중등증-중증 지속성 알레르기비염 환아에서 경구용 2세대 항히스타민제(Zyrtec )와 류코트리엔 수용체 길항제(Singulair )의 치료효과 = The Efficacy of Leukotriene Receptor Antagonist and Second generation Anti-histamine in Treatment for Children with Moderate to Severe Persistent Allergic Rhinitis (PAR)

다국어 초록 (Multilingual Abstract)

Purpose:We evaluated the efficacy of leukotriene receptor antagonist and second generation anti-histamine in children with moderate to severe persistent allergic rhinitis.
Methods:Twenty eight patients who were treated with second generation anti-histamine for 4 weeks (Zyrtec syrupⓇ, Group A)and 58 patients who were treated with leukotriene receptor antagonist for 4 weeks (SingulairⓇ, Group B) were enrolled in this study. Control group (n=22) was received only first generation anti-histamine (Hydroxyzine) intermittently. Efficacy were evaluated by nasal scores in nasal congestion, rhinorrhea, nasal itching, sneezing and total nasal symptom score (a sum of patient ratings of nasal congestion, rhinorrhea, nasal itching, sneezing) before treatment and at 2 and 4 weeks after treatment.
Results:There were no difference in the total IgE and total eosinophil count of 3 groups. There were also no significant difference in the initial symptom scores. For nasal congestion, group A and B showed significant improvement at 2 and 4 weeks after treatment compared with controls (each P=0.006, P=0.000, P=0.023, P=0.001). For sneezing, group A and B showed significant improvement at 2 weeks after treatment compared with controls (each P=0.048, P=0.011) and group B also showed significant improvement at 4 weeks after treatment compared with controls (P=0.041). In total nasal symptom score (TNSS), group A and B showed significant improvement at 2 and 4 weeks after treatment compared with controls (each P=0.014, P=0.005, P=0.008, P=0.005).
Conclusion:In the moderate to severe persistent allergic rhinitis, leukotriene receptor antagonist or second generation anti-histamine is effective in nasal congestion and sneezing.

다국어 초록 (Multilingual Abstract)

Purpose:We evaluated the efficacy of leukotriene receptor antagonist and second generation anti-histamine in children with moderate to severe persistent allergic rhinitis.
Methods:Twenty eight patients who were treated with second generation anti-histamine for 4 weeks (Zyrtec syrupⓇ, Group A)and 58 patients who were treated with leukotriene receptor antagonist for 4 weeks (SingulairⓇ, Group B) were enrolled in this study. Control group (n=22) was received only first generation anti-histamine (Hydroxyzine) intermittently. Efficacy were evaluated by nasal scores in nasal congestion, rhinorrhea, nasal itching, sneezing and total nasal symptom score (a sum of patient ratings of nasal congestion, rhinorrhea, nasal itching, sneezing) before treatment and at 2 and 4 weeks after treatment.
Results:There were no difference in the total IgE and total eosinophil count of 3 groups. There were also no significant difference in the initial symptom scores. For nasal congestion, group A and B showed significant improvement at 2 and 4 weeks after treatment compared with controls (each P=0.006, P=0.000, P=0.023, P=0.001). For sneezing, group A and B showed significant improvement at 2 weeks after treatment compared with controls (each P=0.048, P=0.011) and group B also showed significant improvement at 4 weeks after treatment compared with controls (P=0.041). In total nasal symptom score (TNSS), group A and B showed significant improvement at 2 and 4 weeks after treatment compared with controls (each P=0.014, P=0.005, P=0.008, P=0.005).
Conclusion:In the moderate to severe persistent allergic rhinitis, leukotriene receptor antagonist or second generation anti-histamine is effective in nasal congestion and sneezing.

참고문헌 (Reference)

