montelukast and Dermatitis--Atopic

This review forms part of an annual update series on atopic eczema (AE), where systematic reviews (SRs) are gathered and appraised to provide a summary of key recent research findings. The focus of this article is systemic therapies used in AE, while a review on prevention and topical therapies is provided in Part 1. In total, 17 SRs on various systemic treatments used in AE were first published or indexed in 2018. There is a lack of evidence to support vitamin D supplementation, montelukast and naltrexone in AE treatment. The adverse effects of systemic corticosteroids are the main barrier to their use, and there is also a lack of data to determine the optimal delivery and duration of treatment with them. Of other immunosuppressants, ciclosporin has the most robust evidence of efficacy. Biologic therapies in AE treatment are being increasingly investigated, and to date, the greatest quantity of data and evidence of efficacy relates to dupilumab. The most commonly reported adverse effects are injection-site reactions and conjunctivitis. Other biologics showing some evidence of efficacy include nemolizumab, lebrikizumab and tralokinumab, although further data are needed. There are currently insufficient data on oral small molecules, including Janus kinase inhibitors, in the treatment of AE. A Cochrane review on probiotics showed no significant benefit, and SRs and meta-analyses on complementary and alternative medicines, including probiotics, in paediatric AE demonstrated significant heterogeneity, thereby limiting their interpretation. This summary of recent SRs provides up-to-date evidence for clinicians on systemic therapies in AE.

Topics: Acetates; Adrenal Cortex Hormones; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Biological Therapy; Child; Complementary Therapies; Cyclopropanes; Cyclosporine; Cytochrome P-450 CYP1A2 Inducers; Dermatitis, Atopic; Eczema; Humans; Immunosuppressive Agents; Janus Kinase Inhibitors; Naltrexone; Narcotic Antagonists; Omalizumab; Placebo Effect; Probiotics; Quinolines; Sulfides; Ustekinumab; Vitamin D

The role of leukotrienes and prostaglandins in development of atopy has been prototypically established in studies of asthma pathogenesis. Likewise, both in vitro and in vivo studies of atopic dermatitis have demonstrated that these molecules maintain important pathophysiologic roles. Thus, it follows that targeted therapies against these molecules may be promising in management of atopic dermatitis. Montelukast has had questionable efficacy in patients with atopic dermatitis, whereas small pilots using zileuton did have some clinically significant improvement. There are several agents in development that target leukotrienes and/or prostaglandins as well, including OC000459, Q301, and ZPL-521. In atopic dermatitis, OC000459 did not demonstrate efficacy in clinical trials, and the efficacy of the other 2 agents remains to be seen. Should these medications prove promising, these topical agents may play a future role in chronic maintenance therapy and flare prophylaxis in atopic dermatitis, as antileukotriene therapy does in asthma.

Topics: Acetates; Adult; Animals; Cyclopropanes; Dermatitis, Atopic; Female; Forecasting; Humans; Hydroxyurea; Leukotriene Antagonists; Male; Molecular Targeted Therapy; Prostaglandin Antagonists; Quinolines; Severity of Illness Index; Sulfides; Treatment Outcome

Background Atopic dermatitis (AD) is the most common form of eczema. As leukotriene mediators are involved in the inflammatory phase of atopic dermatitis, montelukast has been suggested as a possible therapy. Aim of the review To evaluate the safety and efficacy of montelukast off-label use for the treatment atopic dermatitis. Method A search was performed from database inception until March 2018 in six electronic databases for randomized-controlled-trials examining the use of montelukast for AD. Results Among 301 articles screened, 11 studies met the inclusion criteria and were included in the review. The study populations consist of paediatric and adult subjects with moderate-to-severe AD. Montelukast use was shown to improve symptoms such as pruritus in four studies. Another 2 studies reported that montelukast could improve symptoms similar to the standard regimen of topical steroid and oral antihistamine. However, five studies reported that montelukast had no effects in symptoms alleviation. The use of montelukast was associated with a similar safety profile to placebo and well-tolerated with minimal adverse effects. Conclusion There is limited evidence to suggest that the off-label use of montelukast is effective in treating moderate-to-severe AD. Further research with larger study populations employing standardized endpoint measuring instrument is warranted to further investigate the off-label use of montelukast in AD treatment. Until then, the use of conventional treatments including optimal daily skin hydration should remain the mainstay in the management of atopic dermatitis. In fact, for moderate-to-severe condition, steroid sparing immune-suppressants should still be used clinically until more effective and safer alternative is discovered.

