montelukast and Sneezing

During the course of development of montelukast, a cysteinyl leukotriene receptor 1 antagonist, for treatment of seasonal allergic rhinitis, a double-blind, non-inferiority study was carried out to evaluate the efficacy and safety of montelukast 5mg and 10mg compared with pranlukast 450mg, which has a similar mechanism of action.. Montelukast 5mg, 10mg or pranlukast 450mg and the corresponding placebo were orally administered to patients with seasonal allergic rhinitis three times a day for 2 weeks. Non-inferior efficacy of montelukast 5mg and 10mg to pranlukast 450mg was investigated by the change from the baseline in the composite nasal symptoms scores over the 2-week treatment period.. Montelukast 5mg, 10mg once daily and the pranlukast 450mg/day showed significant improvements in the change from the baseline in the composite, daytime and nighttime nasal symptom scores, and the improvement lasted for 2 weeks. Montelukast 5mg and 10mg were non-inferior to pranlukast 450mg in the change from the baseline in the composite nasal symptoms scores. The incidence rates of adverse experiences and drug-related adverse experiences were not significantly different among the three treatment groups.. The results indicate that administration of montelukast 5mg and 10mg once daily are potent alternatives for the treatment of seasonal allergic rhinitis and demonstrated that the efficacy and the safety profiles are comparable with pranlukast 450mg/day.

Topics: Acetates; Adult; Chromones; Cyclopropanes; Double-Blind Method; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Nasal Obstruction; Quinolines; Rhinitis, Allergic, Seasonal; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Sneezing; Sulfides; Treatment Outcome

This was a prospective double blind comparative study on 40 patients. It compared the effects of the leukotriene receptor antagonist montelukast and beclomethasone nasal spray on the post-operative course of patients with sinonasal polyps. All patients underwent endoscopic sphenoethmoidectomy and were randomized post-operatively into two groups. Group I: 20 patients (9 females and 11 males) age 17 to 67 (32.4 +/- 9.5 years), receiving 10 mg montelukast orally daily and Group II: 20 patients (6 females and 14 males) age 17 years to 57 years (33.5 +/- 11.9 years), receiving 400 ug beclomethasone local sprays daily. All patients were followed up for 1 year and a symptom score was recorded throughout this period. There was a significant reduction in symptom scores in both groups throughout the study period. In the montelukast group improvement was more marked in itching, post-nasal discharge and headache. The control of sneezing and rhinorrhea was comparable in both groups with a marginal advantage of montelukast. Steroids had a more marked effect on smell disturbances and obstruction. There was no difference in the recurrence rate or in the need for rescue medications between both groups. Both drugs seem to have a complementary action and further studies are needed to determine which patients should receive which treatment.

Topics: Acetates; Adolescent; Adult; Aged; Anti-Asthmatic Agents; Beclomethasone; Chi-Square Distribution; Cyclopropanes; Double-Blind Method; Female; Glucocorticoids; Headache; Humans; Leukotriene Antagonists; Male; Middle Aged; Nasal Polyps; Olfaction Disorders; Postoperative Care; Postoperative Complications; Prospective Studies; Pruritus; Quinolines; Sneezing; Sulfides