• 1 Busse W, "The role of leukotrienes in asthma and allergic rhinitis" 26 : 868-879, 1996
• 2 Johansson SG, "Revised nomenclature for allergy for globar use : Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003" 113 : 832-836, 2004
• 3 Bachert C, "Regulation of proinflammatory cytokines in seasonal allergic rhinitis" 118 : 375-379, 1999
• 4 Nathan RA, "Pharmacotherapy for allergic rhinitis: a critical review of leukotriene receptor antagonists compared with other treatments" 90 : 182-190, 2003
• 5 Creticos PS, "Peptide leukotriene release after antigen challenge in patients sensitive to ragweed" 310 : 1626-1630, 1984
• 6 Baraniuk JN, "Pathogenesis of allergic rhinitis" 99 : S763-S772, 1997
• 7 Philip G, "Montelukast for treating seasonal allergic rhinitis: a randomized, double-blind, placebo-controlled trial performed in the spring" 32 : 1020-1028, 2002
• 8 Christodoulopoulos P, "Molecular pathology of allergic disease. II: Upper airway disease" 105 : 211-223, 2000
• 9 Ciprandi G, "Levocetirizine improves nasal obstruction and moudulates cytokine pattern in patients with seasonal allergic rhinitis: a pilot study" 34 : 958-964, 2004
• 10 Howarth PH, "Leukotrienes in rhinitis" 161 : S133-S136, 2000
• 11 Michel L, "Inhibitory effect of oral cetirizine on in vivo antigen-induced histamine and PAF-acether release and eosinophil recruitment in human skin" 82 : 101-109, 1988
• 12 Rédier H, "Inhibitory effect of cetirizine on the bronchial eosinophil recruitment induced by allergen inhalation challenge in allergic patients with asthma" 90 : 215-224, 1992
• 13 KleinJan A, "Increase in IL-8, IL-10, IL-13, and RANTES mRNA levels (in situ hybridization) in the nasal mucosa after nasal allergen provocation" 103 : 441-450, 1999
• 14 Okayama Y, "In vitro effects of H1-antihistamines on histamine and PGD2 release from mast cells of human lung, tonsil, and skin" 49 : 246-253, 1994
• 15 Ciprandi G, "Fexofenadine treatment reduces nasal congestion in allergic rhinitis" 56 : 1068-1070, 2001
• 16 Nayak AS, "Efficacy and tolerability of montelukast alone or in combination with loratadine in seasonal allergic rhinitis: a multicenter, randomized, double-blind, placebo-controlled trial performed in the fall" 88 : 592-600, 2002
• 17 Mansmann HC Jr, "Efficacy and safety of cetirizine therapy in perennial allergic rhinitis" 68 : 348-353, 1992
• 18 Saito H, "Effects of a cysteinyl leukotriene receptor antagonist on eosinophil recruitment in experimental allergic rhinitis" 113 : 246-252, 2004
• 19 Bisgaard H, "Effect of leukotriene D4 on nasal mucosal blood flow, nasal airway resistance and nasal secretion in humans" 16 : 289-297, 1986
• 20 Horak F, "Effect of desloratadine versus placebo on nasal airflow and subjective measures of nasal obstruction in subjects with grass pollen- induced allergic rhinitis in an allergen-exposure unit" 109 : 956-961, 2002
• 21 Charlesworth EN, "Effect of H1 receptor blockade on the early and late response to cutaneous allergen challenge" 262 : 964-970, 1992
• 22 Howarth PH, "Double-blind, placebo-controlled study comparing the efficacy and safety of fexofenadine hydrochloride (120 and 180 mg once daily) and cetirizine in seasonal allergic rhinitis" 104 : 927-933, 1999
• 23 Lipworth BJ, "Differences in in vitro H1-receptor antagonist potency with fexofenadine and desloratadine do not determine effects on nasal congestion in seasonal allergic rhinitis" 57 (57): 10-, 2002
• 24 van Cauwenberge P, "Consensus statement on the treatment of allergic rhinitis" 55 : 116-134, 2000
• 25 Ho CY, "Comparison of antileukotrienes and antihistamines in the treatment of allergic rhinitis" 21 : 439-443, 2007
• 26 Lockey RF, "Comparative study of cetirizine and terfenadine versus placebo in the symptomatic management of seasonal allergic rhinitis" 76 : 448-454, 1996
• 27 Jin HR, "Cetirizine decreases IL-4, IL-5 and IFN gamma gene expressions in nasal-associated lymphoid tissue of sensitized mice" 16 : 43-48, 2002
• 28 Arnold R, "Cetirizine counter-regulates IL-8 release from human epithelial cells(A549)" 29 : 1681-1691, 1999
• 29 Miadonna A, "Behavior and clinical relevance of histamine and leukotrienes C4 and B4 in grass pollen-induced rhinitis" 136 : 357-362, 1987
• 30 Nimmagadda SR, "Allergy: etiology and epidemiology" 20 : 111-115, 1999
• 31 Bousquet J, "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaborates with the World Health Organization, GA(2)LEN and AllerGen)" 63 (63): 8-160, 2008
• 32 Hsieh JC, "A comparison of cetirizine and montelukast for treating childhood perennial allergic rhinitis" 17 : 59-69, 2004