IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 4412 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
   Article in PDF (110 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Tables

 Article Access Statistics
    Viewed7866    
    Printed113    
    Emailed0    
    PDF Downloaded388    
    Comments [Add]    
    Cited by others 21    

Recommend this journal

 


 
LETTER TO EDITOR
Year : 2006  |  Volume : 72  |  Issue : 4  |  Page : 312-314

Oral montelukast monotherapy is ineffective in chronic idiopathic urticaria: A comparison with oral cetirizine


Shree Skin Centre, 21 and 22, L Market, Sector 8 Nerul, Navi Mumbai - 400 706, India

Correspondence Address:
Kiran V Godse
Shree Skin Centre, 21 and 22, L Market, Sector 8, Nerul, Navi Mumbai - 400 706
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0378-6323.26735

Rights and Permissions



How to cite this article:
Godse KV. Oral montelukast monotherapy is ineffective in chronic idiopathic urticaria: A comparison with oral cetirizine. Indian J Dermatol Venereol Leprol 2006;72:312-4

How to cite this URL:
Godse KV. Oral montelukast monotherapy is ineffective in chronic idiopathic urticaria: A comparison with oral cetirizine. Indian J Dermatol Venereol Leprol [serial online] 2006 [cited 2020 May 29];72:312-4. Available from: http://www.ijdvl.com/text.asp?2006/72/4/312/26735


Sir,

Chronic idiopathic urticaria (CIU) is a common cutaneous disorder, for which there is usually no identifiable cause.[1] H 1 -receptor antagonists are recommended as the first-line treatment in CIU. Chronic urticaria, which cannot be classified in any of the known causes, is described as chronic idiopathic urticaria. Recently, antileukotriene receptors such as montelukast, have been used, either as monotherapy, or in combination with H 1 -receptor antagonists.

We conducted a study to compare the efficacy of oral montelukast with oral cetirizine in the treatment of chronic idiopathic urticaria. Twenty patients (12 females and 8 males) in the age group of 20 to 60 years (mean age 31.2 years) with chronic urticaria, were enrolled in the study after an informed written consent. Exclusion criteria were physical urticaria, urticarial vasculitis, pregnant or lactating women, a history of sensitivity to aspirin or NSAIDs, a history of aggravation of symptoms by pressure, and a positive cutaneous test to autologous serum. Routine investigations like complete blood count, and urine and stool examination were done to rule out infections.

The patients were randomly allocated into two age- and sex-matched groups of 10 patients each [Table - 1]. Randomization was achieved with the help of randomization software. One group was given montelukast 10 mg and the other, cetirizine 10 mg daily in the evening for two weeks. Patients were evaluated at baseline, after a week. and at the end of two weeks.

Improvement was monitored by using the urticaria activity score (UAS) which was estimated at weekly intervals. The UAS consisted of the sum of the wheal number score and the itch severity score. The wheal numbers were graded from 0 to 3 as follows: 0, less than 10 small wheals (diameter, < 3 cm); 1, 10 to 50 small wheals. or less than 10 large wheals (diameter, >3 cm); 2, greater than 50 small wheals or 10 to 50 large wheals; and 3, almost the whole body is covered. The severity of the itching was also graded daily from 0 to 3 (0, none; 1, mild; 2, moderate; and 3, severe). Thus, the UAS ranged from 0 to 6 per week for each patient. Baseline average UAS was 4.6 in the montelukast group and 4.5 in the cetirizine group.

Eight out of ten patients in the montelukast group, reported within seven days of starting treatment due to worsening of itching and lesions, with UAS average score going up to 5.5 in eight patients, while two patients did not follow up. These eight patients were started on cetirizine, 10 mg daily in the evening, for control of urticaria. Treatment with montelukast as monotherapy failed to control the urticarial symptoms such as pruritus and hives. All patients in the cetirizine group showed control of symptoms, with UAS average score coming down to average of 2.2.