Cysteinyl leukotrienes (CysLTs) are a key element of allergic inflammation. Thus, the antagonism of CysLTs appears a potential target of allergic rhinitis management. Antileukotrienes and antihistamines combined showed a synergistic effect in treating seasonal allergic rhinitis (SAR). This double blind, parallel group, randomized study aimed at evaluating the clinical and anti-inflammatory effects exerted by two combinations of antihistamine plus antileukotriene in patients with SAR and mild intermittent asthma. Thirty patients were treated with montelukast added to cetirizine (M-C group) or desloratadine (M-D group) for 2 weeks. The visits, including spirometry, nasal scraping and lavage, were performed in all subjects before and directly after the treatment. Evaluation parameters were: i) nasal symptoms, ii) number of eosinophils and neutrophils, and iii) IL5 and IL8 levels. Both combinations significantly reduced: nasal symptoms (p<0.001), eosinophils and neutrophils (p<0.001), IL5 (p<0.001 for M-C groupand p<0.01 for M-D group), and IL8 levels (p<0.001 for M-C group and p<0.05 for M-D group). M-C combination reduced more significantly than M-D combination: nasal symptoms (p<0.01), inflammatory cells (p<0.01), and cytokines (p<0.01). The present study demonstrates that these antileukotriene-antihistamine combinations are effective in relieving nasal symptoms in SAR. Moreover, these combinations exert additional anti-inflammatory activity as provided by reduction of inflammatory infiltrate and cytokine levels. Finally, cetirizine might exert more beneficial activity than desloratadine when added to montelukast.

Topics: Acetates; Adolescent; Adult; Asthma; Cetirizine; Cyclopropanes; Double-Blind Method; Drug Synergism; Drug Therapy, Combination; Female; Forced Expiratory Volume; Histamine H1 Antagonists; Humans; Interleukin-15; Interleukin-18; Leukocyte Count; Leukotriene Antagonists; Male; Nasal Mucosa; Pruritus; Quinolines; Rhinitis, Allergic, Seasonal; Sneezing; Sulfides; Therapeutic Irrigation

The safety and efficacy of intranasal corticosteroids for the treatment of allergic rhinitis is well documented in the literature. Additionally, an expert panel has concluded that intranasal corticosteroids are the first line of therapy when obstruction is a major component of rhinitis. Montelukast is a leukotriene receptor antagonist recently approved for the treatment of seasonal allergic rhinitis (SAR).. This randomized, double-blind, double-dummy, parallel-group study was conducted to compare the effectiveness of a 15-day course of intranasal fluticasone propionate 200 microg, once daily (FP200QD), to oral montelukast 10 mg, once daily (MON10QD), in relieving daytime and nighttime nasal symptoms associated with SAR.. The intent-to-treat (ITT) analysis population consisted of 705 eligible males and females (> or = 15 years) with SAR randomized to either FP200QD (N = 353) or MON10QD (N = 352). The primary efficacy endpoint was the mean change from baseline in subject-rated daytime total nasal symptom scores (the sum of four individual scores: nasal congestion, itching, rhinorrhea, and sneezing), evaluated via visual analog scales, and averaged over weeks 1 to 2. Secondary endpoints included the four daytime individual nasal symptom scores, the nighttime total, and individual nasal symptom scores (each evaluated on a four-point scale from 0 to 3).. Statistically significant differences favoring FP200QD over MON10QD were observed for the mean change from baseline in daytime total nasal symptom scores (P < 0.001), daytime individual nasal symptom scores (P < 0.001), nighttime total (P < 0.001), and all individual nasal symptom scores (P < or = 0.002) over the 15-day treatment period. FP200QD and MON10QD were both well tolerated.. The results of this well controlled study demonstrated that FP200QD was consistently superior to MON10QD with regard to every efficacy endpoint evaluated, including daytime and nighttime nasal congestion, in subjects with SAR.

Topics: Acetates; Administration, Intranasal; Administration, Oral; Adult; Androstadienes; Anti-Allergic Agents; Cyclopropanes; Female; Fluticasone; Humans; Leukotriene Antagonists; Loratadine; Male; Nasal Obstruction; Pruritus; Quinolines; Rhinitis, Allergic, Seasonal; Sneezing; Sulfides

