montelukast and Food-Hypersensitivity

Previously considered a rare condition, eosinophilic oesophagitis (EoE) has become increasingly recognized as an important cause of dysphagia and food impactions in adults. This is likely attributable to a combination of an increasing incidence of EoE and a growing awareness of the condition. EoE may occur in isolation or in conjunction with eosinophilic gastroenteritis. However, the burgeoning field is likely attributable to the variant that uniquely affects the oesophagus. Adults classically present with symptoms of dysphagia, food impactions, and heartburn. Typical endoscopic features include concentric mucosal rings, linear furrowing, white plaques or exudates and a narrow caliber oesophagus. In some cases, the endoscopic features may appear normal. For years, EoE went unrecognized because eosinophilic infiltration was accepted as a manifestation of reflux, which continues to be a confounding factor in some patients. Current consensus is that the diagnosis of EoE is established by 1) the presence of symptoms, especially dysphagia and food impactions in adults, 2) > or =15 eosinophils per high power field in oesophageal tissue, and 3) exclusion of other disorders with similar presentations such as GERD. Current understanding of EoE pathophysiology and natural history are limited but the entity has been increasingly linked to food allergies and aeroallergens. The main treatment options for EoE are proton pump inhibitors, dietary manipulation, and topical or oral glucocorticoids. This review highlights recent insights into EoE in adults although, clearly, much of the available data overlap with pediatrics and, occasionally, with eosinophilic gastroenteritis.

Topics: Acetates; Adrenal Cortex Hormones; Adult; Cyclopropanes; Dilatation; Eosinophils; Esophagitis; Esophagoscopy; Food Hypersensitivity; Humans; Immunologic Factors; Proton Pump Inhibitors; Quinolines; Sulfides

Eosinophilic esophagitis (EE) is a disease that is being recognized with increasing frequency. In children it is responsible for feeding disorders, vomiting, reflux symptoms and abdominal pain and in adults it causes dysphagia and esophageal food impactions. The diagnosis requires the histologic finding of > 20 eosinophils per high powered field in esophageal squamous mucosa. The most common treatment regimens in children and adults involve the ingestion of topical corticosteroids. Symptomatic relapse after one treatment course is common, and many patients require repeated courses of treatment. The long-term prognosis of EE is largely unknown.

Topics: Acetates; Adrenal Cortex Hormones; Allergens; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Catheterization; Cyclopropanes; Diet; Eosinophilia; Esophagitis; Food Hypersensitivity; Humans; Leukotriene Antagonists; Prognosis; Quinolines; Sulfides

The cause and pathogenesis of chronic urticaria are still poorly understood. IgE-independent reactions, are common in adult patients with chronic urticaria, who have daily spontaneous occurrence of weals. H(1)-receptor antagonists (antihistamines) are the major class of therapeutic agents used in the management of urticaria and angioedema. Nevertheless, chronic urticaria is often difficult to treat and may not be controlled by antihistamines alone. It has been postulated that mediators other than histamine, such as kinins, prostaglandin and leukotrienes, may be responsible for some of the symptoms in urticaria which are not controlled by antihistamines. In this study, which was randomized double-blind, placebo-controlled, we compare the clinical efficacy and safety of montelukast (MT) 10 mg given once a day and cetirizine (CET) 10 mg given once a day with placebo (PLA), in the treatment of patients with chronic urticaria who have positive challenge to acetylsalicylic acid (ASA) and/or food additives.. A group of 51 patients, ranging in age from 15 to 71 years, with chronic urticaria and positive challenge to food additives and/or ASA, participated in this study for a period of 4 weeks, starting from a 3-day run-in. The assessment of the efficacy was based on scores of daily urticaria symptoms.. MT significantly increased the percentage of symptom-free days for hive and itch. Analysis of frequency distribution of urticaria scores for each symptom gave similar results (MT vs. CET and MT vs. PLA, P < 0.001). The interference with sleep due to their skin condition was also lower in the group treated with MT (P < 0.001). In addition, the median number of days without the rescue medication was significantly higher in the MT group (24 days) than both the CET and the PLA groups (18 days, P < 0.001, and 20 days, P < 0.001, respectively). Finally, a low incidence of adverse events was observed in this study.. The results of this comparative study demonstrate that montelukast orally administered once a day is very effective for the treatment of cutaneous symptoms in patients with chronic urticaria due to food additives and/or ASA.

Topics: Acetates; Adolescent; Adult; Aged; Aspirin; Cetirizine; Chronic Disease; Cyclopropanes; Double-Blind Method; Female; Food Additives; Food Hypersensitivity; Histamine H1 Antagonists; Humans; Incidence; Italy; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sleep Stages; Sulfides; Treatment Outcome; Urticaria

Topics: Acetates; Anti-Allergic Agents; Arylsulfonates; Child; Cyclopropanes; Diarrhea; Diet; Enteritis; Eosinophilia; Food Hypersensitivity; Gastritis; Humans; Male; Quinolines; Sulfides; Sulfonium Compounds; Terfenadine; Treatment Outcome

Topics: Acetates; Adolescent; Anaphylaxis; Anti-Allergic Agents; Anti-Asthmatic Agents; Cetirizine; Cyclopropanes; Drug Therapy, Combination; Exercise; Food Hypersensitivity; Humans; Male; Prunus; Quinolines; Sulfides

The aim is to determine immunopathological modifications in rectal mucosa from rabbits after local challenge in ovalbumin (OVA) sensitized animals previously treated with montelukast.. thirty two rabbits divided into four groups: G1: normal; G2: subcutaneously OVA sensitized; G3: sensitized, locally OVA challenged and sampled 4 hours after challenge; and G4: sensitized, locally OVA challenged and treated 4 hours before challenge with montelukast (0.15 mg/kg). Specific anti-OVA IgE levels were evaluated by passive cutaneous anaphylaxis test (PCA). In each group 200 high microscopical power fields (HPF) were counted. Results were expressed as arithmetic mean and SE. Anti -CD4, CD5, micro chain monoclonal antibodies were used. Avidin biotin horseradish peroxidase system was used.. CD 4: G1: 8.3 +/- 0.06; G2: 13.4 +/- 0.08, G3: 8.25 +/- 0.06, G4: 11.8 +/- 0.02. CD 5: G1: 7.3 +/- 0.05; G2: 9.4 +/- 0.05, G3: 11.3 +/- 0.06, G4: 8.1 +/- 0.06. mu chain: G1: 10.4 +/- 0.06; G2: 3.8 +/- 0.02, G3: 6.0 +/- 0.10, G4: 2.2 +/- 0.10. In all cases, experimental groups (G3 vs. G4) presented statistical significant differences (p < 0.05). CD4+, CD5+ cells and mu chain+ decrease in experimental group (G4), probably due to lymphocyte migration inhibition to challenged mucosa. mu chain+ cell decrease could be based on B cell activation and expression of different surface immunoglobulins. Cells expressing mu chain decreased in G2 and G3 likely due to activation of B cells and subsequent expression of other immunoglobulin chains in cell surface.. We conclude that obtained data are important to elucidate immunopathology of local anaphylactic reaction in rectal mucosa from systemic sensitized animals after treatment with montelukast.

Topics: Acetates; Animals; Cyclopropanes; Disease Models, Animal; Food Hypersensitivity; Intestinal Mucosa; Leukotriene Antagonists; Quinolines; Rabbits; Sulfides