Rajput Muhammad Shaheryar Ahmed, Arain Asif Ali, Rajput Arsalan A, Adeel Mohammad, Ghaffar Shehzad, Suahil Anwar
Otolaryngology, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.
Otolaryngology, Head and Neck Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU.
Cureus. 2020 Mar 25;12(3):e7403. doi: 10.7759/cureus.7403.
Introduction Rhinitis is a common respiratory disorder that can be broadly defined as an inflammation of nasal mucosa. Allergic rhinitis is the most common form of chronic rhinitis characterized by one or more symptoms including sneezing, nasal itching, nasal congestion, postnasal drip, and rhinorrhea. Montelukast is an antagonist to the leukotriene receptor. It is non-sedating, dosed once daily, and has a safety profile similar in adults and children, with approval down to six months of age. The purpose of the study was to see the improvement in the severity of symptoms of the patients with allergic rhinitis treated with montelukast. Methods The symptom severity score for allergic rhinitis was calculated by asking the patient to evaluate the severity of individual symptoms (sneezing, nasal congestion, rhinorrhea, and postnasal drip) against the 4-point scoring scale over the last 24 hours. After explaining the scoring system to the patient, a proforma was filled before starting the treatment. A dose of 10 mg of montelukast once daily was prescribed. On the follow-up visit after four weeks of therapy, compliance was ensured and then the symptom severity score was recorded again on the proforma. The total nasal symptom severity score (TNSSS) was calculated as a sum of all four nasal symptoms. Pre- and post-treatment mean of TNSSS was compared using a t-test. P-value of less than 0.05 was considered significant. Results A total of 140 patients were included in the study. The mean age was 30 years. The minimum age was 15 years and the maximum age was 45 years. There were 93 males and 47 females. The difference between pre- and post-mean values of TNSSS was 5.82. Both pre- and post-mean of TNSSS were compared using the t-test, and P-value was significant, i.e., <0.005. Conclusions The common symptoms of allergic rhinitis evaluated in the study showed improvement in response to the treatment with montelukast. The improvement in symptom severity score was maximum in sneezing and least in rhinorrhea. In light of recent developments on neuropsychiatric adverse effects and FDA warnings, caution needs to be exercised to reserve the use of montelukast for the selected patients.
引言
鼻炎是一种常见的呼吸道疾病，广义上可定义为鼻黏膜炎症。变应性鼻炎是慢性鼻炎最常见的形式，其特征为一种或多种症状，包括打喷嚏、鼻痒、鼻塞、鼻后滴漏和流涕。孟鲁司特是白三烯受体拮抗剂。它无镇静作用，每日给药一次，在成人和儿童中的安全性相似，已获批用于6个月及以上儿童。本研究的目的是观察孟鲁司特治疗变应性鼻炎患者症状严重程度的改善情况。
方法
通过让患者根据过去24小时内的4分制评分量表评估个体症状（打喷嚏、鼻塞、流涕和鼻后滴漏）的严重程度，计算变应性鼻炎的症状严重程度评分。向患者解释评分系统后，在开始治疗前填写一份表格。开具每日一次10毫克孟鲁司特的剂量。在治疗四周后的随访中，确保患者依从性，然后再次在表格上记录症状严重程度评分。总鼻症状严重程度评分（TNSSS）计算为所有四种鼻症状的总和。使用t检验比较治疗前后TNSSS的平均值。P值小于0.05被认为具有统计学意义。
结果
本研究共纳入140例患者。平均年龄为30岁。最小年龄为15岁，最大年龄为45岁。男性93例，女性47例。TNSSS治疗前后平均值的差异为5.82。使用t检验比较TNSSS治疗前后的平均值，P值具有统计学意义，即<0.005。
结论
本研究中评估的变应性鼻炎常见症状在接受孟鲁司特治疗后有所改善。症状严重程度评分改善最大的是打喷嚏，最小的是流涕。鉴于近期关于神经精神不良反应的进展和美国食品药品监督管理局的警告，需要谨慎使用孟鲁司特，仅用于选定的患者。
