montelukast and Urticaria

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

Urticaria, by definition, is a disease presenting with wheals, angioedema or both. In patients with recurrent angioedema without wheals, urticaria needs to be distinguished from bradykinin-mediated angioedema, for example, hereditary angioedema or ACE inhibitor-induced angioedema.. Urticaria is comprised of acute and chronic forms. The latter group of chronic urticaria has many different subtypes needing partly different therapeutic approaches. However, all therapeutic approaches for symptomatic treatment center on reducing mast cell-mediator-release and preventing its effect.. The current guidelines recommend non-sedating, second generation H1-antihistamines (nsAHs) as the first-line treatment. If needed, nsAHs are to be used at higher doses (up to fourfold the standard dose), and Omalizumab, Montelukast or Cyclosporin A (not in preferred order) are recommended as third-line options. Many alternative treatments have been reported but not tested in randomized controlled trials. These include among others dapsone, H2-antihistamines, anticoagulants and methotrexate. Some therapies should no longer be used according to current guidelines, since studies have shown their inefficacy or because new safety concerns have emerged. This mainly refers to the formally propagated use of sedating antihistamines at night, which change REM-sleeping-patterns and learning curves and have been shown in head-to-head trials to not be superior in efficacy to non-sedating antihistamines.

Topics: Acetates; Antibodies, Anti-Idiotypic; Antibodies, Monoclonal, Humanized; Chronic Disease; Cyclopropanes; Cyclosporine; Dose-Response Relationship, Drug; Drug Therapy, Combination; Histamine H1 Antagonists; Histamine Release; Humans; Omalizumab; Practice Guidelines as Topic; Quinolines; Sulfides; Treatment Outcome; Urticaria

Chronic idiopathic urticaria (CIU) is a disabling affliction that considerably limits patients' daily activities and interferes with sleep. Clinical studies have shown that histamine H1-receptor antagonists (antihistamines) are highly effective for inhibiting the hives/wheals and pruritus associated with CIU, as well as improving patients' quality of life. Desloratadine is a rapid-acting, once-daily, nonsedating selective H1-receptor antagonist/inverse receptor agonist with proven clinical efficacy in patients with CIU. It has 10-20 times the in vivo H1 receptor-binding affinity of loratadine, its parent compound, and 52-194 times the H1 receptor-binding affinity of cetirizine, ebastine, loratadine, and fexofenadine. Desloratadine displays linear pharmacokinetics after oral administration. Age and sex have no apparent effect on the drug's metabolism and elimination, and food does not affect its bioavailability or absorption. Desloratadine also exerts anti-inflammatory effects via mechanisms that are independent of H1-receptor antagonism. Results from randomized, double-blind, placebo-controlled studies of 6 weeks' duration in adults and adolescents with moderate-to-severe CIU indicate that desloratadine significantly minimizes the severity of pruritus, reduces the number and size of hives, and improves disease-impaired sleep and daily activities. Improvements were noted after a single dose of desloratadine and were maintained over 6 weeks of treatment. Desloratadine was safe and well tolerated in clinical trials of patients with CIU. The adverse effect profile of desloratadine in adults, as well as in children aged from 6 months to 11 years, is comparable to that of placebo. Evaluations of cognitive and psychomotor performance in adults indicate no impairment of function with dosages of desloratadine 5 mg/day. In conclusion, desloratadine is an important therapeutic option for prompt and enduring symptom relief in patients with moderate-to-severe CIU. In addition to efficacy and safety, desloratadine affords a convenient administration regimen, rapid onset of action, and an absence of drug-drug or drug-food interactions. Other important prescribing considerations are that, unlike all first-generation and some second-generation antihistamines, desloratadine is nonsedating at its clinically approved dosage and does not impair psychomotor function.

Topics: Acetates; Adolescent; Adult; Child; Chronic Disease; Cyclopropanes; Drug Therapy, Combination; Histamine H1 Antagonists, Non-Sedating; Humans; Infant; Leukotriene Antagonists; Loratadine; Quality of Life; Quinolines; Sulfides; Urticaria

To review clinical trial data to determine the benefits of using montelukast alone or as combination therapy in the treatment of urticaria.. MEDLINE (1966-March 2006) and International Pharmaceutical Abstracts (1970-October 2005) were searched to find clinical trial publications that addressed the use of montelukast in urticaria.. Six clinical trials were identified. Montelukast was compared alone and as combination therapy with nonsedating histamine1-receptor antagonists to determine efficacy and safety. Patients had chronic or physical urticaria. The results were mixed. Some studies demonstrated that montelukast can decrease urticarial symptoms with minimal adverse effects, while others found no differences.. Large-scale, controlled trials are needed to determine which patients would likely benefit from treatment with montelukast.

