Antileukotriens: new adjunctive therapeutic option in allergic rhinitis and nasal polyposis

ABSTRACT

Allergic rhinitis is one of the most prevalent medical conditions. Almost 40% of the allergic rhinitis patients have lower airways involvement, whereas more than 80% of the allergic asthma patients have concomitant rhinitis symptoms. Therapeutic options include allergen avoidance, antihistamines and intranasal corticosteroids and recently, antileukotrienes. The objective of this study was to determine the efficacy of leukoriene receptor antagonist in the medical management of allergic rhinitis and nasal polyposis as an adjuctive therapy to antihistamines and corticosteroids. The 50 patients recruited for this study were divided into three groups; group I included 23 allergic rhinitis patients without nasal polyposis where antileukotrien [montelukast 10 mg once per day] was given in combination with the antihistaminic [loratadine] 10 mg for 6 months. Group II; included 11 patients with nasal polyposis who were undergoing daily intranasal steroid sprays fluticasone, 200 micro g and antileukotriene was given as an adjunctive therapy. Group III; included 16 nasal polyposis patients who underwent endoscopic ethmoidectomy and bilateral maxillary antrostomy. Treatment administered after surgery was 10 mg of montelukast once daily for 6 months in 9 patients and in a control group of 7 subjects; fluticasone 200 micro g nasal spray and loratadine tablets 10 mg once per day. Six months follow-up for the three groups included rhinoendoscopy, anterior rhinomanometry and computerized tomography [CT]. Group I. revealed clinical subjective improvement in 19 patients [82.6%]. Nasal symptoms; itching, postnasal discharge, headache sneezing and rhinorrhea were improved .There was also a significant improvement in objective assessment. Clinical subjective improvement in group II was experienced only by 3 patients [27%]. Patients in Group III showed in both subgroups total absence of any local recurrence and good nasal patency. Leukotriene synthesis inhibitors appear to be a novel treatment modality for patients with allergic rhinitis when used as adjunctive or alternative therapy. They might play a role in controlling polyposis and their symptoms, and might be an alternative to longterm steroid therapy and repeated surgical therapy