast or zileuton tend to show objective improvements in, or at least stabilisation of, NP. Montelukast treatment may lead to clinical subjective improvement in NP. Montelukast treatment after sinus surgery can lead to a significant reduction in eosinophilic cationic protein levels in serum, with a beneficial effect on nasal and pulmonary symptoms and less impact in NP. Combined inhaled corticosteroids and long-acting β-agonists treatments are most effective for preventing exacerbations among paediatric asthma patients. Treatments with medium- or high-dose inhaled corticosteroids, combined inhaled corticosteroids and LT receptor antagonists, and low-dose inhaled corticosteroids have been reported to be equally effective. Antileukotrienes have also been reported to be effective for allergic rhinitis.
authors.affiliation: Department for ORL Head and Neck Surgery, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey. ccingi@gmail.com.|ENT Department, Eskisehir Osmangazi University, Eskisehir, Turkey. ccingi@gmail.com.
authors.forename: Cemal
authors.initials: C
authors.lastname: Cingi
authors.affiliation: Department for ORL Head and Neck Surgery, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey. nbayarmuluk@yahoo.com.
authors.forename: Nuray Bayar
authors.initials: NB
authors.lastname: Muluk
authors.affiliation: ENT Department, Ankara Koru Hospital, Ankara, Turkey. entdrkagan@gmail.com.
authors.forename: Kagan
authors.initials: K
authors.lastname: Ipci
authors.affiliation: ENT Clinics, Bayındır Içerenköy Hospital, Istanbul, Turkey. esahin@bayindirhastanesi.com.tr.
authors.forename: Ethem
authors.initials: E
authors.lastname: Şahin
mesh_terms: D000818:Animals; D001249:Asthma / Q000188:drug therapy*; D002908:Chronic Disease; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D009298:Nasal Polyps / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*
chemical_list: D020024:Leukotriene Antagonists
keywords: Allergic rhinitis; Antileukotriene drugs; Asthma; Chronic rhinosinusitis with nasal polyposis; Leukotrienes