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The Emerging Role of Leukotriene Modifiers in Allergic Rhinitis

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American Journal of Respiratory Medicine

Abstract

Leukotriene modifiers have been shown to be efficacious in the treatment of asthma. Because of this success, and the fact that leukotrienes can be recovered not only from bronchoalveolar lavage fluid but also nasal lavage fluid, some researchers have suggested that these medications may also be useful for treating allergic rhinitis. Because the upper and lower airways are linked physically, there has been an assumption that therapy for upper and lower airway disease should be similar. This critical appraisal examines available data both supporting and refuting the emerging role of leukotriene modifiers in the treatment of allergic rhinitis.

Although many studies have shown an improvement in nasal symptoms when comparing a leukotriene modifier with placebo, few studies have conclusively shown that a leukotriene modifier is any more effective in treating allergic rhinitis than an antihistamine. Results from several reported studies suggest that the addition of a leukotriene antagonist to an antihistamine is no more efficacious than antihistamine alone. However, many of these studies were small and/or primarily designed to examine the asthmatic response, with nasal symptoms being a lesser endpoint. To better understand how, where, and when leukotriene modifiers should be used in the armamentarium of therapies for allergic rhinitis, larger clinical investigations designed specifically to study allergic rhinitis need to be undertaken. We conclude that currently, the data do not support widespread use of a leukotriene modifier with or without an antihistamine in place of an intranasal corticosteroid with or without an antihistamine in the treatment of allergic rhinitis.

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Acknowledgments

Dr Grayson is on the speakers’ bureau for Merck and Co. Dr Korenblat has performed clinical trials, worked as a consultant, and is on the speakers’ bureau for AstraZeneca and Merck and Co. ## The source of funding for this manuscript came from the National Institutes of Health, grant number AI-01800 to Dr Grayson.

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  1. Division of Allergy and Immunology, Department of Internal Medicine, Washington University School of Medicine, Campus Box 8122, 660 South Euclid Avenue, Campus Box 8122, St Louis, Missouri, 63110, USA

    Mitchell H. Grayson & Phillip E. Korenblat

  2. The Clinical Research Center, St Louis, Missouri, USA

    Phillip E. Korenblat

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Correspondence to Mitchell H. Grayson.

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Grayson, M.H., Korenblat, P.E. The Emerging Role of Leukotriene Modifiers in Allergic Rhinitis. Treat Respir Med 2, 441–450 (2003). https://doi.org/10.1007/BF03256671

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