Topics: Acetates; Cyclopropanes; Dermatitis, Atopic; Humans; Immunosuppressive Agents; Leukotriene Antagonists; Off-Label Use; Quinolines; Randomized Controlled Trials as Topic; Sulfides

Leukotriene inhibitors are the first new class of medications for the treatment of persistent asthma that have been approved by the U.S. Food and Drug Administration in more than two decades. They also have been approved for the treatment of allergic rhinitis. Prescriptions of leukotriene inhibitors have outpaced the evidence supporting their use, perhaps because of perceived ease of use compared with other asthma medications. In the treatment of persistent asthma, randomized controlled trials have shown leukotriene inhibitors to be more effective than placebo but less effective than inhaled corticosteroids. The use of leukotriene inhibitors has not consistently shown an inhaled-steroid-sparing effect, a reduction in need for systemic steroid treatment, or a cost savings. For exercise-induced asthma, leukotriene inhibitors are as effective as long-acting beta2-agonist bronchodilators and are superior to placebo; they have not been compared with short-acting bronchodilators. Leukotriene inhibitors are as effective as antihistamines but are less effective than intranasal steroids for the treatment of allergic rhinitis. The use of leukotriene inhibitors in treating atopic dermatitis, aspirin-intolerant asthma, and chronic idiopathic urticaria appears promising but has not been studied thoroughly. Leukotriene inhibitors have minimal side effects and are well tolerated in most populations.

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Asthma, Exercise-Induced; Cyclopropanes; Dermatitis, Atopic; Humans; Hydroxyurea; Hypersensitivity; Indoles; Leukotriene Antagonists; Phenylcarbamates; Quinolines; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sulfides; Sulfonamides; Tosyl Compounds

The incidence of atopic diseases, including atopic dermatitis, allergic rhinitis, and asthma, has increased in developed countries over the past several decades. These diseases comprise a large component of general pediatric practice. This review will highlight some of the recent advances in understanding the pathogenesis and natural history of these diseases, as well as the current approaches to the treatment of children with atopic diseases.. Recent studies have identified multiple risk factors for the development and progression of atopic diseases. As a result, much research is focused on identifying therapies that can be initiated at a young age to prevent disease progression. New treatment options have become available in recent years, such as topical immunomodulators for atopic dermatitis, leukotriene antagonists for seasonal allergic rhinitis, and alpha-immunoglobulin E therapy for asthma. The importance of viewing allergic rhinitis and asthma as disorders of a single airway has been emphasized. Finally, an update on the national asthma guidelines was recently released in an effort to promote optimal asthma care.. This review summarizes many of the recent advances in the diagnosis and treatment of atopic diseases in children. Although not intended to be a comprehensive review of this broad field, it provides a framework for appreciating the complexity of these diseases and for effectively managing them.

Topics: Acetates; Adrenergic beta-Agonists; Animals; Asthma; Child; Cyclopropanes; Dermatitis, Atopic; Environmental Exposure; Feces; Genetic Predisposition to Disease; Hepatitis A Virus Cellular Receptor 1; Hepatitis A Virus Cellular Receptor 2; Humans; Hypersensitivity, Immediate; Immunosuppressive Agents; Leukotriene Antagonists; Membrane Proteins; Mice; Quinolines; Receptors, Virus; Skin; Sulfides; T-Lymphocytes; Tacrolimus

Cysteinyl leukotrienes have been shown to be important in the pathogenesis of both asthma and rhinitis. Improvement of skin manifestations in atopic dermatitis has been reported with leukotriene receptor antagonists. This article reviews current data on the experimental evidence and clinical efficacy of leukotriene receptor antagonists in the treatment of atopic dermatitis.