Topics: Acetates; Clinical Trials as Topic; Cyclopropanes; Drug Therapy, Combination; Histamine H1 Antagonists, Non-Sedating; Humans; Leukotriene Antagonists; Quinolines; Sulfides; Urticaria

Cold urticaria is characterized by the development of urticaria, usually superficial and/or angioedematous reaction after cold contact. It was found predominantly in young women. The diagnosis is based on the history and ice cube test. Patients with a negative ice cube test may have represented systemic cold urticaria (atypical acquired cold urticaria) induced by general body cooling. The pathogenesis is poorly understood. Cold urticaria can be classified into acquired and familial disorders, with an autosomal dominant inheritance. Idiopathic cold urticaria is most common type but the research of a cryopathy is necessary. Therapy is often difficult. It is essential that the patient be warned of the dangers of swimming in cold water because systemic hypotension can occur. H1 antihistamines can be used for treatment of cold urticaria but the clinical responses are highly variable. The combination with an H2 antagonists is more effective. Doxepin may be useful in the treatment. Leukotriene receptor antagonists may be a novel, promising drug entity. In patients who do not respond to previous treatments, induction of cold tolerance may be tried.

Topics: Acetates; Adrenal Cortex Hormones; Aminophylline; Cold Temperature; Cyclopropanes; Doxepin; Drug Therapy, Combination; Female; Genes, Dominant; Histamine H1 Antagonists; Humans; Hypotension; Male; Quinolines; Stanozolol; Sulfides; Terbutaline; Urticaria

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

Topics: Acetates; Adolescent; Adult; Child; Chronic Disease; Cyclopropanes; Drug Evaluation; Drug Synergism; Drug Therapy, Combination; Female; Follow-Up Studies; Histamine H1 Antagonists; Humans; Indoles; Leukotriene Antagonists; Male; Middle Aged; Phenylcarbamates; Quinolines; Sulfides; Sulfonamides; Tosyl Compounds; Treatment Outcome; Urticaria

Observational reports have linked vitamin D with chronic urticaria, yet no randomized controlled trial has been conducted.. To determine whether high-dose vitamin D supplementation would decrease Urticaria Symptom Severity (USS) scores and medication burden in patients with chronic urticaria.. In a prospective, double-blinded, single-center study, 42 subjects with chronic urticaria were randomized to high (4,000 IU/d) or low (600 IU/d) vitamin D3 supplementation for 12 weeks. All subjects were provided with a standardized triple-drug therapy (cetirizine, ranitidine, and montelukast) and a written action plan. Data on USS scores, medication use, blood for 25-hydroxyvitamin D, and safety measurements were collected.. Triple-drug therapy decreased total USS scores by 33% in the first week. There was a further significant decrease (40%) in total USS scores in the high, but not low, vitamin D3 treatment group by week 12. Compared with low treatment, the high treatment group demonstrated a trend (P = .052) toward lower total USS scores at week 12, which was driven by significant decreases in body distribution and number of days with hives. Beneficial trends for sleep quality and pruritus scores were observed with high vitamin D3. Serum 25-hydroxyvitamin D levels increased with high vitamin D3 supplementation, but there was no correlation between 25-hydroxyvitamin D levels and USS scores. There was no difference in allergy medication use between groups. No adverse events occurred.. Add-on therapy with high-dose vitamin D3 (4,000 IU/d) could be considered a safe and potentially beneficial immunomodulator in patients with chronic urticaria.. clinicaltrials.gov Identifier: NCT01371877.

Topics: Acetates; Adult; Aged; Cetirizine; Cholecalciferol; Chronic Disease; Cyclopropanes; Dietary Supplements; Disease Progression; Female; Humans; Male; Middle Aged; Prospective Studies; Quinolines; Ranitidine; Sulfides; Urticaria; Young Adult

It is well-known that number of drugs may interfere with wheal reactions in skin prick test. However, the effect of long-term use of montelukast, a cystenil leukotriene receptor antagonist, on skin prick test hasn't been full elucidated. The aim of present study was to demonstrate the effect of montelukast on skin prick tests (SPT).. This is a single-center, randomized, double-blinded, placebo-controlled study including two treatment periods with a wash-out interval. The subjects received montelukast (5 mg per day), fexofenadine HCl (60 mg per day) and placebo (lactose) with a double-blinded manner during 7- and 21-days treatment periods with a 14 days wash-out period. Dermatophagoides farinae (D. farinae) was used as the skin test material, while histamine as positive control and normal saline as negative control. Overall, 7 skin prick tests were performed at following time points: before treatment periods, on the last days of both treatment periods, 24 h after completion of treatment periods, and on the last day of 14-days interval.. Sixty house dust mite (HDM) allergic children (23 girls and 37 boys) with allergic rhinitis and/or asthma completed the study. Mean age was 8.3 ± 2.0 years. In the fexofenadine group, a significant suppression was observed in post-treatment values when compared to baseline values in SPT with D. farinae (p = 0.019). In the montelukast group, no significant suppression was observed in SPT with D. farinae at all time points when compared to baseline.. Our results showed that montelukast had no effect on measurements of SPT. Thus, we concluded that there is no need to discontinue the treatment in order to perform SPT in patients receiving montelukast, even in those on montelukast treatment for at least 21 days.

