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Wang H, Ji Q, Liao C, Tian L. A systematic review and meta-analysis of loratadine combined with montelukast for the treatment of allergic rhinitis. Front Pharmacol 2023; 14:1287320. [PMID: 37915414 PMCID: PMC10616259 DOI: 10.3389/fphar.2023.1287320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
Background: Loratadine and montelukast are clinical first-line drugs in the treatment of allergic rhinitis (AR). However, there is no clear evidence of the efficacy of loratadine combined with montelukast in the treatment of AR. This study aimed to evaluate the efficacy and safety of the loratadine-montelukast combination on AR. Methods: In this meta-analysis, searches were conducted on PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and China National Knowledge Infrastructure (CNKI). The search terms included loratadine, montelukast, allergic rhinitis, and clinical trials. Meta-analyses were conducted using Rev Man 5.3 and Stata 15 statistical software. Results: A total of 23 studies with 4,902 participants were enrolled. For the primary outcome, pooled results showed that loratadine-montelukast can significantly reduce total nasal symptom scores (TNSS), when compared with loratadine (SMD, -1.00; 95% CI, -1.35 to -0.65, p < 0.00001), montelukast (SMD, -0.46; 95% CI, -0.68 to -0.25, p < 0.0001), or placebo (SMD, -0.93; 95% CI, -1.37 to -0.49, p < 0.00001). For secondary outcomes, pooled results showed that compared with loratadine, loratadine-montelukast can significantly improve nasal congestion, nasal itching, nasal sneezing, nasal rhinorrhea, and rhinoconjunctivitis quality of life questionnaires (RQLQ). Compared with montelukast, loratadine-montelukast can significantly improve nasal itching, and nasal sneezing. Compared with placebo, loratadine-montelukast can significantly improve nasal congestion, and RQLQ. Conclusion: Loratadine-montelukast combination is superior to loratadine monotherapy, montelukast monotherapy, or placebo in improving AR symptoms. Therefore, loratadine-montelukast combination can be an option for patients with moderate-severe AR or poorly response to monotherapy. Systematic review registration number: clinicaltrials.gov, identifier CRD42023397519.
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Affiliation(s)
- Huan Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qing Ji
- Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
| | - Chao Liao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Li Tian
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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2
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Okubo K, Inoue Y, Numaguchi H, Tanaka K, Saito I, Oshima N, Matsumoto Y, Prohn M, Mehta A, Nishida C, Philip G. Montelukast in the treatment of perennial allergic rhinitis in paediatric Japanese patients; an open-label clinical trial. J Drug Assess 2016; 5:6-14. [PMID: 27785374 PMCID: PMC5040008 DOI: 10.1080/21556660.2016.1209507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/04/2022] Open
Abstract
Background: This study was conducted to evaluate the safety and tolerability, and population pharmacokinetics (PPK) of montelukast as well as efficacy in the treatment of perennial allergic rhinitis (PAR) in paediatric Japanese patients aged between 1 and 15 years. Methods: In this multi-centre, open-label trial, 87 paediatric Japanese patients with PAR received montelukast 4 mg oral granules (OG) for 4 weeks (1-5-year-olds, N = 15), 4 mg OG for 12 weeks (1-5-year-olds, N = 36), 5 mg chewable tablets (CT) for 12 weeks (6-9-year-olds, N = 18), or 5 mg CT for12 weeks (10-15-year-olds, N = 18). Clinical exams and laboratory assessments were conducted at study visits, and adverse events (AE) were monitored throughout the study up to 14 days after the last visit. Population pharmacokinetic approach was used to estimate AUC0-∞, Cmax, Tmax and apparent elimination half-life in each age group. Efficacy was assessed based on global evaluations by the subject's caregiver. Results: There were no serious AEs and one discontinuation due to an AE. The most common AEs in any of the treatment groups were nasopharyngitis, pharyngitis, and acute sinusitis. Montelukast exposure (AUC0-∞) was similar in the 1-5-year-old group and the 6-9-year-old group, but 19% lower in the 10-15-year-old group. Among all patients, the total proportion of patients whose global evaluation was "very much better" was 5.7% (week 2), 11.5% (week 4), and 16.9% (week 12) reflecting improvement in symptoms over time. Conclusion: Montelukast was generally well tolerated in Japanese children with PAR. AUC0-∞was similar in 1-5 and 6-9-year-olds, while a lower exposure was observed in the 10-15-year-old group likely due to differences in bodyweight. The exposure in Japanese paediatric patients was generally consistent with that in non-Japanese paediatric and adult patients. As assessed by the patients' caregivers, montelukast also demonstrated symptomatic improvement based on global evaluations of PAR.