Topics: Acetates; Cyclopropanes; Dermatitis, Atopic; Humans; Leukotriene Antagonists; Leukotrienes; Quinolines; Sulfides; Urticaria

Montelukast is an antagonist of cys-leukotriene receptors used mainly in the treatment of asthma- and seasonal-allergic rhinitis. Initial reports concerning the use of montelukast in atopic dermatitis (AD) have been encouraging, although not consistent.. We have undertaken a randomized, double-blind, parallel-group, placebo-controlled trial to investigate further the efficacy of montelukast in the treatment of atopic eczema.. Following a screening visit, subjects received placebo treatment for 2 weeks in a single-blind phase, followed after visit 2 by an 8-week, double-blind period of treatment with montelukast 10 mg daily or placebo. Subjects were patients aged 16-60 years under our care for treatment of AD of moderate severity, defined by a six-area, six-sign atopic dermatitis (SASSAD) score in the range 12-50. Response to treatment was assessed by investigators and by subjects using a seven-point scale, with response defined as marked improvement or better. In addition, the SASSAD score was used to monitor the severity of clinical signs. The proportion of skin involved was estimated and visual analogue scales were used to record the severity of pruritus and sleep disturbance. Topical corticosteroid usage was recorded using a five-point scale. Adverse events were recorded.. Sixty subjects were recruited and 54 completed the study. The treatment groups were well matched for disease severity at baseline (SASSAD scores were 25 and 29 in the montelukast and placebo groups, respectively). There were no significant differences between the treatment groups in any of the parameters used to assess treatment response. The improvement in mean SASSAD score from baseline (visit 2) to the end of treatment was marginally superior in the placebo group, 1.41 points on montelukast vs. 1.76 on placebo, a difference of 0.35 (95% confidence interval -6.1 to 6.8). Adverse events were generally of a mild nature except for a brief septicaemic illness in one subject receiving montelukast.. The data do not support previous reports of efficacy of montelukast in treatment of AD.

Topics: Acetates; Adolescent; Adult; Cyclopropanes; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Placebos; Quinolines; Sulfides; Treatment Outcome

Moderately severe atopic dermatitis makes up nearly one-fifth of children with atopic dermatitis.. To determine the clinical and laboratory effects of montelukast in moderately severe atopic dermatitis.. Randomized, double-blind, placebo-controlled, crossover trial with washout period, conducted from May 2002 to February 2006. The study involved 25 patients, 2-16 years old with dermatitis. Patients received oral montelukast (9 patients, Group B) or placebo (16 patients, Group A) in phase 1, and were crossed over to placebo or montelukast, respectively, for phase 2. Patients included if > 10% of skin was involved and failed response to 2 week conventional treatment. Itching, sleep disturbance, frequency of use of oral antihistamines & topical steroids, severity scores were serially assessed. In addition, eosinophil and serum IgE were serially collected.. Most of patients were 6-10 years of age. Both groups had comparable gender distribution. The patients in Group B were more likely to have a history of bronchial asthma (55.6%) or allergic rhinitis (33.3%) than patients in Group A, but were less likely to have a positive history of atopy. While on montelukast, there was a reduction of mean score for itching in phase 2, for sleep disturbance in phase 2, for antihistamines in phase 1, for extent-of-disease in phase 1 and 2, and for severity score in phase 2 and blood eosinophil & IgE in phase 2.. Montelukast reduces itching, sleep disturbance, disease extent and severity, blood eosinophil count and serum IgE.

Topics: Acetates; Administration, Oral; Adolescent; Blood Cell Count; Child; Child, Preschool; Cyclopropanes; Dermatitis, Atopic; Drug Administration Schedule; Eosinophils; Female; Histamine H1 Antagonists; Humans; Immunoglobulin E; Male; Quinolines; Sleep; Sulfides; Treatment Outcome

Leukotriene receptor antagonist ( montelukast) are recommended for the treatment of asthma, and have proved anecdotally successfully even in atopic dermatitis. In this open randomized clinical trial, the efficacy and safety of montelukast were assessed in the atopic dermatitis. Out of 31 enrolled patients all completed the study among which 16 in the montelukast group and 15 in the control group. No patient dropped from the study. Statistically significant SCORAD improvement (P = 0.003) was observed in montelukast group but in the control group SCORAD improvement was not statistically significant (P = 0.088). According to the patients impression pruritus was the most influenced SCORAD item by montelukast group immediately followed by sleep loss and inflammatory signs. On the contrary montelukast seemed to be completely devoid of activity on xerosis. No adverse effect of montelukast was observed in the present study.

