University Clinic of Respiratory and Allergic Diseases, Colnik, Slovenia.
Respir Med. 2011 Oct;105 Suppl 1:S84-8. doi: 10.1016/S0954-6111(11)70018-X.
Antihistamines (AH) alleviate pruritus and decrease the incidence of hives in patients with chronic idiopathic urticaria (CU). However, some patients do not respond completely to this therapy. We hypothesized that some of them might benefit from the addition of leukotriene receptor antagonists (LA).
We screened patients diagnosed and treated for CU and selected those that had symptoms despite antihistamine treatment. In a double-blind crossover study, patients took the leukotriene antagonist montelukast (10 mg per day) or placebo. Efficacy was assessed by a symptom score.
In a group of 22 patients, the symptom score was not significantly different between periods using montelukast (48.8; 0-214) or placebo (68.5; 0-230). However in the subgroup of five patients with the most severe urticaria, defined as patients with symptom scores in the upper quartile at inclusion in the study, montelukast (41; 11 214) was superior to placebo (95.5; 48 230; p < 0.05), but only when using an in-house symptom score questionnaire and not when using a validated urticaria activity score questionnaire.
We showed that in patients with antihistamine-resistant CU the addition of montelukast significantly diminished symptoms in only a small minority of patients. However, response to add-on montelukast was seen in the subgroup of patients with particularly severe disease. To confirm this observation, a study with a larger group of patients is warranted.
抗组胺药（AH）可缓解慢性特发性荨麻疹（CU）患者的瘙痒并降低风团的发生率。然而，有些患者对这种治疗方法反应不完全。我们假设他们中的一些人可能会从白三烯受体拮抗剂（LA）的加入中受益。
我们筛选了被诊断和治疗 CU 的患者，并选择了那些尽管接受抗组胺治疗仍有症状的患者。在一项双盲交叉研究中，患者服用白三烯拮抗剂孟鲁司特（每天 10 毫克）或安慰剂。通过症状评分评估疗效。
在 22 名患者的一组中，使用孟鲁司特（48.8；0-214）或安慰剂（68.5；0-230）的时间段内症状评分无显著差异。然而，在最严重荨麻疹的五名患者亚组中，定义为在研究纳入时症状评分处于上四分位数的患者，孟鲁司特（41；11-214）优于安慰剂（95.5；48-230；p<0.05），但仅当使用内部症状评分问卷而不是验证的荨麻疹活动评分问卷时。
我们表明，在抗组胺药耐药性 CU 患者中，仅少数患者添加孟鲁司特可显著减轻症状。然而，在疾病特别严重的患者亚组中观察到对附加孟鲁司特的反应。为了证实这一观察结果，需要进行一项有更大患者群体的研究。
