Leukotriene receptor antagonists as adjuvant therapy of antihistamines in chronic urticaria: a systematic review and meta-analysis.

Certain guidelines recommend a second-generation H1-antihistamine (AH) as first-line treatment for patients with chronic urticaria (CU). However, some patients show insufficient response to a standard dose of this therapy and might benefit from adding leukotriene receptor antagonists (LTA). Therefore, we aimed to perform a systematic review and meta-analysis comparing LTA plus antihistamines with antihistamines alone. We performed a systematic review and meta-analysis, searching PubMed, EMBASE, and Cochrane Central for randomized clinical trial (RCT) data comparing LTA plus AH treatment to AH alone in patients with CU. Statistical analysis was performed using R Studio 4.3.2. Heterogeneity was assessed with I2 statistics. Three studies comprising 234 patients with urticaria were included. The mean age was 37.23 years in the leukotriene antagonist + antihistamines (LTA + AH) group and 39.14 years in the antihistamines (AH) group. Follow-up ranged from 2 to 18 months between studies. There was no statistically significant difference between groups in terms of TSS level (SMD: -74.82; 95% CI: -222.66 to 73.02; P = 0.32; I2 = 98%), neither in terms of pruritus (MD: -0.07; 95% CI: -0.42 to 0.28; P = 0.70; I2 = 74%). After sensitivity analysis, with the systematic exclusion of each study from the grouped estimates, the result for TSS level did not change. These findings suggest that leukotriene receptor antagonists with antihistamines do not have better outcomes than antihistamines alone regarding TSS and pruritus in patients with CU.

An online survey detected knowledge gaps and cost-saving opportunities in asthma maintenance treatment among allergists, pulmonologists, ENTs and primary care.

BACKGROUND: In April 2017 the Mexican Asthma Guidelines (GUIMA) were published. Before the launch, physicians' knowledge was explored related to key issues of the guideline. METHODS: A SurveyMonkey® survey was sent out to board-certified physicians of 5 medical specialties treating asthma. Replies were analyzed per specialty against the GUIMA evidence-based recommendations. We present the treatment part here. RESULTS: A total of 364 allergists (ALLERG), 161 pulmonologists (PULM), 34 ENTs, 239 pediatricians (PED) and 62 general practitioners (GPs) replied to the survey and 247-83-14-135-37 respectively finished it. Spirometry is not routinely indicated when asthma is very probable by ALLERG 54%, PULM 47%, ENT 39%, PED 65%, GP 64%. A fictitious case proposed to the physicians with intermittent asthma was erroneously treated with ICS by ALLERG 9%, PULM 11%, ENT 28%, PED 10%, GP 11%. The mild persistent case received mistakenly ICS-LABA by ALLERG 25%, PULM 26%, ENT 33%, PED 27%, GP 23%. The first-line option for moderate persistent asthma was ICS(median dose) instead of ICS(low)+LABA for ALLERG 29%, PULM 25%, ENT 17%, PED 27%, GP 23% and in severe asthma maintenance treatment PULM20%, ALLERG-ENT-PED-GP 22-34% failed to indicate LABA. Concerning the guidelines' recommendation to use one inhaler for maintenance & rescue in moderate-to-severe asthma, PULM45%, ALLERG-ENT-PED-GP 56-80% (p < 0.00001), erroneously indicated ICS-salmeterol could be used, instead of ICS-formoterol. Oral ß2 or theophylline are no longer recommended, but PULM 37% and ALLERG-ENT-PED-GP 42-62% (p < 0.01) still indicate their use. In severe asthma 61-73% of physicians consider adding LTRA to the treatment; only PULM38%, OTHERS12-25% consider adding tiotropium (p < 0.001) and 3-17% consider adding omalizumab, both guideline recommended add-ons. As for asthma in pregnancy, most surveyed are not aware budesonide is the 1st line option ICS. Finally, 81-97% of the group-members recognized allergen immunotherapy, as a viable add-on, in line with GINA/GEMA/GUIMA recommendations. CONCLUSIONS: An online survey could detect knowledge-gaps related to asthma treatment. Interestingly, surveyed physicians tended to over-treat the milder asthma cases, thus clearly leaving room for cost-savings. Caution should be taken in the promotion of the SMART (single-maintenance-and-reliever-treatment) approach, which can only be done with ICS-formoterol. Many physicians opt for other combinations not apt for this approach. Among all surveyed specialties there is ample room for improvement in mild and severe asthma management.

