Montelukast is not effective in controlling allergic symptoms outside the airways: a randomised double-blind placebo-controlled crossover study.

BACKGROUND: Subjects with atopic syndrome often perceive symptoms from various organs. A single drug that acts on all the syndrome's manifestations would be the ideal treatment. The role of montelukast, a cysteinyl-leukotriene receptor antagonist, is established in treating allergic rhinitis and asthma, but its ability to alleviate atopic symptoms outside the airways is controversial. Our aim was to assess if montelukast could be used to treat all the various symptoms seen in subjects with atopic syndrome. METHODS: A randomised, double-blind, placebo-controlled crossover study on the effect of montelukast in atopic syndrome was conducted during the 2007 pollen season. Forty-five pollen-sensitised subjects who had allergic symptoms from both the upper and lower airways and allergic symptoms outside the airways (conjunctivitis, oral symptoms, eczema and/or urticaria) were recruited. The primary outcome parameter was the allergic symptoms, which were assessed using a questionnaire. Secondary outcome parameters were lower-airway inflammation (exhaled nitric oxide) and the need for rescue medication (inhaled beta2-agonists and oral antihistamines). RESULTS: There were no differences between montelukast and placebo treatments in allergic symptoms, in exhaled NO concentration or in the need for oral antihistamines. The need for inhaled beta2-agonists was significantly lower during montelukast treatment. CONCLUSIONS: Montelukast was not effective in treating allergic symptoms outside the airways in subjects suffering from different manifestations of the atopic syndrome. Based on the current results, montelukast should not be recommended as a general drug to treat all the symptoms of atopic syndrome, but it should be considered as a drug for asthma and rhinitis.

IgE reactivity pattern to timothy and birch pollen allergens in Finnish and Russian Karelia.

BACKGROUND: Little is known about differences in IgE reactivity patterns to individual allergens in random populations. We studied the IgE reactivity profile to individual recombinant (r) and native (n) allergens in sera from subjects sensitized to timothy and/or birch pollen living in Finnish and Russian Karelia. METHODS: Sera from IgE-sensitized adults were obtained from an epidemiological study on a random sample of 1,177 subjects. The IgE reactivity to pollen extracts and eight timothy (rPhl p 1, 2, 5, 6, 7, 11, 12 and nPhl p 4) and three birch pollen allergens (rBet v 1, 2 and 4) were analyzed with UniCAP. RESULTS: The levels of IgE antibodies to timothy and birch pollen were higher in Finnish (median 5.2, range 0.35 to >100 kUA/l,) than in Russian Karelia (median 1.8 kUA/l, range 0.43-25.2 kUA/l, p <0.01). There was a significantly higher prevalence of IgE reactivity to three timothy pollen allergens in Finnish (n=57) than in Russian Karelia (n=12): rPhl p 2, 28 vs. 0%; rPhl p 5, 60 vs. 0%; rPhl p 6, 47 vs. 0%. The prevalence of IgE reactivity to the birch pollen allergens was similar in the two populations. IgE reactivity to rPhl p 2, 5, 6 and 11 was associated with hay fever symptoms. The timothy-pollen-specific serum IgE levels and the numbers of IgE reactivities to individual allergens correlated significantly (rs=0.87, p <0.0001). CONCLUSIONS: The data indicate that timothy- and birch pollen-specific IgE levels are higher in Finnish compared to Russian Karelia. This is reflected in wider IgE reactivity to individual timothy pollen allergens in Finnish Karelia, including the major allergen Phl p 5, and increased pollen allergy.