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Affiliation(s)
- Kimihiro Okubo
- Department of Otorhinolaryngology, Nippon Medical School Hospital,
Tokyo,
Japan
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3
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Liu D, Huang Z, Huang Y, Yi X, Chen X. Measurement of nasal and fractional exhaled nitric oxide in children with upper airway inflammatory disease: Preliminary results. Int J Pediatr Otorhinolaryngol 2015; 79:2308-11. [PMID: 26602553 DOI: 10.1016/j.ijporl.2015.10.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/22/2015] [Accepted: 10/24/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the clinical significance of nasal nitric oxide (nNO) and fractional exhaled nitric oxide (FeNO) concentrations in children with upper airway inflammatory disease. METHODS Fifteen healthy children, 30 with allergic rhinitis (AR), 10 with non-allergic rhinitis (NAR), and 30 with sleep disordered breathing (SDB) were enrolled. The FeNO and nNO concentrations were measured non-invasively using a NIOX MINO system. RESULTS Both nNO and FeNO were significantly higher in children with AR than in healthy children (P=0.000 and P=0.000, respectively). Compared to healthy children, nNO was also significant higher in children with NAR (P=0.011) or SDB (P=0.027). In contrast, FeNO did not differ from controls in children with NAR or SDB. CONCLUSIONS Our data suggest that nNO has potential value for diagnosing upper airway inflammation. Moreover, elevated FeNO distinguishes allergic from non-allergic rhinitis.
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Affiliation(s)
- Dabo Liu
- Department of Otolaryngology, Guangzhou Women and Children's Medical Centre, The Affiliated Hospital of Guangzhou Medical University, No. 318 Renmin Zhong Road, Guangzhou 510115, Guangdong, China.
| | - Zhenyun Huang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Centre, The Affiliated Hospital of Guangzhou Medical University, No. 318 Renmin Zhong Road, Guangzhou 510115, Guangdong, China
| | - Yaping Huang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Centre, The Affiliated Hospital of Guangzhou Medical University, No. 318 Renmin Zhong Road, Guangzhou 510115, Guangdong, China
| | - Xinhua Yi
- Department of Otolaryngology, Guangzhou Women and Children's Medical Centre, The Affiliated Hospital of Guangzhou Medical University, No. 318 Renmin Zhong Road, Guangzhou 510115, Guangdong, China
| | - Xi Chen
- Department of Otolaryngology, Guangzhou Women and Children's Medical Centre, The Affiliated Hospital of Guangzhou Medical University, No. 318 Renmin Zhong Road, Guangzhou 510115, Guangdong, China
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4
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Kim HB, Eckel SP, Kim JH, Gilliland FD. Exhaled NO: Determinants and Clinical Application in Children With Allergic Airway Disease. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 8:12-21. [PMID: 26540497 PMCID: PMC4695403 DOI: 10.4168/aair.2016.8.1.12] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/29/2015] [Indexed: 11/20/2022]
Abstract
Nitric oxide (NO) is endogenously released in the airways, and the fractional concentration of NO in exhaled breath (FeNO) is now recognized as a surrogate marker of eosinophilic airway inflammation that can be measured using a noninvasive technique suitable for young children. Although FeNO levels are affected by several factors, the most important clinical determinants of increased FeNO levels are atopy, asthma, and allergic rhinitis. In addition, air pollution is an environmental determinant of FeNO that may contribute to the high prevalence of allergic disease. In this review, we discuss the mechanism for airway NO production, methods for measuring FeNO, and determinants of FeNO in children, including host and environmental factors such as air pollution. We also discuss the clinical utility of FeNO in children with asthma and allergic rhinitis and further useful directions using FeNO measurement.
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Affiliation(s)
- Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sandrah P Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, California, USA
| | - Jeong Hee Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea. .,Environmental Health Center for Allergic Rhinitis, Inha University Hospital, Ministry of Environment, Incheon, Korea
| | - Frank D Gilliland
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, California, USA.
