|Marcin Kurowski, Marek L. Kowalski|
Leukotrienes (LTs)B4, C4, D4 adn E4 are main arachidonic acid metabolites. They are release, among others, from mast cells, eosinophils and basophils and play major role in development as well as sustaining of the allergic inflammation. Leukotrienes C4, D4 and E4 are responsible for the majority of the clinical symptoms of allergic diseases.
Antileukotriene drugs have been employed in the asthma treatment for many years. The concept of united airways disease, or a common inflammatory process underlying allergic diseases of the upper and lower airways, as well as clinical efficacy of antileukotrienes in the treatment of asthma, justify the attempts to use leukotriene modifiers in the treatment of allergic rhinitis (AR). In 2004 a meta-analysis of 11 studies on antileukotrienes efiicacy in the treatment of AR was published. Antileukotrienes proved to be significantly more efficient than placebo in reducing symptoms and improving quality of life. Their efficacy was comparable to that antihistamines yet significantly lower than the efficacy of topical steroids. In some studies it was shown that the efficacy of intranasal steroids and concomitantly administered antihistamine and antileukotriene agent, in reducing daytime AR symptoms are comparable. Few studies have addressed prophylactic properties of antileukotriene drugs. It was noticed that these drugs, when applied together with an antihistamine several weeks before the pollen season, may contribute to the alleviation of clinical AR symptoms during natural allergen exposure.
Encouraging results of the so far conducted studies have allowed placement of antileukotrienes in the AR treatment guidelines being part of the ARIA document. Antileukotriene drugs may constitute useful add-on treatment, on top of the existing antihistamine or intranasal steroid. They may also allow tapering the dose of topical steroids or even their complete withdrawal.
keywords: leki antyleukotrienowe, alergiczny nieżyt nosa, leczenie, farmakoprofilaktyka, antileukotriene drugs, allergic rhinitis, treatment, pharmacoprophylaxis
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