The Effects of Montelukast on Intradermal Wheal and Flare

Abstract

OBJECTIVE: We sought to determine the effect of montelukast, a leukotriene receptor antagonist, on intradermal skin testing.

STUDY DESIGN AND SETTING: We conducted a prospective, randomized, double-blind, placebo-controlled study in a university setting.

METHODS: After a 1 -week washout of allergy pharmacotherapy, intradermal skin testing was performed on 23 atopic subjects. Whealing size was measured 20 minutes after injection. Subjects then began a 1 -week regimen of daily loratadine, montelukast, or placebo. At 1 week, subjects again underwent intradermal skin testing. The change in wheal size was then calculated from baseline.

RESULTS: A significant difference (P < 0.05) between the montelukast and loratadine groups in suppression of intradermal whealing at 1 week was observed. No significant difference was noted between the montelukast and placebo subjects.

CONCLUSIONS: Montelukast demonstrated no significant suppression of skin whealing after antigen challenge over placebo.

SIGNIFICANCE: Montelukast does not need to be discontinued before intradermal allergy testing.

Get full access to this article

View all access options for this article.

References

Demoly

Michel

FB.

Bousquet

In vivo methods for the study of allergy: Skin tests. Techniques, and interpretation. In Middleton

Reed

, editors. Allergy principles and practice. St Louis: Mosby; 1998. pp. 430–9.

Harvima

RJ.

Schwartz

LB.

Mast cell-derived mediators. Immunopharmacology of mast cells and basophils. London: Academic Press Ltd; 1993. pp. 115–38.

3 Barr

RM.

Koro

Francis

, et al. The release of prostaglandin D2 from human skin in vivo and in vitro during immediate allergic reactions. Br J Pharmacol 1988;94:773–80.

4 Talbot

SF.

Atkins

PC.

Goetzl

, et al. Accumulation of leukotriene C4 and histamine in human allergic reactions. J Clin Invest 1985;76:650–6.

5 Saarinen

JV.

Harvima

RJ.

Naukkarinen

, et al. Release of histamine and leukotriene C4 in immediate allergic wheal reaction as measured with the microdialysis technique. Arch Dermatol Res 2000;292:333–40.

6 Soter

NA.

Lewis

RA.

Corey

, et al. Local effects of synthetic leukotrienes (LTC4, LTD4, LTE4, and LTB4) in human skin. J Invest Dermatol 1983;80:115–9.

7 Greenberger

PA.

Smith

LJ.

Patterson

, et al. Comparison of cutaneous and bronchial reactivity to leukotriene D4 in humans. J Lab Clin Med 1984;108:70–5.

8 Maxwell

DL.

Atkinson

BA.

Spur

, et al. Skin responses to intradermal histamine and leukotrienes C4, D4, and E4 in patients with chronic idiopathic urticaria and in normal subjects. J Allergy Clin Immunol 1990;86:759–65.

9 Camp

RD.

Coutts

AA.

Greaves

, et al. Responses of human skin to intradermal injection of leukotriene C4, D4, and B4. Br J Pharmacol 1983;80:497–502.

10.

Bisgaard

Vascular effects of leukotriene D4 in human skin. J Invest Dermatol 1987;88:109–14.

11.

Bisgaard

Lerche

Krestensen

JK.

Leukotriene- and histamine-induced increases in vascular permeability and interstial transport in the skin. J Invest Dermatol 1985;84:427–9.

12.

Bisgaard

Kristensen

Sondergaard

The effect of leukotriene C4 and D4 on cutaneoous blood flow in humans. Prostaglandins 1982;23:797–801.

13.

13 Long

WF.

Taylor

RJ.

Wagner

, et al. Skin test suppression by antihistamines and the development of sub-sensitivity. J Allergy Clin Immunol 1985;76:113–7.

14.

Bousquet

Chanal

Skassa-Brociek

Lack of sub-sensitivity to loratadine during long-term dosing during 12 weeks. J Allergy Clin Immunol 1990;86:248–53.

15.

Chipps

BE.

Soootka

AK.

Sander

JP.

Effect of theophylline and terbutaline on immediate skin tests. J Allergy Clin Immunol 1980;65:61–4.

16.

16 Israel

Rubin

Kemp

, et al. The effect of inhibition of 5-lipoxygenase by zileuton in mild-to-moderate asthma. Ann Intern Med 1993;119:1059–66.

17.

Knap

HR.

Reduced allergen-induced nasal congestion and leukotriene synthesis with an orally active 5-lipoxygenase inhibitor. N Engl J Med 1990;323:1745–8.

18.

18 Dahlen

Zetterstrom

Bjorck

, et al. The leukotriene-antagonist ICI-204,219 inhibits the early airway reaction to cumulative bronchial challenge with allergen in atopic asthmatics. Eur Respir J 1994;7:324–31.

19.

19 Reicin

White

Weinstein

, et al. Montelukast, a leukotrient receptor antagonist, in combination with loratadine, a histamine receptor antagonist, in the treatment of chronic asthma. Arch Intern Med 2000;160:2481–8.

20.

Meltzer

Role for cysteinyl leukotriene receptor antagonist therapy in asthma and their potential role in allergic rhinitis based on the concept of “one linked airway disease”. Ann Allergy Asthma Immunol 2000;84:176–87.

21.

21 Saarinen

JV.

Harvima

RJ.

Horsmanheimo

, et al. Modulation of the immediate allergic wheal reaction in the skin by drugs inhibiting the effects of leukotriene C4 and prostaglandin D2. Eur J Clin Pharmacol 2001;57:1–4.

22.

22 Simons

Johnston

, et al. Suppression of the early and late cutaneous allergic responses using fexofenadine and montelukast. Ann Allergy Asthma Immunol 2001;86:44–50.

23.

23 Cuhadaroglu

Erelel

Kiyan

, et al. Role of Zafirlukast on skin prick test. Allergol Immunopathol 2001;29:66–8.

24.

Fuller

RW.

Black

PN.

Dollery

CT.

Effect of the oral leukotriene D4 antagonist LY171883 on inhaled and intradermal challenge with antigen and leukotriene D4 in atopic subjects. J Allergy Clin Immunol 1989;83:939–44.

25.

25 Berstein

JA.

Greenberger

PA.

Patterson

, et al. The effect of the oral leukotriene antagonist ICI 204,219 on leukotriene D4 and histamine-induced cutaneous vascular reactions in man. J Allergy Clin Immunol 1991;87:93–8.

26.

Atkins

PC.

Cutanteous late phase responses: An allergic inflammatory response. Allergy Proc 1989;10:417–21.