Topics: Acetates; Allergens; Animals; Asthma; Chi-Square Distribution; Child; Cyclopropanes; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Pyroglyphidae; Quinolines; Reference Values; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Sensitivity and Specificity; Skin Tests; Statistics, Nonparametric; Sulfides; Terfenadine; Urticaria

Antihistamines (AH) alleviate pruritus and decrease the incidence of hives in patients with chronic idiopathic urticaria (CU). However, some patients do not respond completely to this therapy. We hypothesized that some of them might benefit from the addition of leukotriene receptor antagonists (LA).. We screened patients diagnosed and treated for CU and selected those that had symptoms despite antihistamine treatment. In a double-blind crossover study, patients took the leukotriene antagonist montelukast (10 mg per day) or placebo. Efficacy was assessed by a symptom score.. In a group of 22 patients, the symptom score was not significantly different between periods using montelukast (48.8; 0-214) or placebo (68.5; 0-230). However in the subgroup of five patients with the most severe urticaria, defined as patients with symptom scores in the upper quartile at inclusion in the study, montelukast (41; 11 214) was superior to placebo (95.5; 48 230; p < 0.05), but only when using an in-house symptom score questionnaire and not when using a validated urticaria activity score questionnaire.. We showed that in patients with antihistamine-resistant CU the addition of montelukast significantly diminished symptoms in only a small minority of patients. However, response to add-on montelukast was seen in the subgroup of patients with particularly severe disease. To confirm this observation, a study with a larger group of patients is warranted.

Topics: Acetates; Chronic Disease; Cross-Over Studies; Cyclopropanes; Double-Blind Method; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Male; Middle Aged; Quinolines; Sulfides; Surveys and Questionnaires; Treatment Outcome; Urticaria

Chronic idiopathic urticaria (CIU) is often difficult to treat. Although histamine-releasing activity is detectable for up to 50% of CIU patients, antihistamine therapy provides only a limited response.. This study aimed to assess the clinical efficacy of combined leukotriene receptor antagonist (LRA) and H1 antihistamine, H1 and H2 antihistamine, and two H1 antihistamines as a synergistic therapeutic regimen for treating CIU compared with a matched placebo modality.. A total of 120 newly diagnosed adult patients were evaluated. Patients were single blinded and randomly assigned to one of four medication groups that received the following regimens for 4 weeks: Group A, combination of sedating H1 antihistamine and non-sedating H1 antihistamine; Group B, combination of H1 antihistamine and H2 antihistamine; Group C, combination of H1 antihistamine and LRA; and Group D, matched placebo medication. The primary measure of treatment efficacy was the daily urticaria activity score (UAS) of 'wheal and itch'. A positive therapeutic response was defined as a reduction to < 25% of baseline weekly UAS, while a relapse was a return to > 75% of baseline weekly UAS.. In all, 107 patients completed the trial medication. At the end of 4 weeks, the UAS score as a response to treatment was 23.3% for Group A, 63.3% for Group B, 53.3% for Group C, and no real change for the placebo treatment group.. The combination of LRA and H1 receptor antagonist is promising for CIU treatment and is reasonably well tolerated by patients. The combination of H1- and H2-receptor antagonists provided the greatest treatment efficacy by the measures used in this small study.

Topics: Acetates; Adolescent; Adult; Cetirizine; Chronic Disease; Cyclopropanes; Drug Therapy, Combination; Famotidine; Female; Histamine H1 Antagonists; Histamine H2 Antagonists; Humans; Hydroxyzine; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Single-Blind Method; Sulfides; Urticaria; Young Adult

The non- or low-sedating H1 receptor antagonists represent the basic therapy for urticaria.. To test an alternative approach to patients unresponsive to conventional treatment.. A total of 22 patients with chronic urticaria unresponsive to conventional antihistamine treatment were enrolled for this study. They had uncontrolled urticaria even using multiple combinations of antihistamines on maximum doses and corticosteroids in short cycles (prednisone 20-40 mg, per os once a day, 3-7 days per month). Cutaneous biopsies of the urticaria lesions were taken. These findings were classified as: (I) a mixture of perivascular dermal inflammatory infiltrate composed of lymphocytes, monocytes and neutrophils and/or eosinophils; (II) inflammatory infiltrate composed chiefly of neutrophils; and (III) inflammatory infiltrate composed mainly of eosinophils. According to histology, the patients were submitted to one of the following therapeutic schemes: class A - antihistamine treatment plus dapsone; class B - colchicine or dapsone; class C - montelukast.. Four patients in class A, 08 in class B and seven in class C displayed complete control of urticaria after 12 weeks of treatment; one patient in class B and two in class C did not respond to treatment. Two years after discontinuation, 16 patients are still free of urticaria.. This study suggests an alternative approach for treating unresponsive chronic urticaria.

Topics: Acetates; Adult; Anti-Infective Agents; Chronic Disease; Colchicine; Cyclopropanes; Dapsone; Drug Therapy, Combination; Female; Histamine H1 Antagonists; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides; Tubulin Modulators; Urticaria