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5
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Yilmaz O, Altintas D, Rondon C, Cingi C, Oghan F. Effectiveness of montelukast in pediatric patients with allergic rhinitis. Int J Pediatr Otorhinolaryngol 2013; 77:1922-4. [PMID: 24210867 DOI: 10.1016/j.ijporl.2013.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 10/05/2013] [Accepted: 10/09/2013] [Indexed: 11/24/2022]
Abstract
Allergic rhinitis (AR) is one of the most common chronic diseases of childhood and carries significant morbidity as well as physical and psychosocial consequences. Therapy aims to alleviate clinical symptoms, prevent complications and improve psychosocial consequences. Leukotrienes which are amongst the main mediators in pathogenesis of AR have chemotactic properties and lead to increased vascular permeability. Thus, leukotriene antagonism may be an effective therapeutic option in treatment of allergic diseases, specifically AR. Montelukast which is a leukotriene receptor type I inhibitor has variable efficacy in children with AR and the guidelines recommend its use in children with seasonal AR aged six years and above. Although its efficacy is inferior to anti-histamines and intranasal corticosteroids, combination treatment may warrant clinical efficacy. Therefore, montelukast may be considered to be a well-tolerated therapeutic option for children with AR with minor side effects though long term results need to be assessed. In conclusion, larger scale research enrolling pediatric cases with seasonal and persistent AR are required before concise recommendations about montelukast use in pediatric AR can be made.
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Affiliation(s)
- Ozge Yilmaz
- Celal Bayar University Medical Faculty, Department of Pediatric Allergy and Pulmonology, Manisa, Turkey.
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Ludviksdottir D, Diamant Z, Alving K, Bjermer L, Malinovschi A. Clinical aspects of using exhaled NO in asthma diagnosis and management. CLINICAL RESPIRATORY JOURNAL 2012; 6:193-207. [DOI: 10.1111/crj.12001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Kjell Alving
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
| | - Leif Bjermer
- Department of Respiratory Diseases and Allergology; Skane University; Lund; Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology; Uppsala University; Uppsala; Sweden
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Stefanska J, Sarniak A, Wlodarczyk A, Sokolowska M, Pniewska E, Doniec Z, Nowak D, Pawliczak R. Apocynin reduces reactive oxygen species concentrations in exhaled breath condensate in asthmatics. Exp Lung Res 2012; 38:90-9. [PMID: 22296407 DOI: 10.3109/01902148.2011.649823] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Asthma is an inflammatory airway disease, and oxidative stress was proven to be involved in its pathogenesis. Apocynin effectively inhibits the main source of reactive oxygen species (ROS)-nicotinamide adenine dinucleotide phosphate (NADPH) oxidase-by blocking its activation. The aim of this study was to investigate the effect of inhaled apocynin on ROS and RNS (reactive nitrogen species) concentration in 14 nonsmoking mild asthmatics. Effects of nebulized apocynin (0.5 mg/mL) were assessed in exhaled breath condensate (EBC) after 30, 60, and 120 minutes, and safety parameters have been analyzed. Apocynin significantly decreased H2O2 concentration in EBC in comparison with placebo after 60 and 120 minutes. Moreover, apocynin significantly reduced NO(-2) concentration 30 and 60 minutes after nebulization and caused a significant decrease of NO(-3) concentration in EBC 60 and 120 minutes after administration, comparing with placebo. No adverse events have been observed throughout the study. This research confirmed anti-inflammatory properties of nebulized apocynin, which might be an effective and safe drug in bronchial asthma.
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Affiliation(s)
- J Stefanska
- Department of Immunopathology, Medical University of Lodz, Lodz, Poland
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Choi BS, Kim KW, Lee YJ, Baek J, Park HB, Kim YH, Sohn MH, Kim KE. Exhaled nitric oxide is associated with allergic inflammation in children. J Korean Med Sci 2011; 26:1265-9. [PMID: 22022176 PMCID: PMC3192335 DOI: 10.3346/jkms.2011.26.10.1265] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 08/29/2011] [Indexed: 11/21/2022] Open
Abstract
Exhaled nitric oxide (eNO) has been proposed as a noninvasive marker of airway inflammation in asthma. In asthmatic patients, exhaled NO levels have been shown to relate with other markers of eosinophilic recruitment, which are detected in blood, sputum, bronchoalveolar lavage fluid and bronchial biopsy samples. The purpose of this study was to assess the possible relationship between eNO and allergic inflammation or sensitization in childhood asthma and allergic rhinitis. Subjects consisted of 118 asthmatic children, 79 patients with allergic rhinitis, and 74 controls. Their age ranged from 6 to 15 yr old. eNO level, peripheral blood eosinophil count, eosinophil cationic protein (ECP), serum total IgE level and specific IgE levels were measured. Methacholine challenge test and allergic skin prick test for common allergens were performed in all subjects. Atopic group (n = 206, 44.48 ± 30.45 ppb) had higher eNO values than non-atopic group (n = 65, 20.54 ± 16.57 ppb, P < 0.001). eNO level was significantly higher in patients with asthma (42.84 ± 31.92 ppb) and in those with allergic rhinitis (43.59 ± 29.84 ppb) than in healthy controls (27.01 ± 21.34 ppb, P < 0.001) but there was no difference between asthma and allergic rhinitis group. eNO also had significant positive correlations with Dermatophagoides pteronyssinus IgE level (r = 0.348, P < 0.001), Dermatophagoides farinae IgE level (r = 0.376, P < 0.001), and the number of positive allergens in skin prick test (r = 0.329, P = 0.001). eNO had significant positive correlations with peripheral blood eosinophil count (r = 0.356, P < 0.001), serum total IgE level (r = 0.221, P < 0.001), and ECP (r = 0.436, P < 0.001). This study reveals that eNO level is associated with allergic inflammation and the degree of allergic sensitization.
