montelukast and Angioedema

Chronic urticaria (CU) is defined by episodes of urticaria with or without angioedema, which recur daily or nearly daily over more than 6 weeks. Sudden manifestations of CU with or without known causes are termed chronic spontaneous urticaria, which is differentiated from chronic inducible urticaria. The differential diagnoses of CU in childhood range from self-limiting dermatoses to severe systemic diseases. Further targeted steps are taken to detect potential trigger factors or underlying illnesses only if suspicion arises on anamnestic grounds and CU is best treated in accordance with international guidelines. First-line therapy consists of non-sedating H

Topics: Acetates; Angioedema; Child; Child, Preschool; Chronic Disease; Cyclopropanes; Cyclosporine; Diagnosis, Differential; Guideline Adherence; Histamine Antagonists; Humans; Infant; Long-Term Care; Omalizumab; Quinolines; Skin; Sulfides; Urticaria

The literature on chronic idiopathic urticaria (CIU) lacks large-scale population-based studies.. To characterize an insured population with CIU, including their demographic characteristics and comorbidities.. We conducted a cross-sectional analysis using insurance claims. We included patients with 1 outpatient claim with an International Classification of Diseases, 9(th)Edition, Clinical Modification (ICD-9-CM) code for idiopathic, other specified, or unspecified urticaria (ICD-9-CM 708.1, 708.8, or 708.9) and either (1) another of these claims 6 or more weeks later; (2) a claim for angioedema (ICD-9-CM 995.1) 6 or more weeks from the urticaria diagnosis; or (3) overlapping claims for 2 prescription medications commonly used for CIU.. We identified 6,019 patients who had claims consistent with CIU. The mean age was 36 years. Fifty-six percent of patients had primary care physicians as their usual source of care, 14% had allergists, and 5% had dermatologists. Allergic rhinitis was diagnosed in 48%, asthma in 21%, other allergy in 19%, and atopic dermatitis in 8%. Sixty-seven percent of patients used prescription antihistamines, 54% used oral corticosteroids (OCSs), 24% used montelukast, and 9% used oral doxepin. Antihistamine users received a mean of 152 days of prescription antihistamines, OCS users 30 days of OCSs, montelukast users 190 days of montelukast, and oral doxepin users 94 days of doxepin.. Primary care physicians managed most patients with CIU. Antihistamines were the most common treatment for CIU, although OCSs were frequently prescribed. Thirty days of OCS supply among users may represent multiple steroid bursts each year. Given the known risks of OCSs, identifying other CIU treatments with more favorable safety profiles may be beneficial.

Topics: Acetates; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Angioedema; Chronic Disease; Cross-Sectional Studies; Cyclopropanes; Doxepin; Drug Prescriptions; Fees, Pharmaceutical; Female; Health Care Costs; Histamine Antagonists; Humans; Insurance Claim Review; Male; Middle Aged; Practice Patterns, Physicians'; Quinolines; Sulfides; Urticaria; Young Adult

A possible case of montelukast-induced angioedema is reported.. A 46-year-old woman with a history of severe allergies, including food allergies, and angioedema was evaluated at the emergency department (ED) for an acute episode of angioedema. Upon arrival at the ED, the patient had severe jaw tightness, facial numbness, uncontrollable cheek lifting, swollen eyes, and a swollen protruding tongue and was unable to catch her breath. Her dyspnea was apparent, and she was unable to talk and instead used hand and face gestures for affirmative and negative responses. The patient was treated with 0.3 mg epinephrine intramuscularly into the right thigh. After treatment, she had a temperature of 37 degrees C, a pulse of 90 beats/ min, a blood pressure value of 100/59 mm Hg, a respiratory rate of 16 breaths/min, and 100% oxygen saturation on room air. After stabilization, she reported that her allergies had been adequately controlled with ebastine 10 mg daily, montelukast 10 mg daily, and vitamins (unspecified). The patient reported that since she started montelukast one month prior, she experienced three similar episodes, the first occurring five days after starting the drug. She mentioned being diagnosed and adequately treated these three times in the ED for angioedema. The patient denied any changes in eating habits or in her medications except for starting montelukast. She was observed at the ED for an hour and then discharged after stabilization on hydroxyzine hydrochloride 25 mg orally daily and fexofenadine hydrochloride 180 mg orally daily. Montelukast was discontinued.. A patient developed angioedema four times during one month of treatment with montelukast.

Topics: Acetates; Angioedema; Cyclopropanes; Female; Humans; Hypersensitivity; Leukotriene Antagonists; Middle Aged; Quinolines; Sulfides

Topics: Acetates; Adolescent; Adult; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides; Urticaria