Antileukotriene agents are widely used for the treatment of allergic conditions including bronchial asthma and allergic rhinitis. The influence of montelukast on skin reactivity has not been clearly evaluated. The aim of this study was to determine the effect of montelukast on wheal, flare and itching in skin prick tests (SPTs).. Fifteen atopic patients (5 women and 10 men) with average age 28.04 (SD+/-8.24) were tested with histamine, codeine, negative control solution and allergen extract (grasses). Montelukast (10mg), loratadine (10mg) or placebo were given to the volunteers for 5 days in a double-blind manner, followed by SPT, with 14 days of wash-out period.. There was no differences in wheal, flare and itching (p=0.205; 0.086 and 0.069, respectively, Wilcoxon rank-sum test) between SPT performed after placebo and wash-out period. The analysis revealed a statistically significant suppression of wheal and flare by loratadine (p<0.05 for all tested solutions). Pre-treatment with montelukast did not influence wheal size (p=0.099, 0.21, 0.066 for histamine, codeine and allergens, respectively), but significantly reduced flare (p=0.005; 0.003; 0.02 for histamine, codeine and allergens, respectively). We found a significant suppression of itching produced by montelukast (p=0.02) and loratadine (p=0.03) as compared to placebo (p=0.068 vs. wash out).. Our data show a tendency to suppressive effect of montelukast on flare and itching but not on wheal which is basic for SPT interpretation. We conclude that found suppression have little impact on clinical effectiveness of SPT as a diagnostic tool.

Topics: Acetates; Allergens; Antipruritics; Capsules; Codeine; Cross-Over Studies; Cyclopropanes; Double-Blind Method; Female; Histamine; Humans; Leukotriene Antagonists; Loratadine; Male; Pollen; Pruritus; Quinolines; Skin; Skin Tests; Sulfides; Time Factors; Treatment Outcome; Urticaria

Delayed pressure urticaria (DPU) comes under the heading of physical urticaria. Characteristically itchy, tender or painful weals occur at sites of local pressure including the waistband, soles of the feet and palms of the hands. Lesion onset is typically 3-12 h after the application of pressure, and lesions may persist for more than 24 h. The treatment of DPU is often unsatisfactory.. To determine the efficacy of desloratadine and montelukast in the treatment of DPU.. The study was conducted in 36 subjects affected by DPU. A challenge test with a dermographometer was administered to confirm the diagnosis. After diagnosis, patients were randomized to receive the following treatment once daily for 2 weeks: (i) oral desloratadine 5 mg plus oral placebo; (ii) oral desloratadine 5 mg plus montelukast 10 mg; and (iii) oral placebo alone.. At rechallenge, patients from the treatment groups (desloratadine plus montelukast group and desloratadine alone group) demonstrated a significant reduction in mean diameter of papules after 70 s of pressure compared with the placebo group (P < 0.05). Moreover, patients treated with desloratadine plus montelukast showed a significant reduction in mean diameter of papules at 70 s of pressure compared with those treated with desloratadine alone (P < 0.05). In addition, the combination was effective in improving clinical parameters (erythema, oedema and pruritus, and number of separate urticarial episodes).. This study has demonstrated that both desloratadine alone and desloratadine plus montelukast administered once daily yield improvements with respect to the baseline assessment, regarding the suppression of the dermographometer challenge test papule and clinical improvement of urticaria. However, the combination of desloratadine and montelukast was shown to be more efficacious and may therefore be proposed in patients with DPU, in order to avoid corticosteroid therapy.

Topics: Acetates; Administration, Oral; Adolescent; Adult; Cyclopropanes; Double-Blind Method; Drug Therapy, Combination; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Leukotriene Antagonists; Loratadine; Male; Middle Aged; Pressure; Quinolines; Skin Tests; Sulfides; Urticaria

Many patients with chronic idiopathic urticaria are not sufficiently controlled with histamine H(1)-receptor antagonists. Leukotriene receptor antagonists have been reported to be effective for certain cases of urticaria, although their proper application remains to be established. To study the effectiveness of montelukast, a leukotriene receptor antagonist, for the treatment of chronic urticaria that was not controlled by histamine H(1)-receptor antagonists. Twenty-five patients with chronic idiopathic urticaria were treated with 10 mg of montelukast for one week or more, without changing any precedent treatment that they were using before the study including histamine H(1)-receptor antagonists. The effectiveness of montelukast for each patient was evaluated and compared with clinical features and/or backgrounds of the patients. Twelve patients, including six who had been treated with corticosteroids, were evaluated as "markedly improved" or "improved" following treatment with montelukast. There was no statistically significant relation of the effectiveness to the complications with non-steroidal anti-inflammatory drugs (NSAIDs) intolerance, mechanical urticaria, or reactions to autologous serum skin test. However, the patients for whom montelukast was effective were younger (33.2+/-16.3 years, mean +/- SD)(P<0.05, Mann-Whitney test) and their duration of illness shorter (15.9+/-18.3 months) (P<0.005, Mann-Whitney test) than those of patients for whom montelukast was ineffective (45.9+/-15.0 years, 89.6+/-71.7 months). Montelukast may be worth trying for patients with chronic idiopathic urticaria, when the condition is not sufficiently controlled with histamine H(1)-receptor antagonists.

