Dermatologic and Ocular DiseasesThe addition of zafirlukast to cetirizine improves the treatment of chronic urticaria in patients with positive autologous serum skin test results
Section snippets
Subjects
Patients with chronic urticaria were recruited from 7 centers. Enrollment criteria required that patients be 12 years of age or older, have a history of urticaria for at least 6 weeks' duration, and have at least 6 hives present 2 days per week. Only subjects with a history of a suboptimal response to H1 antagonists were recruited. Therefore, a treatment effectiveness score (TES) of less than 5 while taking an H1 antagonist (on a scale of 0 to 10) was required at the time of enrollment.
Study design
Fig 1
Results
Table I summarizes the demographic characteristics of the population studied and displays the baseline (post-randomization) TES and VAS scores. There were no statistically significant differences between the groups. A total of 95 patients were enrolled with 86 completing the study. Numbers of patients at visits 4, 5, and 6 were 95, 90, and 86, respectively. There were 3 and 6 patients in the combination and monotherapy groups, respectively, who did not complete the study. Those who dropped from
Discussion
Leukotrienes have been identified as potentially important bioactive mediators that participate in the pathogenesis of chronic urticaria.24 The purpose of this study was to determine whether blocking LTD4 receptors with a leukotriene receptor antagonist (zafirlukast) in combination with an H1 antagonist was more effective than an H1 antagonist alone in the treatment of refractory chronic urticaria. We found that patients with chronic urticaria exhibiting an incomplete response to H1-antagonist
Acknowledgments
Investigator sites included Hal Nelson, Anjuli Nayak, Theodore Chu, Sheldon Spector, Jonathan Corren, and Albert Finn.
References (32)
- et al.
Leukotrienes, LTC4 and LTB4, in bronchoalveolar lavage in bronchial asthma and other respiratory diseases
J Allergy Clin Immunol
(1989) Vascular effects of leukotriene D4 in human skin
J Invest Dermatol
(1987)- et al.
Local effects of synthetic leukotrienes (LTC4, LTD4, LTE4, and LTB4) in human skin
J Invest Dermatol
(1983) - et al.
The effect of the oral leukotriene antagonist, ICI 204,219, on leukotriene D4 and histamine-induced cutaneous vascular reactions in man
J Allergy Clin Immunol
(1991) The leukotriene receptor antagonist montelukast in the treatment of chronic idiopathic urticaria: a single-blind, placebo-controlled, crossover clinical study
J Allergy Clin Immunol
(2002)- et al.
Comparative studies of functional and binding assays for IgG anti-Fc(episilon)RI alpha-subunit in chronic urticaria
J Allergy Clin Immunol
(1998) - et al.
Anti-Fc(epsilon)RI auto antibodies and basophil histamine releasability in chronic idiopathic urticaria
J Allergy Clin Immunol
(1998) - et al.
A double-blind, placebo-controlled trial of fexofenadine HCl in the treatment of chronic idiopathic urticaria
J Allergy Clin Immunol
(1999) - et al.
Successful treatment of autoimmune chronic idiopathic urticaria with intravenous cyclophosphamide
Ann Allergy Asthma Immunol
(2002) - et al.
Expression and localization of the cysteinyl leukotriene 1 receptor in human nasal mucosa
Clin Exp Allergy
(2002)
The preclinical pharmacology of ICI 204,219: a peptide leukotriene antagonist
Am Rev Respir Dis
Clinical practice: chronic urticaria and angioedema
N Engl J Med
Production and antagonism of cutaneous vascular permeability in the guinea pig in response to histamine, leukotrienes and A23187
J Pharmacol Exp Ther
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 Allergy
Zafirlukast has no beneficial effects in the treatment of chronic urticaria
Clin Exp Allergy
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