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Affiliation(s)
- Bong Seok Choi
- Department of Pediatrics, Good Gangan Hospital, Busan, Korea
| | - Kyung Won Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Ju Lee
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Jiyoung Baek
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Bin Park
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
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Linhares D, Jacinto T, Pereira AM, Fonseca JA. Effects of atopy and rhinitis on exhaled nitric oxide values - a systematic review. Clin Transl Allergy 2011; 1:8. [PMID: 22409776 PMCID: PMC3339369 DOI: 10.1186/2045-7022-1-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 08/17/2011] [Indexed: 11/27/2022] Open
Abstract
Background Atopy and rhinitis are among the factors affecting exhaled nitric oxide (FeNO) values and may contribute to difficulties in the clinical interpretation of FeNO measurements. However, data assessing their effects on FeNO values had never been summarized. This review aims to evaluate the effect of atopy and rhinitis in FeNO values in otherwise healthy individuals. Methods A systematic review was performed in Pubmed, Scopus and ISI Web of Knowledge. A two-step selection process was completed, and from 2357 references 19 were included. The inclusion criteria were: participants without known diseases other than rhinitis; atopy assessement by SPT or Specific IgE; and FeNO measurements according to ATS/ERS recommendations. Results The 8 articles measuring FeNO in children showed higher values in both allergic rhinitis and atopic children when compared with healthy children. The 11 articles performed in adults observed higher FeNO in AR patients comparatively with either healthy or atopic individuals. However, adult healthy and atopic individuals had similar FeNO values. Conclusions FeNO values are higher in individuals with rhinitis and/or atopy without other health problems. These effects are small, seem to be independent and should be further studied using multivariate models. The effect of atopy was observed only in children. The combined effect of atopy and rhinitis produced higher FeNO values in adults. These results support that both atopy and rhinitis should be considered when interpreting or when defining FeNO reference values.
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Affiliation(s)
- Daniela Linhares
- Health Information and Decision Sciences, Faculty of Medicine of University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal.
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Abstract
Allergic rhinitis affects millions of Americans and the numbers continue to increase. Fortunately, there exists a wide array of pharmacotherapeutic options with relatively safe side effect profiles for the management of the varying subtypes. Additionally, there are newer agents on the horizon. The efficacies of intranasal corticosteroids, antihistamines, combination topical therapy, leukotriene inhibitors, mast cell stabilizers, anticholinergics, mucolytics, decongestants, and anti-IgE are reviewed.
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Novel antioxidant approaches to the treatment of upper airway inflammation. Curr Opin Allergy Clin Immunol 2010; 10:34-41. [PMID: 19935060 DOI: 10.1097/aci.0b013e328334f613] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Current understanding of the role of oxidative stress in airway inflammation suggests that antioxidant therapy may be important to optimize the treatment. This review summarizes recent investigations of novel antioxidant agents for upper airway inflammation, with selected studies focused on lower airway disease as additional candidate therapeutics. RECENT FINDINGS Recently investigated antioxidant therapies for airway inflammation may be broadly grouped into three categories: endogenous metabolic agents, vitamins/nutrients, and botanical extracts. Studies examining effects in upper airway inflammation are limited and primarily consist of in-vitro human and in-vivo animal models. More extensive studies have investigated the benefits of antioxidants in lower airway conditions such as allergic asthma. Existing evidence identifies antioxidant agents with potential therapeutic value, although human studies suggest that subpopulations affected by specific genetic, environmental, dietary factors, or all are most likely to benefit from antioxidant therapy. SUMMARY Oxidative stress plays a causative role in upper airway inflammation, and novel strategies to mitigate cellular injury with antioxidant therapy may ameliorate disease in target populations. Preclinical studies demonstrate evidence of anti-inflammatory effects for a number of promising antioxidant agents. Well designed interventional human studies of the upper airway, which account for complex gene-environment-diet interactions, will be necessary to adequately examine the potential clinical benefit of antioxidant therapies for rhinosinusitis.