Topics: Acetates; Adolescent; Adult; Cyclopropanes; Dermatitis, Atopic; Female; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides; Treatment Outcome

The choice of oral therapeutic agents for the treatment of atopic dermatitis (AD) in children is limited. Montelukast, a specific cysteinyl leukotriene (LT) receptor antagonist, may be useful in alleviating AD symptoms.. To evaluate the clinical and immunological effects of montelukast in children with AD.. After a 2-week run-in, children with AD were started on oral montelukast 5 mg once-daily for children < 12 years of age and 10 mg for older children. The clinical severity of AD as indicated by the SCORing Atopic Dermatitis (SCORAD) score, and serum soluble CD14 and urinary leukotriene E4 (LTE4) concentrations were evaluated at baseline and the end of a 3-month treatment period.. Four boys and three girls, with a median (range) age of 12 (3-16) years, participated in the study. The total SCORAD was reduced in five patients (by 30-84%) and remained similar in two patients. Their median (range) SCORAD scores before and after treatment were 34.7 (16.5-54.8) and 17.0 (6.9-36.9) (p = 0.046). The intensity component of SCORAD also decreased from 5 (2-10) to 3 (1-7) (p = 0.042). Serum sCD14 levels increased significantly from 5533 (4575-6452) ng/ml to 6259 (5617-8988) ng/ml (p = 0.028), whereas urinary LTE4 levels remained the same (p = 0.735).. Montelukast, at doses recommended for asthma treatment, resulted in over 30% reduction in the total SCORAD in some children. Treatment with montelukast may also be associated with deviation of the immune system towards the Th1-specific pathway.

Topics: Acetates; Administration, Oral; Adolescent; Child; Child, Preschool; Cyclopropanes; Dermatitis, Atopic; Female; Humans; Leukotriene Antagonists; Lipopolysaccharide Receptors; Male; Quinolines; Statistics, Nonparametric; Sulfides; Treatment Outcome

In a randomized, double-blind, placebo-controlled 4-week trial, 59 patients with moderate to severe atopic dermatitis were treated orally with 10 mg of the leukotriene antagonist montelukast. Forty-seven patients completed the study. No difference in efficacy was seen among patients who received montelukast and the group given a placebo.

Topics: Acetates; Adolescent; Adult; Age Factors; Aged; Cyclopropanes; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Prospective Studies; Quinolines; Severity of Illness Index; Sulfides

Butterbur or Petasites hybridus is an herbal remedy that exhibits antihistamine and antileukotriene activity and has been shown to attenuate the response to adenosine monophosphate challenge in patients with allergic rhinitis and asthma. However, no data are available regarding its effects on the histamine and allergen cutaneous response.. To evaluate the effects of butterbur compared with fexofenadine and montelukast on the histamine and allergen wheal and flare cutaneous responses.. Atopic patients were randomized into a double-blind, double-dummy, crossover study to receive for 1 week butterbur, 50 mg twice daily (8 AM and 10 PM); fexofenadine, 180 mg once daily (10 PM), and placebo once daily (8 AM); montelukast, 10 mg once daily (10 PM), and placebo once daily (8 AM); or placebo twice daily (8 AM and 10 PM). Patients attended the department at 10 AM and had measurements of the cutaneous wheal and flare responses to histamine, allergen, and saline control at 10-minute intervals for 60 minutes.. Twenty patients completed the study. The mean +/- SE histamine wheal and flare responses, respectively, were significantly attenuated (P < .05) by fexofenadine (9.4 +/- 1.8 mm2 and 13.5 +/- 3.2 mm2) compared with placebo (15.5 +/- 3.3 mm2 and 179.8 +/- 74.3 mm2) but not by butterbur (16.4 +/- 2.1 mm2 and 297.7 +/- 121.2 mm2) or montelukast (19 +/- 1.9 mm2 and 240.2 +/- 66.6 mm2). The allergen wheal and flare responses, respectively, were also significantly attenuated (P < .05) by fexofenadine (31.1 +/- 6.3 mm2 and 256.9 +/- 86.5 mm2) compared with placebo (65.4 +/- 15.2 mm2 and 1,014.5 +/- 250.0 mm2) but not by butterbur (50.4 +/- 9.2 mm2 and 1,110.3 +/- 256.1 mm2) or montelukast (58.8 +/- 9.1 mm2 and 1,463.6 +/- 295.6 mm2).. Butterbur did not produce any significant effects on the histamine and allergen cutaneous response compared with placebo, whereas mediator antagonism with fexofenadine but not montelukast produced significant attenuation. This finding would suggest that butterbur may not be effective in allergic skin disease.