Topics: Acetates; Adolescent; Adult; Aged; Child; Child, Preschool; Chronic Disease; Cyclopropanes; Drug Resistance; Female; Histamine H1 Antagonists; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides; Urticaria

Chronic urticaria (CU) is a common skin condition. It is frequently a disabling disease due to the persistency of clinical symptoms, the unpredictable course and negative influence on the quality of life.. The aim of this study is to determine whether montelukast, a LTD4 receptor antagonist, plus desloratadine, is more efficacious than desloratadine alone in the treatment of chronic urticaria.. A randomized, double-blind, placebo-controlled study was conducted on 81 patients with a diagnosis of CU. A 1-week single-blind placebo run-in period (baseline) was followed by a 6-weeks double blind active treatment period. The patients were randomized to receive the following treatment once daily: (a) oral desloratadine (5 mg) plus placebo; (b) desloratadine (5 mg) plus montelukast (10 mg); (c) oral placebo alone. The study ended after another 1-week single-blind placebo washout period.. The evaluable population thus consisted of 76 patients. Both desloratadine alone and desloratadine plus montelukast administered once daily yielded improvements with respect to the baseline assessment as regards pruritus, number of separate episodes, size and number of weals, visual analogue score and patients' quality of life and with respect to the placebo group both in the active treatment period and in the run-out period. However, desloratadine plus montelukast was shown to improve the symptoms and patients' quality of life significantly more than desloratadine alone, although it did not have a significant effect on the number of urticarial episodes.. The combination of desloratadine plus montelukast is effective in the treatment of CU. It may therefore be a valid alternative in patients with relatively mild CU, in view of its efficacy and the lack of adverse events.

Topics: Acetates; Administration, Oral; Adolescent; Adult; Aged; Chronic Disease; Cyclopropanes; Double-Blind Method; Drug Therapy, Combination; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Leukotriene Antagonists; Loratadine; Male; Middle Aged; Pruritus; Quality of Life; Quinolines; Severity of Illness Index; Sulfides; Treatment Outcome; Urticaria

H 1 -receptor antagonists are considered to be particularly effective in reducing pruritus, and they are therefore recommended as first-line treatment in patients with chronic idiopathic urticaria (CIU). Recently, antileukotriene receptors have been used in patients with CIU, either administered as monotherapy or combined with H 1 -receptor antagonists.. We compared the clinical efficacy of 5 mg of desloratadine administered once daily either as monotherapy or combined with a leukotriene antagonist, 10 mg of montelukast daily, and 10 mg of montelukast administered daily as monotherapy for the treatment of patients affected by CIU with placebo.. One hundred sixty patients aged 18 to 69 years (mean +/- SD, 43.9 +/- 13.4 years) with a history of moderate CIU were selected. A randomized, double-blind, double-dummy, placebo-controlled, parallel-group study design was used. Patients were treated with 5 mg of desloratadine once daily (n = 40), 10 mg of montelukast once daily (n = 40), 5 mg of desloratadine (n = 40) in the morning plus montelukast in the evening, or matched placebo (n = 40). Assessment of treatment efficacy was based on scores of daily cutaneous symptoms evaluated reflectively and instantaneously.. Only the group treated with desloratadine as monotherapy or as combined therapy concluded the whole study. Twenty-seven of the 40 patients in the montelukast group and 35 of the 40 patients in the placebo group discontinued the treatment. As reflective evaluation, all groups showed significant differences compared with the placebo group in terms of total symptom score, number of hives, and size of largest hive. In addition to the pruritus, only the groups treated with desloratadine as monotherapy or combined therapy showed significant differences compared with those receiving placebo, whereas there were no differences between the montelukast and placebo groups. Finally, no differences were found between the desloratadine group and the desloratadine plus montelukast group. The instantaneous evaluation demonstrated similar results regarding the desloratadine group and the desloratadine plus montelukast group versus the placebo group, whereas there were no significant differences between the group treated with montelukast alone and the placebo group for pruritus and size of largest hive. No differences were found between the group treated with desloratadine alone and the desloratadine plus montelukast group.. The results of this comparative study demonstrate that desloratadine is highly effective for the treatment of patients affected by CIU. In addition, the regular combined therapy of desloratadine plus montelukast does not seem to offer a substantial advantage with respect to desloratadine as monotherapy in patients affected by moderate CIU.

Topics: Acetates; Adolescent; Adult; Aged; Chronic Disease; Cyclopropanes; Double-Blind Method; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Leukotriene Antagonists; Loratadine; Male; Middle Aged; Quinolines; Sulfides; Treatment Outcome; Urticaria

Topics: Acetates; Adult; Aged; Cyclopropanes; Double-Blind Method; Drug Therapy, Combination; Female; Histamine H1 Antagonists; Humans; Leukotriene Antagonists; Loratadine; Male; Middle Aged; Quinolines; Sulfides; Urticaria

Chronic idiopathic urticaria (CIU) might be refractory to standard therapies. For the patients with severe unremitting CIU who have failed to benefit from conventional therapy with antihistamines, other effective and safe therapeutic modalities are required.. A randomized, single-blind, placebo-controlled crossover study was conducted to evaluate the efficacy and safety of the new selective leukotriene antagonist montelukast sodium in the treatment of refractory CIU.. Thirty patients with refractory CIU were enrolled in the trial. After informed consent was obtained, patients were randomly assigned to 2 groups. The patients in group A received 10 mg/d montelukast and a nonsedating H(1) antihistamine (cetirizine) when needed for 6 weeks. After a 2-week washout period, they received placebo for 6 weeks and the same H(1) antihistamine as needed. Group B received the treatment vice versa. Improvement was monitored by using the self-estimated urticaria activity score, which is the sum of the wheal number score and the itch severity score, and the antihistamine counts used in each study period.. More significant decreases occurred in urticaria activity scores with montelukast therapy compared with those with placebo therapy (P <.001). H(1) antihistamine use was also significantly less frequent during the montelukast period (P <.001). There were no significant side effects with montelukast therapy.. The present study results suggest that montelukast might be an effective and safe therapeutic agent in the treatment of refractory CIU.

