Comparative effects of fexofenadine and montelukast on allergen-induced wheal and flare.
ABSTRACT Comparisons of the efficacy, onset and duration of action of fexofenadine and montelukast are limited. This study evaluated the pharmacodynamic properties of these agents in an allergen-induced wheal-and-flare model. This randomized, placebo-controlled, crossover study was composed of three treatment periods and two visits on consecutive days for each period, with each period separated by a 14-day (+/-4) washout. At each treatment visit, subjects received a predose allergen skin-prick test followed by either a single dose of fexofenadine HCl 180 mg, montelukast sodium 10 mg, or placebo. Allergen skin-prick testing was performed at 20, 40, and 60 minutes, then hourly through 12 hours and at 23 hours and 24 hours postdose. Adults (n = 48) with positive skin-prick tests were included in the analysis. Significant flare inhibition occurred from 40 minutes through 24 hours postdose for fexofenadine versus placebo (p < 0.05), whereas montelukast did not reach statistical significance for flare inhibition at any time point compared with placebo. Significant wheal inhibition occurred from 60 minutes through 24 hours postdose for fexofenadine versus placebo (p = 0.0012); montelukast did not significantly suppress wheal versus placebo at any time point. Fexofenadine had greater suppression than montelukast for both wheal and flare from 40 minutes through 24 hours (p < .05). Maximum suppression of flare and wheal reached 79.0 and 72.3% for fexofenadine, and 7.3 and 9.6% for montelukast. Fexofenadine suppressed the allergen-induced wheal-and-flare response to a significantly greater extent, and had a significantly faster onset of action, compared with montelukast.
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Article: Treatment of chronic urticaria.[Show abstract] [Hide abstract]
ABSTRACT: Urticaria is a disorder characterized by rapid onset of localized swelling of the skin or mucosa, called wheals or urtica. According to frequency and duration, urticaria can be divided into acute and chronic type. Chronic urticaria is any type of urticaria occurring every day or twice per week, lasting longer than 6 weeks. Chronic urticaria is a common disorder and estimated prevalence is 1% of the population. Also, it is not rare in childhood. The pathogenesis of chronic urticaria has not yet been completely understood. Chronic urticaria is a heterogeneous group of disorders, and according to the etiology and cause, several groups of chronic urticaria are distinguished, i.e. autoimmune, pseudoallergic, infection-related, physical urticaria, vasculitis urticaria and idiopathic urticaria. Treatment and management of chronic urticaria can be non-pharmacological and pharmacological, and sometimes it is not possible to control the disease with antihistamines only, which are considered to be the mainstay of treatment. In severe cases of chronic urticaria, especially if autoimmunity has been proven, several authors describe different modules of immunomodulation: cyclosporine, cyclophosphamide, mycophenolate-mofetil, omalizumab, plasmapheresis, systemic corticosteroids, and immunoglobulin therapy. This article primarily addresses the treatment of chronic idiopathic and autoimmune urticaria.Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo 12/2009; 17(4):305-22. · 0.58 Impact Factor
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ABSTRACT: Because antileukotrienes may inhibit inflammation, it is plausible that montelukast administered for a long time could suppress skin wheal and flare reaction, and thus, it should be discarded prior to the tests. This study assessed the effect of long-lasting treatment with montelukast alone or in combination with antihistamines on wheal and flare in skin pricks tests (SPT) in patients sensitized to perennial allergens. We conducted a 32-week, double-blind, placebo-controlled, cross-over and randomized trial that implicated two arms: arm A, 20 patients received levocetirizine, montelukast with or without levocetirizine or placebo; arm B, 20 patients received desloratadine, montelukast with or without desloratadine or placebo. All treatment periods lasted 6 weeks and were separated by 2-week washouts. At baseline and on the last day of each treatment period, SPT were performed in all participants. Both levocetirizine and desloratadine in monotherapy, or in combination with montelukast, were effective in reducing wheal and flare in SPT. Monotherapy with montelukast did not change the size of the wheal for either histamine or for house dust mites, in either arm of the study, but significantly reduced the size of flare for histamine in arm A. Addition of montelukast to antihistamine did not exceed efficacy of monotherapy with antihistamine in both arms of the study. Since the size of wheal determines the results of SPT, montelukast, even taken for a long time, does not have to be discarded prior to the tests.Agents and Actions 11/2013; 63(3). DOI:10.1007/s00011-013-0688-y · 2.14 Impact Factor
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ABSTRACT: 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 (5mg per day), fexofenadine HCl (60mg 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, 24h 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.International journal of pediatric otorhinolaryngology 08/2013; 77(10). DOI:10.1016/j.ijporl.2013.07.019 · 0.85 Impact Factor