Topics: Acetates; Adult; Anti-Inflammatory Agents; Cross-Over Studies; Cyclopropanes; Dermatitis, Atopic; Double-Blind Method; Female; Histamine; Humans; Male; Petasites; Phytotherapy; Quinolines; Skin Tests; Sulfides; Terfenadine

Topics: Acetates; Adolescent; Adult; Cyclopropanes; Dermatitis, Atopic; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides

Cysteinyl leukotrienes have been shown to be important in the pathogenesis of allergen-induced (atopic) asthma and rhinitis. Skin manifestations of atopic dermatitis have been reported to improve with leukotriene antagonists. Montelukast, a newer leukotriene antagonist, which is efficacious and safe in patients with asthma 6 years of age and older, has not been reported as therapy for atopic dermatitis. This article reports findings from a pilot study designed to determine whether montelukast is effective in decreasing the signs or symptoms of atopic dermatitis.. Our purpose was to compare the efficacy of montelukast with placebo as a treatment for patients with atopic dermatitis.. The study involved 8 adult patients (male and female) with at least 1 year of intermittent or persistent atopic dermatitis as determined by Hanifin criteria. Medication was given in a randomized, double-blind, placebo-controlled, crossover manner over 8 weeks as adjunctive treatment. Global evaluation of 6 signs (erythema, induration, excoriation, lichenification, scaling, erosion) were scored on a 0 to 3 scale each week, with a blinded investigator evaluating at the initiation, crossover, and final visit. A 30% decrease in total score was considered clinically significant.. A significant difference in atopic dermatitis scores between placebo and active agent (P =.014) was recognized. There was no significant interaction between order and treatment. Atopic dermatitis scores tended to be higher with placebo. The mean standard deviation was 8.7 +/- 2.0. The mean for active agent was 6. 8 +/- 2.1.. This study demonstrates that there is a modest, but significant, alleviation of atopic dermatitis with the use of the leukotriene antagonist montelukast used in an adjunctive manner over a 4-week period.

Topics: Acetates; Adolescent; Adult; Cyclopropanes; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Leukotriene Antagonists; Male; Pilot Projects; Quinolines; Sulfides; Treatment Outcome

The primary action of leukotrienes includes contraction of human airway muscle, chemotaxis, and increased vascular permeability, with secondary effects of inhibiting allergen-induced early and late responses. Although there is limited available information and research regarding leukotrienes in atopic dermatitis (AD), there is evidence to support their role in the pathogenesis of the disease. We conducted a pilot study to test the efficacy of montelukast, a cysteinyl-leukotriene-1 receptor antagonist, in 15 patients (6-16 years of age) with moderate-to-severe AD, using a randomized double-blind placebo-controlled crossover study. These patients had chronic moderate-to-severe AD, despite being on conventional therapy. They were randomized either to placebo for 4 weeks and then the study drug for 4 weeks, or vice versa. There was a 2-week run-in period for all participants before commencement of the study, and a 2-week washout before crossover. At enrollment and on each follow-up visit, every patient was assessed by a single observer and objectively scored for disease extent and severity. A subjective score was given for the impact of eczema on daily living. There was statistical improvement in patents on active treatment compared with placebo in the severity of AD (p < 0.05). Our findings suggest that leukotriene receptor antagonist as an adjunct treatment has an anti-inflammatory effect on moderate-to-severe AD. A larger trial is needed to ascertain its efficacy fully.