To compare the efficacy ofprednisolone, montelukast, and omalizumab in reducing allergic symptoms and inflammation at tissue level in an experimental allergic rhinitis model.. Forty Sprague Dawley rats were randomized into 5 groups as naive (NS/NC), sensitized/challenged (S/C) by subcutaneous ovalbumin antigen injection, and montelukast-, prednisolone-, and omalizumab-treated groups. A nasal allergen challenge was performed every day from day 20 to day 26. The number of sneezes and nasal/eye rubbing movements, IL-4 and CysLT levels in serum, nasal and bronchoalveolar lavage fluids determined by ELISA, and histopathological findings of nasal mucosa, sinus, and lung tissues were compared.. All of the treatments significantly controlled the allergic symptoms of sneezing and nasal/eye rubbing (P < 0.05). IL-4 and CysLT levels on days 20 and 26 were significantly higher in the S/C group compared to the NS/NC group (P < 0.05). Montelukast significantly decreased serum and nasal IL-4 and CysLT levels (P < 0.05), prednisolone decreased nasal lavage IL-4 and CysLT levels (P < 0.05), and omalizumab lowered nasal lavage CysLT levels (P < 0.05).. Prednisolone, montelukast, and omalizumab were found to be effective in controlling the allergic symptoms of allergic rhinitis and upper/lower airway inflammation in an experimental allergic rhinitis model.

Topics: Acetates; Animals; Anti-Allergic Agents; Antibodies, Anti-Idiotypic; Antibodies, Monoclonal, Humanized; Cyclopropanes; Disease Models, Animal; Lung; Mast Cells; Nasal Mucosa; Omalizumab; Prednisolone; Quinolines; Random Allocation; Rats; Rats, Sprague-Dawley; Rhinitis, Allergic; Sneezing; Sulfides

Different drugs from various pharmacological classes were compared for their ability to protect against the nasal effects of acute allergen challenge in a guinea pig model. In the model, sneezing and nose rubbing were recorded after an initial allergen challenge in guinea pigs previously sensitized to egg albumin. Four days later the same guinea pigs were re-challenged a second time when anesthetised. In these anaesthetized animals, nasal airway pressure, pulmonary inflation pressure and cellular infiltration into nasal lavage fluid were measured. The drug tested were autacoid antagonists (mepyramine--3mg/kg, cetirizine--3mg/kg and montelukast--10mg/kg), L-NAME (10 or 20mg/kg), heparin (20mg/kg) and dexamethasone (20mg/kg) given either intraperitoneally or intravenously; all were given shortly before challenge. Sneezing induced by allergen challenge was statistically significantly reduced by mepyramine, cetirizine and dexamethasone whereas only cetirizine reduced nose rubbing. Changes in nasal airway pressure due to allergen exposure were reduced by cetirizine, montelukast, L-NAME, and heparin, but not by mepyramine, nor dexamethasone. In the presence of L-NAME, nasal airway pressure actually changed in the opposite direction. Cellular infiltration, as assessed by cytometry in nasal lavage fluid 60min after acute allergen challenge, was reduced by montelukast and heparin but not by antihistamines, L-NAME nor dexamethasone. This pattern of effects of the drugs, given by doses and routes previously described in the literature as being effective was not completely consistent with expected responses. The lack of effect of dexamethasone probably reflects the fact that it was given acutely whereas in the clinic chronic administration is used. The two antihistamines were not identical in their actions, presumably reflecting the fact that cetirizine has therapeutic actions not entirely confined to blockade of H1 receptors. Montelukast has not been reported to have major effects on sneezing and itching in the clinic but reduces nasal obstruction (lower nasal airway pressure or nasal patency). Montelukast's effects on cellular infiltration indicate the possible involvement of leukotrienes. Heparin has actions on inflammatory cell infiltration. This could explain its profile of reducing both cellular infiltration, and increased nasal airway pressure.

Topics: Acetates; Acute Disease; Animals; Cetirizine; Cyclopropanes; Dexamethasone; Disease Models, Animal; Guinea Pigs; Heparin; Histamine H1 Antagonists; Male; Nasal Obstruction; NG-Nitroarginine Methyl Ester; Ovalbumin; Pyrilamine; Quinolines; Rhinitis, Allergic, Seasonal; Sneezing; Sulfides