AAAAI logo

Home

 Allergy & Asthma Disease Management Center
Funded by an educational grant from sanofi-aventis US


Ask the Expert Current Literature Quiz of the Month Allergy/Respiratory Digest CME Article Meetings/Calendars AAAAI Educational Resources Other Links Comments/Suggestions



AND THE ANSWERS ARE . . .

  1. Montelukast (Mont) a leukotriene antagonist, is more effective than most second/third generation antihistamines (AH) as monotherapy for AR
    False
  2. Second/third generation AH have a beneficial drying effect on watery nasal discharge because of their anti-cholinergic activity.
    False
  3. Nasal corticosteroid spray treatment is more effective than most AH in the treatment of the nasal congestion which occurs in perennial AR.
    True
  4. Pseudoephedrine can be given along with AH to enhance the beneficial effects on nasal itching.
    False
  5. Some AH do not affect cognitive function or auto driving capacity.
    True

Comments
AH are usually the first line therapy for AR. The current second/third generation AH are often very beneficial in reducing the itching, sneezing and watery nasal discharge in AR. However, this reduction in nasal discharge is not due to anti-cholinergic effects since the newer AH (unlike the first generation AH) have little blocking effect at the cholinergic receptor. These newer AH are also much less lipophilic and therefore pass into the central nervous system much less than older AH such as diphenhydramine. Therefore, some of these newer AH such as fexofenadine do not significantly reduce cognitive/driving capacity.

AH should be tried first in the treatment of AR. Nasal congestion in AR may be reduced by treatment with fexofenadine or desloratadine but sometimes not sufficiently in some cases (perhaps because mediators other than histamine are responsible for the congestion). Therefore, nasal corticosteroid therapy (which usually markedly reduces such nasal congestion) is generally more effective in reducing nasal congestion in studies in which it is compared to AH treatment. Pseudoephedrine is a vasoconstrictor that may reduce nasal congestion but has no effects on the (histamine-mediated) nasal itching of AR.

A number of studies have shown some efficacy of Mont, a leukotriene antagonist, in the treatment of AR, when compared to placebo. However, most studies have shown no greater efficacy of Mont than of current AH when used as a monotherapy of AR. In some studies, the efficacy of Mont was much less than AH. Some, but not other, studies have shown a modest additive benefit when Mont treatment was added to AH therapy in AR.

Reference
1. Arch Intern Med 2001;161:2581-87
2. J Allergy Clin Immunol 2005;35:207-12
3. Clin Exp Allergy 2002;32:1504-9
4. Arch Otolaryngol Head Neck Surg. 2005;131:223-8
5. Clin Exp Allergy 2005;35:207-12




Please tell us what you think of this site.