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12
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Effects of montelukast on quality of life in patients with persistent allergic rhinitis. Otolaryngol Head Neck Surg 2010; 142:654-8. [PMID: 20416451 DOI: 10.1016/j.otohns.2010.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 12/30/2009] [Accepted: 01/12/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the effects of montelukast monotherapy on health-related quality of life (HRQL) in patients with persistent allergic rhinitis. STUDY DESIGN The study was placebo-controlled, randomized, and double blinded. SETTING Tertiary university hospital. SUBJECTS AND METHODS There were 46 patients in the study group and 24 patients in the control group, all of whom had a diagnosis of persistent allergic rhinitis of at least two years. The patients were evaluated at two control visits after the diagnosis. The study group was given 10-mg montelukast oral tablets, while the control group was given a placebo, and these were taken daily for one month. For evaluation of HRQL in both groups, the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was used. RESULTS There was a larger decrease in the overall RQLQ score for the group using montelukast compared with the placebo group (P < 0.001). The difference between scores at baseline versus the end of the first month for all domains was statically significant in both the placebo group and study group (P < 0.001). The difference in change from baseline to the end of the first month (treatment difference) between the placebo group and the study group was statically significant, in favor of the study group, for sleep, practical problems, nasal problems, and activities that have been limited by nose or eye symptoms, and for overall score (P < 0.001, P < 0.001, P = 0.003, P < 0.001, and P < 0.001, respectively). CONCLUSION Montelukast is a drug that improves the disease-specific quality of life in patients being treated for persistent allergic rhinitis better than placebo.
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Bergmann-Hug K, Wirth R, Henseler M, Helbling A, Pichler WJ, Schnyder B. Effect of natural seasonal pollen exposure and repeated nasal allergen provocations on elevation of exhaled nitric oxide. Allergy 2009; 64:1629-34. [PMID: 19627276 DOI: 10.1111/j.1398-9995.2009.02087.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exhaled nitric oxide (FENO) is a marker for allergic airway inflammation. We wondered whether in patients with intermittent allergic rhinitis only (i) natural pollen exposure and (ii) artificial pollen exposure by repeated nasal allergen provocations may lead to an elevation of FENO. METHODS In two prospective studies, we compared the FENO of nonatopic controls with the FENO of nonasthmatic individuals with mild intermittent rhinitis to tree and/or grass pollen. Study I: 13 atopic individuals and seven controls had measurements of FENO, blood eosinophils and eosinophilic cationic protein (ECP) before, during and after pollen season. Study II: 16 atopic individuals and 12 controls had nasal allergen provocations on four following days out of pollen season, with daily measurements of FENO before, 2 and 6 h after provocation, and determination of blood eosinophils, ECP and FEV1 at baseline, on days 5 and 10-12. RESULTS Natural pollen exposure (study I) caused a significant elevation of FENO in allergic individuals. Nasal allergen provocations (study II) did not elicit a statistically significant rise neither of FENO nor of blood eosinophils between baseline and day 5. However, a subgroup of four individuals with a rise of blood eosinophils during nasal allergen provocations showed also a rise of FENO. CONCLUSIONS We suppose that in allergic rhinitis a concomitant reaction of the bronchial system is dependent on a strong local inflammation leading to a generalized immune stimulation.
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Affiliation(s)
- K Bergmann-Hug
- Department of Rheumatology and Clinical Immunology/Allergology, Division of Allergology, Inselspital, University of Bern, Bern, Switzerland
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14
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Antus B, Horváth I. Exhaled nitric oxide and carbon monoxide in respiratory diseases. J Breath Res 2007; 1:024002. [PMID: 21383433 DOI: 10.1088/1752-7155/1/2/024002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Breath tests have gained increasing interest in recent years mainly driven by the unmet clinical need to monitor airway diseases and to obtain information on unravelled aspects of respiratory disorders. A prototype of such measurement reaching clinical significance besides its use as a research tool is the measurement of exhaled nitric oxide (NO). It took hardly more than a decade after the discovery that exhaled breath contains NO for this measurement to be approved for clinical practice to monitor anti-inflammatory treatment in asthma. Recent studies demonstrate that using exhaled NO measurement to guide anti-inflammatory treatment in asthma may help clinical decision making. A similarly small molecule present in exhaled breath is carbon monoxide, which is not only a biomarker of cigarette smoking but has also been suggested to reflect ongoing oxidative stress/antioxidant defense. The scope of this review is the exciting field of exhaled monoxides. Since several other biomarkers have also been studied in the exhaled breath this review will provide a brief introduction to them.
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Affiliation(s)
- Balázs Antus
- Department of Pathophysiology, National Koranyi Institute for Pulmonology, Budapest, Hungary
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