The effects of leukotriene receptor antagonists (LT-RA) in patients with CIU have been evaluated mostly, in a heterogeneous population of patients. The majority are anecdotal reports of chronic urticaria cases, and only a few placebo-controlled studies are reported.[2],[3],[4],[5],[6] Of these studies, four demonstrated a beneficial effect of LT-RAs,[2],[4],[5],[6] whereas one demonstrated that LT-RAs did not benefit the patients.[5] A clinical trial from Italy found that a combination of desloratadine and montelukast does not seem to offer a substantial advantage to desloratadine monotherapy in patients affected by moderate CIU.[7] In this trial, Di Lorenzo and coworkers reported the results of a placebo-controlled, double-blind examination of desloratadine, montelukast, both, or neither in 160 patients with moderate CIU. Desloratadine was clearly the most effective treatment. All of the 80 subjects who received desloratadine, completed the study. There was no additional benefit for any outcome, with the addition of montelukast to desloratadine. Monotherapy with montelukast was more effective than placebo, but montelukast was consistently less effective than desloratadine. Furthermore, 27 of the 40 subjects on montelukast monotherapy failed to complete the 6-week study, as did 35 of the 40 subjects receiving placebo. The results of this study do not support the use of LTRAs as either monotherapy or add-on therapy in moderate CIU, in patients with negative autologous serum skin tests, whose urticaria is not worse when challenged with aspirin or NSAIDs.[7] Moreover, montelukast has been reported to cause urticaria in a case report.[8]

This study could not be completed as the montelukast group of patients showed no control of symptoms, and patients demanded the rescue medication i.e., cetirizine. There are no published studies from India about use of montelukast in urticaria. While monotherapy with montelukast is probably not advisable, it needs to be validated in the Indian population, whether addition of montelukast to an antihistamine offers any additional advantage. Larger and better-designed studies are required to settle this question.

 
  References Top

1.Tharp MD. Chronic urticaria: Pathophysiology and treatment approaches. J Aller Clin Immunol 1996;98:325-30.  Back to cited text no. 1  [PUBMED]  
2.Pacor ML, Di Lorenzo G, Corrocher R. Efficacy of leukotriene receptor antagonist in chronic urticaria. A double-blind, placebo-controlled comparison of treatment with montelukast and cetirizine in patients with chronic urticaria with intolerance to food additive and/or acetylsalicylic acid. Clin Exp Aller 2001;31:1607-14.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Nettis E, Dambra P, D'Oronzio L, Loria MP, Ferrannini A, Tursi A. Comparison of montelukast and fexofenadine for chronic idiopathic urticaria. Arch Dermatol 2001;137:99-100.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Erbagci Z. The leukotriene receptor antagonist montelukast in the treatment of chronic idiopathic urticaria: A single-blind, placebo-controlled, crossover clinical study. J Aller Clin Immunol 2002;110:484-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Reimers A, Pichler C, Helbling A, Pichler WJ, Yawalkar N. Zafirlukast has no beneficial effects in the treatment of chronic urticaria. Clin Exp Aller 2002;32:1763-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Bagenstose SE, Levin L, Bernstein JA. The addition of zafirlukast to cetirizine improves the treatment of chronic urticaria in patients with positive autologous serum skin test results. J Aller Clin Immunol 2004;113:134-40.  Back to cited text no. 6    
7.Lorenzo GD, Pacor ML, Mansueto P, Pellitteri EM, Bianco CL, Ditta V, et al . Randomized placebo-controlled trial comparing desloratadine and montelukast in monotherapy and desloratadine plus montelukast in combined therapy for chronic idiopathic urticaria J Aller Clin Immunol 2004;114:619-25.  Back to cited text no. 7    
8.Minciullo PL. Montelukast-induced generalized urticaria. Ann Pharmacother 2004;38:999-1001.  Back to cited text no. 8    


    Tables

[Table - 1]

