Leukotriene receptor antagonists in monotherapy or in combination with antihistamines in the treatment of chronic urticaria: a systematic review

Abstract

Gabriele Di Lorenzo1, Alberto D’Alcamo1, Manfredi Rizzo1, Maria Stefania Leto-Barone1, Claudia Lo Bianco1, Vito Ditta1, Donatella Politi1, Francesco Castello1, Ilenia Pepe1, Gaetana Di Fede2, GiovamBattista Rini11Dipartimento di Medicina clinica e delle Patologie Emergenti; 2Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, ItalyAbstract: In vitro and in vivo clinical and experimental data have suggested that leukotrienes play a key role in inflammatory reactions of the skin. Antileukotriene drugs, ie, leukotriene receptor antagonists and synthesis inhibitors, are a class of anti-inflammatory drugs that have shown clinical efficacy in the management of asthma and in rhinitis with asthma. We searched MEDLINE database and carried out a manual search on journals specializing in allergy and dermatology for the use of antileukotriene drugs in urticaria. Montelukast might be effective in chronic urticaria associated with aspirin (ASA) or food additive hypersensitivity or with autoreactivity to intradermal serum injection (ASST) when taken with an antihistamine but not in mild or moderate chronic idiopathic urticaria [urticaria without any possible secondary causes (ie, food additive or ASA and other NSAID hypersensitivity, or ASST)]. Evidence for the effectiveness of zafirlukast and the 5-lipoxygenase inhibitor, zileuton, in chronic urticaria is mainly anecdotal. In addition, there is anecdotal evidence of effectiveness of antileukotrienes in primary cold urticaria, delayed pressure urticaria and dermographism. No evidence exists for other physical urticarias, including cholinergic, solar and aquagenic urticarias, vibratory angioedema, and exercise-induced anaphylaxis.Keywords: chronic idiopathic urticaria, leukotriene receptor antagonists, montelukast, zafirlukast, antihistamine