Evaluación clínica de niños con rinitis alérgica tratados con montelukast / Clinical Evaluation in Children with Allergic Rhinitis Treated with Montelukast

Introducción: la rinitis alérgica es un trastorno sintomático, con inflamación de la mucosa nasal mediada por IgE e inducida por la exposición a alérgenos. Sus tres síntomas cardinales son la obstrucción nasal, los estornudos y la rinorrea. La rinitis alérgica es un problema global que va aumentando su prevalencia. Objetivo: evaluar la efectividad del montelukast en los niños con rinitis alérgica persistente perteneciente al Policlínico René Ávila Reyes de Holguín durante el periodo de octubre de 2012 a febrero de 2013. Método: se realizó un estudio analítico prospectivo en 20 pacientes pediátricos con rinitis alérgica persistente con edades entre los 6 y 19 años. Las variables estudiadas fueron sexo, edad, otras enfermedades alérgicas, síntomas nasales diurnos, síntomas nocturnos, síntomas oculares diurnos y valor total de eosinófilos. Se utilizó la prueba de McNemar con un p=0,01. Resultados: predominaron 12 pacientes del sexo masculino, (60,0%), 16 pacientes con asma bronquial (80,0%) y 8 con dermatitis atópica (40,0%). Antes del tratamiento 20 niños presentaban prurito nasal, luego del mismo solo un niño mantuvo esta condición (5,0%); 16 niños presentaban congestión nasal (80,0%) después del tratamiento solo un niño conservó esta condición (5,0%). Antes del tratamiento solo un paciente presentaba valores normales de la eosinófilos y luego del mismo esta cifra aumentó a 17 niños para el 85,0%. Conclusiones: en el grupo de estudio predominaron los pacientes masculinos, adolescentes y con asma bronquial. El montelukast fue efectivo en el manejo y control de los síntomas de los pacientes con rinitis alérgica.

Introduction: Allergic rhinitis is an IgE-mediated inflammation of the nasal mucosa induced after allergen exposure and presents with the 3 cardinal symptoms of sneezing, nasal obstruction, and rhinorrhea. Allergic rhinitis is a global health problem and is increasing in prevalence. Objective: to evaluate the effectiveness of montelukast in children with persistent allergic rhinitis in the Rene Avila Reyes Polyclinic, in Holguín, from October 2012 to February 2013. Methods: a prospective analytical study was performed including 20 patients aged from 6 to 19 years old. The variables analyzed in the study were: sex, age, other allergicdiseases, nasal symptoms in the day, symptoms in the night, and ocular symptoms in the day and total eosinophils. For comparative analysis we used the McNemar test p=0.01. Results: 12 patients (60.0%) of male sex were found, 16 (80.0%) with Bronchial Asthma and 8 (40.0%) with atopic dermatitis. Before the treatment 20 patients had nasal itch, 16 had nasal obstruction and 1 patient had normal levels of eosinophils. After treatment with montelukast 1 patient (5.0%) had nasal itch and nasal obstruction and 3 patients had high levels of eosinophils. Conclusions: in the population had prevalence of male patients, adolescents and with Bronchial Asthma. Montelukast was effective for managing and control of symptoms the patients with Allergic Rhinitis.

