Efficacy of prophylactic treatment with montelukast and montelukast plus add-on loratadine for seasonal allergic rhinitis
Efficacy of prophylactic treatment with montelukast and montelukast plus add-on loratadine for seasonal allergic rhinitis
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DOI：
10.2500/aap.2012.33.3514
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发表时间：
2012-03-01
影响因子：
2.8
通讯作者：
Fujieda, Shigeharu
中科院分区：
文献类型：
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作者：
Yamamoto, Hideyuki;Yamada, Takechiyo;Fujieda, Shigeharu
半胱氨酰白三烯和白三烯受体占有率与季节性变应性鼻炎（SAR）的几个过程有关，包括鼻塞、鼻溢液和炎症细胞的募集。我们研究了是否增加氯雷他定，抗组胺药，可能是有效的SAR患者表现出不满意的控制症状与白三烯受体拮抗剂（LTRA）孟鲁司特单用。由日本雪松花粉引起的SAR患者（SAR-JCP;平均年龄29.4岁）在JCP峰值消散前预防性给予孟鲁司特1个月。患者每天在视觉模拟量表（VAS）上记录症状（打喷嚏、流涕、鼻塞和眼部症状）的严重程度。我们选择了在花粉高峰期（3月2日至3月8日）之前任何症状VAS评分> 50的患者，并将其指定为“控制不良”患者。然后，在JCP的高峰期（从3月9日开始），我们进行了一项随机、双盲、安慰剂对照研究，以确定附加氯雷他定是否对这些“控制不佳”的患者有效。单用孟鲁司特有效，通过VAS评分的改善进行评价，137例患者中有95例（69.3%）。与安慰剂组相比，氯雷他定辅助治疗显著降低了鼻部症状（p < 0.05）、打喷嚏（p < 0.05）和流涕（p < 0.05）的总评分。3例SAR-JP患者中有2例在JCP轻度消散的情况下，通过单独使用孟鲁司特预防性治疗可控制SAR症状（VAS评分[s]低于50）。此外，在选定的SAR-JCP患者中发现了添加抗组胺药对打喷嚏和流涕的影响。
Cysteinyl leukotriene and leukotriene receptor occupancy have been linked to several processes in seasonal allergic rhinitis (SAR), including nasal congestion, rhinorrhea, and recruitment of inflammatory cells. We investigated whether add-on loratadine, an antihistamine, might be effective for SAR patients showing unsatisfactory control of symptoms with the leukotriene receptor antagonist (LTRA) montelukast alone. Patients with SAR caused by Japanese cedar pollen (SAR-JCP; mean age, 29.4 years) were given prophylactic montelukast for 1 month before peak JCP dispersal. Patients recorded the severity of the symptoms (sneezing, rhinorrhea, nasal congestion, and ocular symptoms) daily on visual analog scale (VAS). We selected patients with VAS scores of > 50 for any of the symptoms just before the peak pollen season (March 2 to March 8) and designated them as "poorly controlled" patients. Then, in the peak JCP season (from March 9), we conducted a randomized, double-blind, placebo-controlled study to determine whether add-on loratadine might be effective for these "poorly controlled" patients. Montelukast alone was effective, as evaluated by improvement of the VAS scores, in 95 of the 137 patients (69.3%). Add-on loratadine significantly decreased the total scores for nasal symptoms (p < 0.05), sneezing (p < 0.05), and rhinorrhea (p < 0.05) when compared with placebo. The symptoms of SAR in two of three SAR-JP patients could be controlled (VAS score[s] under 50) by prophylactic treatment with montelukast alone under the condition of mild JCP dispersal. Furthermore, the effect of add-on antihistamine on sneezing and rhinorrhea was found in selected SAR-JCP patients.