Topics: Acetates; Adult; Chronic Disease; Cross-Over Studies; Cyclopropanes; Female; Histamine H1 Antagonists; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Single-Blind Method; Sulfides; Urticaria

Topics: Acetates; Adult; Aged; Chronic Disease; Cyclopropanes; Double-Blind Method; Female; Histamine H1 Antagonists; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides; Terfenadine; Treatment Outcome; Urticaria

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

Delayed pressure urticaria (DPU) is a rare form of chronic inducible urticaria (CIndU) when it manifests alone. Treatment of DPU is disappointing owing to the lack of response to antihistamines, even when up-dosing. In addition, the absence of randomized clinical trials and the low number of patients included in the studies mean that there is little scientific evidence for the validity of omalizumab in DPU.. Objectives of the study were to perform a real-world study of the effectiveness and safety of omalizumab in DPU patients without chronic spontaneous urticaria or other forms of CIndU and to describe their clinical and diagnostic features.. We performed an ambispective observational study of 14 patients with DPU who did not respond to 2 or more second-generation H1-antihistamines in an up-dosing regimen and/or corticosteroids, montelukast, or cyclosporine. Treatment was initiated with omalizumab 300 mg every 4 weeks. We recorded the following: age, time to diagnosis, previous treatment, diagnostic testing (mean time threshold after removing the stimulus and duration of the lesions), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D dimer, total IgE, antithyroid peroxidase (anti-TPO) antibodies, and the Urticaria Control Test (UCT) score before and after the first dose. We evaluated the efficacy of omalizumab according to the Urticaria Control Test score. We analyzed the time to complete or satisfactory response after the first dose (superfast) and its adverse effects.. Women accounted for 64.28% patients. The mean age at diagnosis was 43.64 (±13.78) years. The time to diagnosis was 4.53 (±5.54) years. The mean time threshold after removing the stimulus was 4.18 h (±2.75). The mean duration of lesions after testing was 32.42 (±13.8) hours. High ERS values (>20.0 mm/h) were detected in 50% of patients. CRP was >0.5 mg/dL in 42.85% and D dimer levels were high (>500.0 ng/mL) in 3/10 patients. Anti-TPO level was normal in 100% of patients. Total IgE was >100 IU/mL in 6/8 patients. Medium UCT levels before treatment with omalizumab were 3.07 (±2.40), reaching 15.28/16 (±1.72) after the first dose of omalizumab. All 14 patients responded superfast, and none experienced an adverse reaction.. Despite the limitation of a low sample size in this real-life study, our findings suggest that omalizumab is a rapid, effective, and safe treatment for patients with DPU refractory to antihistamines in an up-dosing regimen. We recommend omalizumab for patients who do not respond to up-dosing antihistamines and montelukast.

Topics: Acetates; Adrenal Cortex Hormones; Adult; Anti-Allergic Agents; C-Reactive Protein; Chronic Disease; Chronic Urticaria; Cyclopropanes; Cyclosporins; Female; Histamine Antagonists; Humans; Immunoglobulin E; Middle Aged; Omalizumab; Peroxidases; Quinolines; Sulfides; Treatment Outcome; Urticaria

Solar urticaria (SU) is a rare photodermatosis causing a significant impact on patients' quality of life (QoL), and treatment is often challenging.. To analyse clinical experience with a tailored stepwise therapeutic approach.. A retrospective cohort design was used. Patients with suspected SU underwent laboratory investigations and photoprovocation. Those with a high minimal urticaria dose (MUD) were treated with a single antihistamine (protocol 1), and those with a lower MUD received three types of antihistamines (protocol 2); both protocols included a leucotriene receptor antagonist (LRA). In cases of failure, treatment was switched to omalizumab at doses of < 300 mg/month with incremental dosage increases as necessary (monthly dose range, 150-600 mg/month). Symptom relief and photoprovocation under treatment were evaluated.. In total, 30 patients (10 men, 20 women) were enrolled. Most (87%) were sensitive to visible light (1-70 J/cm. Symptoms of SU can be well controlled by treatment with antihistamines and an LRA tailored to the degree of photosensitivity, followed by omalizumab in refractory cases. This has important implications for patient QoL.

Topics: Acetates; Adolescent; Adult; Aged; Anti-Allergic Agents; Cetirizine; Child; Cohort Studies; Cyclopropanes; Disease Management; Female; Histamine Antagonists; Humans; Leukotriene Antagonists; Loratadine; Male; Middle Aged; Omalizumab; Photosensitivity Disorders; Quinolines; Retrospective Studies; Sulfides; Terfenadine; Urticaria; Young Adult

Topics: Acetates; Anti-Inflammatory Agents; Antimalarials; Cetirizine; Chronic Disease; Cyclopropanes; Diphenhydramine; Drug Resistance; Histamine Antagonists; Humans; Hydroxychloroquine; Infant; Male; Quinolines; Ranitidine; Skin; Sulfides; Urticaria

Solar urticarial (SU) is characterized by erythema, whealing, and/or pruritus occurring minutes after sun exposure. Treatment is difficult and often unsatisfactory.. To determine the action spectra and minimal urticaria dose (MUD) and to tailor a treatment regimen graded according to disease severity in a series of patients with SU.. Eleven patients (seven females, four males, age range: 5-60 years) with a clinical history suggestive of SU, verified by photo-provocation tests to ultraviolet A (UVA), visible light, and/or UVB, were treated with various combinations of antihistamines and leukotriene receptor antagonist.. All patients were sensitive to visible light (median MUD 50 J/cm(2)). Three patients were sensitive to UVA (median MUD 3.75 J/cm(2)), and one patient was sensitive to UVB (MUD of 0.03 J/cm(2)). Two patients experienced a spontaneous remission without treatment. One patient declined treatment. The remaining eight patients were managed by a combination of antihistamines (desloratidine, fexofenadine, cetirizine HCl) and a leukotriene receptor antagonist (montelukast). Seven of the 8 patients experienced a sustained remission of symptoms and signs following treatment.. Photoprovocation for SU with determination of action spectra and MUD enables specifically tailored treatment regimens consisting of combinations of antihistamines and leukotriene receptor antagonist.

Topics: Acetates; Adolescent; Adult; Cetirizine; Child; Child, Preschool; Cyclopropanes; Drug Therapy, Combination; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Leukotriene Antagonists; Loratadine; Male; Middle Aged; Photosensitivity Disorders; Quinolines; Remission Induction; Remission, Spontaneous; Severity of Illness Index; Sulfides; Sunlight; Terfenadine; Ultraviolet Rays; Urticaria; Young Adult

Topics: Acetates; Anaphylaxis; Cyclopropanes; Diagnosis, Differential; Hot Temperature; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides; Urticaria; Young Adult

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

Chronic idiopathic urticaria is a common skin disorder characterized by recurrent appearance of wheals and/or angioedema for more than 6 weeks without an identifiable cause. Consensus guidelines suggest use of leukotriene receptor antagonists (montelukast or zafirlukast) in patients whose urticaria is resistant to antihistamines. Our objectives were (1) document the efficacy of montelukast in our patients, and (2) evaluate whether any clinical features or available laboratory investigations were associated with a response to montelukast. Patients who received montelukast between the years 2008-2011 (4-year period) were retrospectively identified from clinic letters. Clinical features and laboratory investigations were collected and analyzed. The primary end point was adequate control of disease without the need for systemic steroid therapy. 25 patients (10 males and 15 females; median age, 33 years; age range, 13-66 years) with an average duration of urticaria at 3.8 years received montelukast 10mg daily. 12 patients (48%) were better on montelukast with combined anti-H1 and anti-H2 therapy, with no statistical significance between median age and duration of urticaria between males and females. In 11 patients, montelukast had no effect and in 2 patients the urticaria worsened after montelukast was started. 15 patients had peripheral blood basopenia of which 5 patients responded to montelukast. Two patients had positive antinuclear antibody, 3 thyroid peroxidase antibodies and 4 with positive basophil histamine release. All 20 patients who had complement C3 and C4 levels done were within normal limits. Four of 6 patients (67%) with positive specific IgE responded to montelukast and combined anti-H1/H2 therapy. Almost half of our patients with chronic urticaria responded to montelukast and combined anti-H1 and anti-H2 therapy. We were unable to identify any clinical features or laboratory markers that were associated with a response to montelukast. Further studies are required to understand the failure of response of leukotriene inhibition in urticaria.

Topics: Acetates; Adolescent; Adult; Aged; Chronic Disease; Cyclopropanes; Drug Therapy, Combination; Female; Histamine H1 Antagonists; Histamine H2 Antagonists; Humans; Immunoglobulin E; Leukotriene Antagonists; Male; Middle Aged; Practice Guidelines as Topic; Quinolines; Retrospective Studies; Sulfides; Treatment Outcome; Urticaria; Young Adult

Histamine is the main mediator of urticaria and H1-receptor antagonists represent the treatment of choice in all patients with chronic urticaria. Leukotriene receptor antagonists as montelukast have also been used in patients with chronic urticaria unresponsive to H1-antihistamines alone. We report a patient with chronic urticaria whose disease was paradoxically exacerbated by H1-antihistamines and montelukast, and controlled by immunosuppressive drugs as ciclosporin and azathioprine. Urticaria exacerbations were caused by different molecules including either piperidine (fexofenadine, desloratadine, ebastine, rupatadine) or piperazine (hydroxyzine, cetirizine) derivatives as well as by montelukast suggesting that an IgE-mediated mechanism was not involved. A possible explanation of the observed urticaria exacerbation is that H1-antihistamines and montelukast may shift the H1 histamine receptor and the leukotriene receptor to the active conformation instead of the inactive state. The beneficial effects of ciclosporin and azathioprine confirm that immunosuppressive drugs have an important role in the treatment of refractory chronic urticaria and back the hypothesis that an autoimmune/autoreactive mechanism often underlies the disease.

Topics: Acetates; Adult; Azathioprine; Chronic Disease; Cyclopropanes; Cyclosporine; Histamine H1 Antagonists; Humans; Male; Quinolines; Sulfides; Urticaria

Topics: Acetates; Anti-Asthmatic Agents; Chronic Disease; Cyclopropanes; Female; Humans; Immunologic Tests; Middle Aged; Quinolines; Sulfides; Urticaria

In addition to histamine, leukotriene C4 (LTC4) might also play a role in mediating cold urticaria wheals. To study the significance of LTC4 vs. histamine, 6 patients with cold urticaria were challenged with the ice cube test before and after ingestion of 10 mg cetirizine (antihistamine), 10 mg montelukast (leukotriene antagonist) or a combination of both drugs. Cetirizine diminished the cold-induced wheal by 50+/- 42%. Montelukast had no significant effect, and the combination of both drugs diminished the wheal by 37+/- 33%. Furthermore, a skin microdialysis technique detected the release of histamine in the cold-induced wheal, whereas no LTC4 release was detected. In conclusion, the antihistamine is effective and histamine is released, whereas the leukotriene antagonist is not effective and LTC4 is not released in the cold urticaria wheal.

Topics: Acetates; Adult; Anti-Allergic Agents; Cetirizine; Cold Temperature; Cyclopropanes; Female; Histamine; Humans; Leukotriene Antagonists; Leukotriene C4; Male; Middle Aged; Quinolines; Sulfides; Urticaria

Topics: Acetates; Administration, Oral; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides; Treatment Outcome; Urticaria

To report a case of generalized urticaria induced by montelukast treatment.. A 28-year-old man with allergic rhinitis and moderate persistent asthma developed generalized urticaria 5 days after the initiation of montelukast and inhaled fluticasone. Symptoms disappeared within one day after suspension of both drugs. Two months later, after the resumption of montelukast and fluticasone, the patient developed generalized urticaria and eyelid angioedema, which were successfully treated with intravenous betamethasone, achieving complete remission within hours. After 2 days, the patient resumed inhaled fluticasone only and continued this therapy for several months without any adverse reaction.. We attributed the adverse reaction to montelukast because of the temporal relationship between use of montelukast and urticaria, the absence of other identified causative factors and other explanations for allergic reactions, and the positive dechallenge and rechallenge. The Naranjo probability scale showed a probable relationship between skin manifestations and montelukast treatment.. The use of antileukotrienes is increasing in asthma therapy. In cases of generalized urticaria in asthmatic patients undergoing montelukast therapy, physicians should be aware of a potential adverse reaction to this drug.

Topics: Acetates; Adult; Cyclopropanes; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides; Urticaria

Topics: Acetates; Aminocaproic Acid; Child; Chronic Disease; Cyclopropanes; Drug Therapy, Combination; Humans; Male; Quinolines; Ranitidine; Sulfides; Urticaria

Topics: Acetates; Adult; Aged; Chronic Disease; Cyclopropanes; Female; Follow-Up Studies; Humans; Indoles; Leukotriene Antagonists; Leukotrienes; Male; Middle Aged; Phenylcarbamates; Quinolines; Remission Induction; Severity of Illness Index; Sulfides; Sulfonamides; Tosyl Compounds; Treatment Outcome; Urticaria

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

Montelukast is an orally administered cysteinyl receptor antagonist, approved for the treatment of asthma. There is pharmacological plausibility of its effectiveness in the treatment of other immunologically mediated conditions such as eczema and urticaria. The objective of this study was to determine whether there are any beneficial effects of montelukast on eczema and urticaria.. A non-interventional observational cohort study was conducted between February 1998 and December 1998 using Prescription-Event Monitoring (PEM). During PEM studies, patients are systematically identified from dispensed prescription data and questionnaires are sent to the prescribing general practitioner (GP) asking them to report events occurring during and after treatment. In this study, events reported as eczema or urticaria improved were identified. A simple questionnaire was sent to the GPs for additional information.. The cohort comprised 15,612 patients, in which 16 reports of eczema or urticaria improved were identified. Questionnaires were sent to the GPs for additional information. Fifteen of the 16 questionnaires were returned. In 5 cases the GPs thought that there was an improvement of eczema or urticaria with montelukast treatment in patients who had history of longstanding eczema or urticaria. Of the remaining 11 cases there was an alternative explanation for the improvement of eczema or urticaria in 10 cases and one was unassessable.. PEM is conducted to monitor the safety of medicines, and doctors report events including improvement in pre-existing conditions. Although the number of cases of improvement of eczema or urticaria in this cohort is small, there is a possibility that leukotriene inhibitors may be helpful in the treatment of these diseases. Further studies are needed to provide evidence as to whether montelukast will have a role in the treatment of these conditions.

Topics: Acetates; Adult; Aged; Child; Cohort Studies; Cyclopropanes; Drug Evaluation; Drug Monitoring; Eczema; England; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides; Surveys and Questionnaires; Treatment Outcome; Urticaria

Topics: Acetates; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Middle Aged; Pressure; Quinolines; Sulfides; Urticaria

Topics: Acetates; Adult; Cold Temperature; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Quinolines; Sulfides; Urticaria

Topics: Acetates; Adult; Chronic Disease; Cyclopropanes; Drug Therapy, Combination; Female; Humans; Leukotriene Antagonists; Prednisone; Quinolines; Sulfides; Urticaria