Bloqueio do receptor de leucotrieno CysLT1 em pacientes com fenômeno de Raynaud: evidência capilaroscópica do papel do leucotrieno / CysLT1 receptor inhibition in patients with Raynaud's phenomenon: capillaroscopic evidence of the role of leukotriene

OBJETIVO: Avaliar a ação do medicamento inibidor do receptor de leucotrieno CysLT1 (montelucaste) nas alterações vasculares das mãos em pacientes com fenômeno de Raynaud. MÉTODOS: Foram selecionadas pacientes com fenômeno de Raynaud secundário à doença inflamatória do tecido conjuntivo, excluindo tabagismo, hipertensão arterial e diabetes mellitus. As pacientes mantiveram a medicação prévia e iniciaram o uso de montelucaste 10 mg/dia por 60 dias. Foi realizada capilaroscopia periungueal dos dedos das mãos antes do uso da medicação e após 30 e 60 dias. A análise estatística foi feita por meio de porcentagem, média, desvio-padrão e teste exato de Fisher, com intervalo de confiança de 95 por cento. RESULTADOS: Foram estudadas cinco pacientes mulheres, brancas, com fenômeno de Raynaud secundário a doenças do tecido conjuntivo, das quais três apresentavam esclerodermia e duas apresentavam doença mista do tecido conjuntivo. A média de idade foi de 42,4 ± 12,4 anos, e a média de tempo de doença foi de 9,6 ± 4,8 anos. As pacientes estavam em uso de até 20 mg/dia de prednisona (pacientes com doença mista do tecido conjuntivo), nifedipina, pentoxifilina. As medicações foram mantidas. Após o uso de inibidor de receptor de leucotrieno por dois meses, o controle com capilaroscopia ungueal demonstrou diminuição do edema e da palidez e normalização do número, tamanho e distribuição dos capilares. CONCLUSÃO: O uso do montelucaste modificou as alterações capilares observadas na capilaroscopia periungueal de pacientes com fenômeno de Raynaud.

OBJECTIVE: To assess the effect of the leukotriene receptor inhibitor (montelukast) on vascular alterations in fingers of patients with Raynaud's phenomenon. METHODS: Patients with Raynaud's phenomenon of the hands secondary to inflammatory connective tissue disease were selected, and those with the following characteristics were excluded: smokers, arterial hypertension, and diabetes mellitus. All patients maintained their previous medications and started the use of montelukast, 10 mg/day, for 60 days. Naifold capillaroscopy of fingers was performed before the use of medication and after 30 and 60 days. Statistical analysis was performed with percentage, media, standard deviation, Fisher exact test, with 95 percent of confidence interval. RESULTS: The study assessed five Caucasian, female patients with Raynaud's phenomenon secondary to inflammatory connective tissue disease (three with scleroderma and two with mixed connective tissue disease), aged 42.4 ± 11.5 years, and with 9.6 ± 4.8 years of disease duration. Patients were on nifedipine and pentoxifylline, and those with mixed connective tissue disease were also on prednisone. The medications were maintained. After using montelukast for two months, nailfold capillaroscopy showed a reduction in edema and pallor, and normalization of capillary number, size, and distribution. CONCLUSION: The use of montelukast modified the capillary abnormalities observed on nailfold capillaroscopy of patients with Raynaud's phenomenon.

Tratamiento farmacológico para el control del asma en el niño

El presente artículo presenta las recomendaciones de un grupo de expertos venezolanos reunidos en Caracas en Octubre de 2009 por la Sociedad Venezolana de Puericultura y Pediatría en relación al tratamiento farmacológico del asma infantil. Se presentan los objetivos del tratamiento, los medicamentos recomendados, la terapia inicial y de mantenimiento y el tipo de dispositivo para la administración de drogas por vía inhalatoria, de acuerdo a la edad del paciente.

This article presents the recommendations made by a group of Venezuelan experts during a consensus meeting held in Caracas in October, 2009, under the auspices of the Venezuelan Society of Pediatrics, on the pharmacological treatment of childhood asthma. Goals of treatment, recommended medications, initial and maintenance therapy, and devices utilized for delivery of inhaled drugs according to patient’s age are presented.