Topics: Acetates; Activities of Daily Living; Administration, Oral; Adolescent; Child; Cyclopropanes; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Leukotriene Antagonists; Male; Pilot Projects; Quinolines; Sulfides

Literature evidence suggests leukotriene involvement in the pathogenesis of atopic dermatitis. This article aimed to discuss whether the off-label use of montelukast, a leukotriene receptor antagonist, is justifiable for the treatment of atopic dermatitis.. Most non-randomized studies supported the use of montelukast for atopic dermatitis treatment. However, evidence from these studies should be interpreted with caution as it is relatively weak due to the absence of randomization, control groups and blinding processes, subjecting the results to high risk of selection and reporting biases. The inconsistent findings across RCTs may be related to the limited number of patients, nuances in study designs, varying severity of disease and the concomitant use of steroids in some of the studies.. Current literature evidence is limited to rationally support the use of montelukast in atopic dermatitis treatment. For now, the conventional treatments should be preferred in the clinical setting.

Topics: Acetates; Cyclopropanes; Dermatitis, Atopic; Humans; Leukotriene Antagonists; Quinolines; Randomized Controlled Trials as Topic; Sulfides; Treatment Outcome

Topics: Acetates; Asthma; Child; Clinical Trials as Topic; Cyclopropanes; Dermatitis, Atopic; Humans; Information Storage and Retrieval; Leukotriene Antagonists; Male; Quinolines; Sulfides

Topics: Acetates; Anaphylaxis; Anti-Asthmatic Agents; Asthma; Child, Preschool; Conjunctivitis, Allergic; Cyclopropanes; Dermatitis, Atopic; Humans; Infant; Leukotriene Antagonists; Male; Prognosis; Quinolines; Respiratory Hypersensitivity; Sulfides

Leukotrienes are potent proinflammatory mediators derived from of arachidonic acid through the 5- lipoxygenase pathway. Experimental data suggest a role for cysteinyl leukotrienes in the pathogenesis of atopic dermatitis and there is a rationale for the use of pharmacological agents to antagonize their effects in the treatment of atopic dermatitis. We report 2 cases of severe atopic dermatitis successfully treated with montelukast as a single therapeutic agent in a daily dose of 10 mg for 8 weeks when corticosteroid treatment was contraindicated or failed to control the disease. Our observations suggest that montelukast may be used as an alternative steroid sparing medication for severe atopic dermatitis, especially in patients with associated asthma and rhinitis.

Topics: Acetates; Adult; Cyclopropanes; Dermatitis, Atopic; Female; Humans; Leukotriene Antagonists; Quinolines; Sulfides

Allergic diseases, e.g., allergic rhinitis, atopic dermatitis and asthma, are common problems in children. Researches on the pathogenesis of allergic diseases have led to the development of new specific antiinflammatory medications, including Montelukast, which blocks the interaction of cysteinyl leukotrienes to their receptors and resulting downstream events. Several studies have demonstrated the effect of regular Montelukast therapy on asthma, allergic rhinitis, viral-induced wheezing in bronchiolitis and chronic rhinitis symptoms. Evidence base medicine now shows that Montelukast can be used as a monotherapy in mild persistent asthma and can be an add-on drug to inhaled corticosteroid (ICS) in moderate to severe persistent asthma. Even in allergic rhinitis, Montelukast has a role in controlling rhinitis symptoms. Montelukast demonstrated a safety profile similar to placebo and more safety than ICS. Moreover Montelukast can improve quality of life in patients with asthma and comorbid allergic rhinitis.

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Child; Cyclopropanes; Dermatitis, Atopic; Family Practice; Humans; Leukotriene Antagonists; Pediatrics; Quinolines; Rhinitis, Allergic, Seasonal; Sulfides

Topics: Acetates; Adolescent; Adult; Aged; Child; Child, Preschool; Cyclopropanes; Dermatitis, Atopic; Female; Humans; Indoles; Leukotriene Antagonists; Phenylcarbamates; Quinolines; Sulfides; Sulfonamides; Tosyl Compounds; Treatment Outcome

Topics: Acetates; Asthma; Cyclopropanes; Dermatitis, Atopic; Humans; Leukotriene Antagonists; Quinolines; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sulfides; Treatment Outcome

Topics: Acetates; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antipruritics; Cyclopropanes; Dermatitis, Atopic; Diabetes Complications; Female; Humans; Hydroxyzine; Leukotriene Antagonists; Prednisone; Quinolines; Sulfides; Treatment Failure