This article has been cited by
1 Management of urticaria: not too complicated, not too simple
M. Ferrer,J. Bartra,A. Giménez-Arnau,I. Jauregui,M. Labrador-Horrillo,J. Ortiz de Frutos,J. F. Silvestre,J. Sastre,M. Velasco,A. Valero
Clinical & Experimental Allergy. 2015; 45(4): 731
[Pubmed] | [DOI]
2 Treatment of Chronic Urticaria in Children with Antihistamines and Cyclosporine
Lisa Neverman,Miles Weinberger
The Journal of Allergy and Clinical Immunology: In Practice. 2014;
[Pubmed] | [DOI]
3 Leukotriene receptor antagonists for chronic urticaria: a systematic review
Nipun de Silva,Hasitha Damayanthi,Anoja Rajapakse,Chaturaka Rodrigo,Senaka Rajapakse
Allergy, Asthma & Clinical Immunology. 2014; 10(1): 24
[Pubmed] | [DOI]
4 Urticaires : diagnostic, prise en charge et traitement
A. Soria,C. Francès
La Revue de Médecine Interne. 2014;
[Pubmed] | [DOI]
5 Alternative Agents in Refractory Chronic Urticaria: Evidence and Considerations on Their Selection and Use
David A. Khan
The Journal of Allergy and Clinical Immunology: In Practice. 2013; 1(5): 433
[Pubmed] | [DOI]
6 Evidence-Based Management of Chronic Urticaria in Children
Ivan Pavic,Iva Hojsak,Jasna Cepin-Bogovic
Pediatric Allergy, Immunology, and Pulmonology. 2012; 25(4): 198
[Pubmed] | [DOI]
7 Add-on montelukast in antihistamine-resistant chronic idiopathic urticaria
Mitja Kosnik, Tjasa Subic
Respiratory Medicine. 2011; 105: S84
[VIEW] | [DOI]
8 Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report1 : Unmet clinical needs in chronic urticaria
Allergy. 2011; 66(3): 317
[VIEW] | [DOI]
9 The employment of leukotriene antagonists in cutaneous diseases belonging to allergological field
Nettis, E., DæErasmo, M., Di Leo, E., Calogiuri, G., Montinaro, V., Ferrannini, A., Vacca, A.
Mediators of Inflammation. 2011; 2010(art): 628171
[Pubmed]
10 Leukotriene receptor antagonists in monotherapy or in combination with antihistamines in the treatment of chronic urticaria: A systematic review
Di Lorenzo, G., DæAlcamo, A., Rizzo, M., Leto-Barone, M.S., Lo Bianco, C., Ditta, V., Politi, D., (...), Rini, G.
Journal of Asthma and Allergy. 2009; 2: 9-16
[Pubmed]
11 Chronic urticaria and treatment options
Godse, K.V.
Indian Journal of Dermatology. 2009; 54(4): 310-312
[Pubmed]
12 Montelukast is not effective in controlling allergic symptoms outside the airways: A randomised double-blind placebo-controlled crossover study
Lehtimäki, L., Petäys, T., Haahtela, T.
International Archives of Allergy and Immunology. 2009; 149(2): 150-153
[Pubmed]
13 Chronic autoimmune urticaria in children
Cherrez Ojeda, I., Cruz, E., León, R., Mantilla, R., Guerrero, T., Soria, J., Tafur, A., (...), Gabino, G.
Allergologia et Immunopathologia. 2009; 37(1): 43-47
[Pubmed]
14 Chronic autoimmune urticaria in children
I. Cherrez Ojeda,E. Cruz,R. León,R. Mantilla,T. Guerrero,J. Soria,A. Tafur,L. Chica,G. Gabino
Allergologia et Immunopathologia. 2009; 37(1): 43
[Pubmed] | [DOI]
15 Montelukast does not inhibit the late phase reaction in parthenium dermatitis
Chembolli, L., Srinivas, C.R.
Indian Journal of Dermatology. 2009; 54(1): 94
[Pubmed]
16 Therapeutic alternatives for chronic urticaria: An evidence-based review, part 1
Morgan, M., Khan, D.A.
Annals of Allergy, Asthma and Immunology. 2008; 100(5): 403-412
[Pubmed]
17 Therapeutic alternatives for chronic urticaria: an evidence-based review, part 1
Matt Morgan,David A. Khan
Annals of Allergy, Asthma & Immunology. 2008; 100(5): 403
[Pubmed] | [DOI]
18 An update on childhood urticaria and angioedema
Evan Bailey,Marcus Shaker
Current Opinion in Pediatrics. 2008; 20(4): 425
[Pubmed] | [DOI]
19 An update on childhood urticaria and angioedema
Bailey, E., Shaker, M.
Current Opinion in Pediatrics. 2008; 20(4): 425-430
[Pubmed]
20 Management of autoimmune urticaria
Inamadar, A., Palit, A.
Indian Journal of Dermatology, Venereology and Leprology. 2008; 74(2): 89-91
[Pubmed]
21 Antihistamines in the treatment of chronic urticaria
Jáuregui Presa, I., Ferrer, M., Montoro, J., Dávila, I., Bartra, J., Del Cuvillo, A., Mullol, J., (...), Valero, A.
Journal of Investigational Allergology and Clinical Immunology. 2007; 17(Suppl 2): 41-52
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow