Antileukotriene Drugs Research Articles

Allergic rhinitis – a review of current diagnostic and therapeutic methods

Allergic rhinitis (AR) is a common disease characterized by inflammation of the nasal mucosa caused by exposure to allergens such as pollen, house dust mites, animal dander, and molds. Symptoms include sneezing, nasal itching, watery discharge, and nasal congestion, often associated with conjunctivitis. AR can significantly reduce patients' quality of life, affecting their ability to perform daily activities and causing sleep disturbances and fatigue. Diagnosis of AR is based on a past medical history, assessment of clinical symptoms, and allergy tests, such as skin tests, and measure of specific class E (IgE) immunoglobulins in blood serum level. Treatment includes allergen avoidance, pharmacotherapy, and allergen immunotherapy. Antihistamines, intranasal glucocorticosteroids, cromones, and anti-leukotriene drugs are the basis of pharmacotherapy, helping to control symptoms and improve a patient's quality of life. Allergen immunotherapy, both subcutaneous and sublingual, is effective in modifying the course of the disease and reducing hypersensitivity to allergens. New therapeutic and diagnostic approaches, such as biomarkers and biologics, are under investigation and may offer more personalized and effective AR treatment in the future. A holistic approach to AR, including patient education and lifestyle modification, is crucial for long-term therapeutic success. The article aims to review current diagnostic and therapeutic methods used in AR.

Potential of Anti-Leukotriene Drugs as New Therapeutic Agents for Inhibiting Cholangiocarcinoma Progression.

Cholangiocarcinoma (CCA) is a cancer with a poor prognosis due to difficulties in diagnosis and limited treatment options, highlighting the urgent need for new targeted therapies. In a clinical setting, we found that leukotriene levels in bile were higher than in serum. Immunohistochemical analysis of surgically resected samples also revealed that CysLT receptor 1 (CysLTR1) was more highly expressed in CCA than in normal bile duct tissue, prompting us to investigate leukotriene as a potential therapeutic target in CCA. In vitro studies using CCA cell lines expressing CysLTR1 showed that leukotriene D4, a major ligand of CysLTR1, promoted cell proliferation, with increased phosphorylation of AKT and extracellular signal-regulated kinase 1/2 (ERK1/2). Additionally, treatment with two clinically available anti-allergic drugs-zileuton, an inhibitor of CysLT formation, and montelukast, a CysLTR1 inhibitor-had inhibitory effects on cell proliferation and migratory capacity, accompanied by the reduced phosphorylation of AKT and ERK1/2. Furthermore, the simultaneous administration of both drugs synergistically enhanced the inhibitory effect on cell proliferation. Our study suggests that use of these drugs may represent a novel approach to treat CCA through drug repositioning.

Is chronic urticaria or urticarial vasculitis a diagnostic dilemma?

Introduction. Urticarial vasculitis (UV) is a rare disease that has two components: clinical manifestations of urticaria and histopathological signs of cutaneous leukocytoclastic vasculitis of small vessels, predominantly involving postcapillary venules. This condition is characterized by chronic or recurrent episodes of urticaria, each element of which lasts more than 24 hours and is accompanied by a feeling of pain and burning. The aim is to reveal the key points of pathogenetic mechanisms, differential diagnosis and therapeutic tactics of UV based on a clinical case. Clinical case. A clinical case of a 17-year-old boy with normocomplementemic UV is described. The patient's main complaint was a long-lasting rash (more than three weeks) with itching. From the anamnesis it is known that the provoking factors for the onset of the disease were an insect bite and the start of taking a new drug, namely vitamin K (two days before the onset of the disease). Throughout this time, the child was examined by various specialists and received treatment. Alternative diagnoses: bacterial folliculitis, viral exanthem, unspecified urticaria. There was no positive effect from the received treatment. The diagnosis of UV was made in the sixth week of the disease using a punch biopsy. Regression of the skin syndrome was achieved using a combination of antihistamine and antileukotriene drugs. Conclusions. Performing a punch biopsy, which is currently the gold standard for diagnosis, allows us to solve the diagnostic dilemma: “UV or chronic urticaria”. Timely diagnosis helps to avoid false diagnoses and, as a result, incorrect treatment of UV. The description of this clinical case is a contribution to the disclosure of this globally complex problem. The research was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the child and child's parents was obtained for conducting the research. No conflict of interest was declared by the authors.

Montelukast: results and prospects for applications in pediatric practice

The Centers for Disease Control and Prevention reports that more than 4 million children have been diagnosed with asthma. Currently, there is no treatment that could prevent the development of asthma or change its natural course over long-term follow-up. However, the disease can be controlled using treatments used in clinical practice. For persistent asthma in children aged 5 years and younger, low doses of inhaled glucocorticosteroids are recommended, as well as the administration of montelukast, a leukotriene receptor antagonist. In addition, montelukast is prescribed to patients with allergic rhinitis as an alternative to or in combination with oral antihistamines or nasal corticosteroids. Leukotrienes are lipid mediators that play a key role in acute and chronic inflammation and allergic diseases. They exhibit their biological effects by binding to specific G-protein-coupled receptors. Each subtype of the leukotriene receptor has unique functions and expression patterns. Leukotrienes play an important role in various allergic diseases, including bronchial asthma and allergic rhinitis. Montelukast is a cysteinyl leukotriene receptor-1 antagonist widely used to suppress the inflammatory response in asthma and allergic rhinitis. This review briefly summarizes the biology of leukotrienes and their receptors, recent developments in the field of antileukotriene drugs and the prospects for their different therapeutic applications. The role of antileukotriene drugs and key indications for the use of montelukast in the complex therapy of asthma and allergic rhinitis in children have been determined.

Fibrodysplasia Ossificans Progressiva: Literature Review and Case Report

Background. Fibrodysplasia ossificans progressiva (FOP) is a genetic disease of the heterotopic ossification group associated with the mutation in ACVR1/ALK2 gene. FOP is characterized by progressive heterotopic endochondral ossification of connective tissue that occurs in postnatal period. It leads to formation of qualitatively normal bone in extraskeletal areas. Congenital hallux deformity is typical for this disease. The clinical picture is characterized by aggravations that are usually caused by trauma or viral infections. Formation of Heterotopic ossificate formation can be observed during aggravations. There is no etiological treatment for FOP. Systemic glucocorticosteroids, non-steroidal anti-inflammatory drug (NSAIDs), mast cell stabilisers, antileukotriene drugs and bisphosphonates can be used in these patients.Clinical case description. The child was born with congenital hallux deformity typical for FOP. The disease onset was noted at the age of 2 years 8 months with a tumor-like painful mass on the neck. Oncological (lymphoproliferative) disease was suspected but biopsy from the lesion did not confirm its malignant nature. The child was consulted by pediatric rheumatologist who has diagnosed FOP. Etanercept and zoledronic acid were administrated, though etanercept was later discontinued. For now, the child receives zoledronic acid infusions 2 times per year and daily NSAIDs.Conclusion. The difficulties in FOP diagnosing are associated to its sporadic nature and clinical picture similarity to other diseases. Suspected malignancy leads to biopsy that is highly undesirable in FOP patients due to high risk of iatrogenic complications.

The role of IL-33 and IL-1β in the development of persistent allergic rhinitis in overweight/obese children

BACKGROUND: Few works were devoted to the study of the role of cytokines in children with allergic rhinitis (AR) with comorbid obesity.
 AIMS: To study the level of cytokines interleukin (IL)1, IL-33, IL-6, tumor necrosis factor (TNF)-, and total IgE in the blood serum of overweight/obese children with intermittent and persistent AR.
 MATERIALS AND METHODS: This cross-sectional observational study analyzed 69 children aged 710 years with AR in the remission period and was conducted from November 2020 to February 2021. All children went through a comprehensive examination for 3 days, including the definition of the serum concentrations IL-1, IL-33, IL-6, TNF-, and total IgE. Before blood sampling, children did not use nasal glucocorticosteroids, antileukotriene drugs for the last 4 weeks, and antihistamines for the last 7 days. Bioimpedansometry was used to assess the body weight by calculating the %FM (percentage of body fat mass).
 RESULTS: The study included 44 children with AR and overweight/obesity (group I) and 25 children with AR and normal body weight (group II). The analysis of AR showed that in group I, intermittent AR was detected in 11 (25.0%) children (subgroup IA), whereas a persistent course was found in 33 children (75.0%) (subgroup IB). In group II, intermittent AR was detected in 13 (52.0%) children (subgroup IIA), whereas persistent AR in 12 children (48.0%) (subgroup IIB). The level of IL-1 in the blood serum was significantly higher in the subgroup IB than in subgroup IA (p=0.009). The concentration of IL-33 in children with persistent AR and obesity was significantly lower than that in children with intermittent AR and obesity (p=0.039). The level of IL-33 in the serum negatively correlated with %FM in group IA (r=-0.6673, p=0.035). The concentration of IL-1 negatively correlated with %FM in group IIB (r=-0,738, p=0,037). The levels of IL-6, TNF, and total IgE in obese children did not depend on the severity of AR.
 CONCLUSIONS: The predictors of persistent AR in children with obesity are a decrease in the level of IL-33 and an increase in IL-1 in the blood serum. The negative correlation between the degree of obesity and IL-33 concentration in children with intermittent AR opens a window of opportunity for the personified management of children with AR and comorbid obesity.

Antileukotriene drugs as a tool for improving the quality of life in patients with allergic rhinitis

Introduction. Allergic rhinitis (AR) is immunoglobulin E (IgE) mediated disease. Which, after exposure to allergens, manifests itself with various symptoms such as sneezing, runny nose, nasal itching, and nasal congestion, which seriously affects the quality of life of patients. In some patients, AR poses a risk of developing serious mental disorders. Currently, various medicines are used for treatment. Objective. Consideration of the effectiveness of AR therapy with antileukotriene drugs, depending on the mental state of the patient. Materials and methods. The study involved 200 people diagnosed with AR. The patients were divided into 2 groups: group 1 (100 people) with basic therapy with intranasal glucocorticosteroids (inGCS – mometasone furoate) and group 2 (100 people) – inhalers in combination with an antileukotriene drug (montelukast). All were screened for the presence of a depressive disorder. The tactics of case management and prescription of drugs were defined by the level of depression. Patients with AR have mental health problems that correlate with AR symptoms. Results. Patients of the 1st group, who did not achieve complete relief of AR symptoms, when assessing their mental state using the PHQ-2 and PHQ-9 questionnaires, showed a mild depression (23 people). The symptoms of AR were stopped, when an anti-leukotriene drug was added to the therapy. Conclusions. With the ineffectiveness of the basic therapy of inGCS and a negative assessment of the patient’s mental state, the use of an antileukotriene drug is justified to improve the level of depressive mood and complete relief of symptoms of AR.

Anti-leukotriene drugs in the therapy of inflammatory diseases


 A key part of many chronic diseases is inflammation controlled by inflammatory mediators. Regulation of their function allows to mute the inflammatory response, which is a desired effect in the treatment of inflammatory diseases. The source of mediators is arachidonic acid, converted to pro-inflammatory mediators by cyclooxygenases (COX) or lipooxygenases (LOX). The 5-LOX pathway is full of target points for regulation of biosynthesis of cysteinyl leukotrienes (CysLT) – one of the major classes of inflammatory mediators. These compounds exert their activity through specific leukotriene receptors – first (CysLT1R) and second (CysLT2R). Drugs that inhibit CysLT synthesis as well as leukotriene receptors antagonists (LTRA) form group of drugs known as anti-leukotriene drugs. Currently, only a few representatives of this group are available in the pharmacies around the world: the 5-LOX inhibitor – zileuton – and three CysLT1R antagonists – montelukast, pranlukast, zafirlukast. LTRAs due to their wide range of anti-inflammatory effects, are a group of drugs with a high potential in the treatment of inflammatory diseases. The study of new applications of known LTRAs and the search for new members of the LTRA group are the main directions of development in this field of pharmacy. This work summarizes the benefits of using anti-leukotriene drugs in the treatment od chronic diseases and presents new directions of using LTRAs.

The role of leukotriene receptor blockers in the treatment of allergic rhinitis in combination with chronic rhinosinusitis with nasal polyps

Background. Leukotrienes play an important role in the pathogenesis of allergic rhinitis (AR) and eosinophilic type of chronic rhinosinusitis with nasal polyps (CRSwNP). There is a phenotype of CRSwNP in combination with AR, which has specifics of local inflammation.The aim of our study was to investigate the efficacy of using an antileukotriene drug in the treatment of AR in combination with CRSwNP.Materials and methods. 63 patients with AR and bilateral CRSwNP after endoscopic bilateral polypotomy were randomly divided into 2 groups. In the 1st group 32 people (age 50.28 ± 1.37 years) were prescribed a basic therapy with nasal spray of mometasone furoate at a daily dose of 400 µg in combination with montelukast 1 tab. 10 mg at night, in the 2nd group 31 people (age 50.31 ± 1, 16 years old) received only mometasone furoate monotherapy. Endoscopic examination of the nasal cavity was performed once every 3 months. The follow-up period was 1 year.Results. After 3 months in the 1st group of patients there was a recurrence of polyp growth was observed in 25% of cases, in the 2nd group in 35.5% of patients (p < 0.05). After 6 months, the number of relapses of CRSwNP decreased to 15.6% of cases in group 1 and to 22.6% in group 2 (p < 0.05). After 9 months in group 1 recurrence of NP was recorded in 12.5% of patients and nasal polyps were completely absent during endoscopic examination in 9.4% of cases, in the 2nd group, relapse was detected in 19.35% of patients (p < 0.05). 1 year after surgery, in group 1, relapse of NP was found in 12.5% of patients with AR and in 12.5% of cases was remission of the pathological process with cancellation of basic therapy. In group 2, recurrence of NP was in 16.1% of cases, there were no reasons for withdraw treatment of intranasal glucocorticosteroids in this group.Discussion. The clinical effectiveness of the addition of Montelukast to basic therapy has been reflected in a reduction in the growth rate of polyposic vegetation, the number of repeated operations and the stabilization of the flow of chronic inflammatory process.Conclusions. In the case of the clinical phenotype of AR with CRSwNP, the addition of a leukotriene receptor blocker montelukast to the basic therapy of intranasal glucocorticosteroids made it possible to improve drug control of both diseases and reduce the frequency of CRSwNP relapses.

Tyrosine kinase inhibitors for the treatment of indolent systemic mastocytosis: Are we there yet?

Indolent systemic mastocytosis (ISM) is the most prevalent form of systemic mastocytosis. Many patients with ISM suffer from mast cell (MC) mediator-related symptoms. In a small number of patients, hematologic progression is seen in the follow-up. In some patients with ISM, symptoms arising from MC-derived mediators including gastrointestinal symptoms, anaphylaxis, and neuropsychiatric symptoms are kept under control with conventional mediator-targeting drugs or MC-stabilizing agents. However, in a substantial number of patients, the symptoms are refractory to such conventional therapy. For these patients, novel drugs and targeted approaches are considered. One reasonable approach may be to apply tyrosine kinase inhibitors directed against KIT and other key kinase targets expressed in neoplastic MCs in ISM. Because MCs in more than 90% of all patients with typical ISM display the KIT D816V mutant receptor, clinically effective KIT-targeting drugs have to be active against this mutant form of KIT. The 2 such most effective and well-studied agents currently available are midostaurin and avapritinib. Other KIT-targeting drugs, such as imatinib or masitinib, are less effective or even noneffective against KIT D816V and are thus recommended for use only in patients with other KIT mutant forms (noncodon 816 mutations) or with wild-type KIT. In the present article, we review the current state in the treatment of ISM with tyrosine kinase inhibitors, with special emphasis on treatment responses and potential adverse effects. In fact, all of these agents also have unique and common adverse effects, and their use to treat patients with ISM should be balanced against their toxicity and short- and long-term safety.

Opportunities for correction of individual links of the pathogenesis of allergic rhinitis and bronchial asthma with assessment of the quality of life of patients

Introduction. One of the antileukotriene drugs for the treatment of bronchial asthma and allergic rhinitis with and without polyposis is montelukast. The presented article presents the results of the analysis of the effectiveness, safety and impact on the quality of life of patients, the use of the singular, in various forms of allergic rhinitis and associated comorbid conditions.Aim of the study. To assess the impact on the quality of life of patients, the effectiveness and safety of the use of montelukast in the complex therapy of patients with allergic rhinitis and comorbid diseases.Materials and methods.A simple, blind, randomized, controlled clinical trial involved 97 patients divided into 4 groups: patients with moderate allergic rhinitis; allergic rhinitis of moderate severity and bronchial asthma; severe allergic rhinitis and bronchial asthma; severe allergic rhinitis, bronchial asthma and polypous rhinosinusitis. In parallel with the comparison of drug tolerability, safety and clinical symptoms (rhinorrhea, nasal congestion, itching, sneezing, bronchopulmonary manifestations), the quality of life was assessed using a special SNOT-22 questionnaire.Results. The use of the antileukotriene drug montelukast in the complex therapy of allergic rhinitis and related comorbid conditions significantly improved the clinical symptoms and quality of life of patients over the entire period of treatment in all groups. There was an increase in the suppression of leukotriene-mediated effects when using montelukast, more in the group of people with allergic rhinitis and bronchial asthma, such as symptoms of the allergic triad, mucus hypersecretion, bronchospasm, eosinophilia, increased vascular permeability, etc.Conclusion. In the treatment of patients with allergic rhinitis and morbid conditions, Singular has demonstrated an inhibitory effect on cysteinyl leukotrienes, high bioavailability, good tolerability and safety.

Structural basis of leukotriene B4 receptor 1 activation

Leukotriene B4 receptor 1 (BLT1) plays crucial roles in the acute inflammatory responses and is a valuable target for anti-inflammation treatment, however, the mechanism by which leukotriene B4 (LTB4) activates receptor remains unclear. Here, we report the cryo-electron microscopy (cryo-EM) structure of the LTB4 -bound human BLT1 in complex with a Gi protein in an active conformation at resolution of 2.91 Å. In combination of molecule dynamics (MD) simulation, docking and site-directed mutagenesis, our structure reveals that a hydrogen-bond network of water molecules and key polar residues is the key molecular determinant for LTB4 binding. We also find that the displacement of residues M1013.36 and I2717.39 to the center of receptor, which unlock the ion lock of the lower part of pocket, is the key mechanism of receptor activation. In addition, we reveal a binding site of phosphatidylinositol (PI) and discover that the widely open ligand binding pocket may contribute the lack of specificity and efficacy for current BLT1-targeting drug design. Taken together, our structural analysis provides a scaffold for understanding BLT1 activation and a rational basis for designing anti-leukotriene drugs.

Вплив базисної фармакотерапії на стан мозкової гемодинаміки у хворих на бронхіальну астму дітей

У статті проаналізовано вплив базисної фармакотерапії на стан екстра- та інтракраніальної церебральної гемодинаміки у хворих на бронхіальну астму (БА) дітей. Монотерапія антилейкотрієновими препаратами нормалізує найбільшу кількість показників церебральної гемодинаміки, на другому місці — комбіноване лікування глюкокортикостероїдами та антилейкотрієновими препаратами, найменш ефективна базисна інгаляційна глюкокортикостероїдна терапія. Жодна проаналізована схема не усуває явища гіпоперфузії у вертебробазилярній зоні у хворих на БА дітей. У період ремісії декілька показників церебральної гемодинаміки, щодо яких усі перелічені схеми базисної фармакотерапії БА були ефективними, погіршилися та статистично не відрізнялись від аналогічних показників хворих із неконтрольованим перебігом БА. Хворі на БА діти повинні перебувати під наглядом дитячого невролога та потребують планового допплерографічного дослідження магістральних судин голови та шиї незалежно від ступеня контролю основного захворювання.

Bronchial Asthma and COVID-19: Comorbidity Issues

This literature review presents findings on various aspects of concurrent bronchial asthma and COVI D -1 9. In particular, it discusses issues of bronchial asthma incidence among patients with confirmed COVI D -1 9, the influence of bronchial asthma on the risk of the new coronavirus infection, and the specific course of bronchial asthma in COVI D -1 9 patients. It considers the use of individual components of basic asthma therapy during the pandemic, in particular, inhaled and systemic corticosteroids, antileukotriene drugs, and targeted therapy. The article pays attention to recommendations for the choice of inhalation devices in light of prevention of the new coronavirus infection spread.

Особливості лікування бронхіальної астми у дітей з надлишковою масою тіла та ожирінням

У статті розглянуто питання терапії бронхіальної астми (БА) у дітей з надлишковою масою тіла та ожирінням. Описано основні медикаментозні та немедикаментозні підходи до лікування БА у дітей з надлишковою масою тіла та ожирінням. Акцентовано увагу на перевагах використання антилейкотрієнових препаратів у базисній терапії БА у таких пацієнтів.

Ефективність застосування протизапального препарату антилейкотрієнової дії — монтелукасту натрію як засобу контролюючої терапії бронхіальної астми та алергічного риніту у дітей

У статті надано сучасні погляди на проблему бронхіальної астми та алергічного риніту як коморбідної патології у дітей. Розглянуто концепцію єдиного хронічного алергічного респіраторного синдрому. Згідно з міжнародними та національними рекомендаціями з ведення хворих на бронхіальну астму й алергічний риніт визначено місце антилейкотрієнів у лікуванні цієї коморбідної патології. Наведено дані щодо комплайєнсу в терапії дітей з бронхіальною астмою та шляхи її оптимізації. Науково обґрунтовано застосування монтелукасту натрію в загальній базовій терапії персистуючих форм алергічного риніту та бронхіальної астми легкого ступеня тяжкості в дітей. У статті подано результати застосування антилейкотрієнового препарату — монтелукасту натрію у контролюючій терапії персистуючих форм бронхіальної астми та алергічного риніту легкого ступеня тяжкості у дітей віком 2–11 років. Результатами проведеного нами дослідження доведено, що 6-місячне використання препарату є високоефективним (95,0 %), що забезпечує контроль за перебігом хвороби. Монтелукаст особливо показаний у разі переважання нічних ознак захворювання, у випадках астми фізичного та психоемоційного навантаження, при аспіриновій астмі, розвитку загострень хвороби, зумовлених змінами метеоумов і вірусними інфекціями.

Эффективность использования антилейкотриеновых препаратов для лечения бронхиальной астмы у детей с избыточной массой тела и ожирением

Актуальность. Избыточная масса тела и ожирение снижают эффективность базисной противоастматической терапии ингаляционными глюкокортикостероидами и их комбинацией с β2-агонистами длительного действия и теофиллинами, поэтому достижение контролируемости астмы требует повышения дозы препаратов. Антилейкотриеновые препараты рассматривают в качестве второй линии терапии как альтернативу кортикостероидам при лечении легкой персистирующей астмы и как компонент базисной противовоспалительной терапии персистирующей среднетяжелой астмы. Выбор варианта базисной терапии при одновременном наличии астмы и избыточной массы тела у детей должен быть обоснован врачом исходя из риск-ориентированного подхода к терапии. Цель: сравнить эффективность двух схем базисной терапии бронхиальной астмы у детей с избыточной массой тела и ожирением — схемы использования средних доз ингаляционных глюкокортикостероидов и схемы использования комбинации низких доз ингаляционных глюкокортикостероидов с антилейкотриеновым препаратом. Материалы и методы. Проведено исследование 64 больных бронхиальной астмой детей в возрасте от 6 до 18 лет с избыточной массой тела и ожирением. Дети были разделены на две терапевтические группы методом случайной выборки. Дети I группы получали комбинацию антилейкотриенового препарата с низкими дозами ингаляционных глюкокортикостероидов в течение 3 месяцев (схема терапии І). Дети II группы получали средние дозы ингаляционных глюкокортикостероидов в течение 3 месяцев (схема терапии ІІ). Для сравнения эффективности схем терапии всем детям была проведена спирометрия, анализ уровня сывороточного лептина, оценка клинических симптомов астмы, астма-контроль тест, оценка качества жизни по опроснику PAQLQ. Для анализа результатов использовали непараметрические методы статистической обработки данных. Результаты. Результат попарных сравнений терапевтических групп между собой после лечения выявил статистически значимое (p < 0,05) различие результатов лечения в пользу схемы терапии I как в улучшении показателей (Ме [QI; QIII]) клинических симптомов (уменьшение дневных, ночных симптомов и применение бронхолитиков при необходимости), так и в снижении уровня провоспалительного адипокина лептина в сыворотке крови и улучшении показателей качества жизни по шкалам PAQLQ «Активность» и «Симптомы». При межгрупповом сравнении результатов астма-контроль теста показатель относительного риска 2,06 (95% ВІ 1,1 ÷ 3,9) указывает на увеличение в среднем в 2 раза риска достижения полностью контролируемой астмы при применении схемы терапии I по сравнению с применением схемы терапии II (p = 0,037). Выводы. Терапевтический эффект схемы терапии с использованием комбинации низких доз ингаляционных глюкокортикостероидов с антилейкотриеновым препаратом позволяет рекомендовать именно ее при выборе варианта базисной терапии среднетяжелой бронхиальной астмы у детей с избыточной массой тела и ожирением.

Age-related evolution of bronchial asthma in pediatric practice and approaches to improving prognosis

The main high-risk group for a diagnosis of bronchial asthma (BA) are children with recurrent obstructive bronchitis, complicated by a widespread form of acute respiratory viral infections. Basic therapy of BA is aimed at suppressing inflammation of the bronchial wall. In addition to inhaled glucocorticosteroids, the antileukotriene drug montelukast has a proven anti-inflammatory effect. This article discusses published work on the effect of montelukast on inflammation biomarkers in real clinical practice and remodeling of the bronchial wall in the experiment. A comparative study of the clinical efficacy of an antileukotriene drug and inhaled glucocorticosteroids in patients of different age groups and asthma phenotypes is presented. The use of montelukast in children at high risk of developing BA, with an indication for allergic rhinitis, is discussed. Presented current information on the risk of psychiatric AE against the background of using an antileukotriene drug. Literature review is illustrated by our own observation: a cohort of 127 patients was formed on the basis of the dispensary group of the City Allergy Cabinet of the Children’s City Polyclinic No. 44 in St. Petersburg in 2018, a prospective observation was conducted, which lasted 2 years. The inclusion criteria were age of 5 years to 5 years 11 months (5 ± 0.5 years) and an established diagnosis of mild BA. The patients were followed up for 2 years with evaluation of the change of basic therapy, control of the disease and functional indices achieved with therapy with the original drug montelukast. This observation showed high clinical efficacy of montelukast monotherapy in the group of preschool-age patients, which was expressed by a significant proportion of patients who had no exacerbations of BA for a year, a high score on the Asthma Control Test, statistically insignificant increase in forсed expiratory volume in 1 second after bronchodilator. Today Montelukast is a safe, effective and widely prescribed component of therapeutic regimen in patients with varying degrees of severity of bronchial asthma over the age of 2 years.

Is it always easy for children with mild asthma?

Bronchial asthma is the most common chronic disease of children, the worst way is their quality of life. Compliance in the treatment of children is very important, since the actual effect of a drug is determined by both the effective drugs and patient adherence and correct use. A relevant test is the use of mild asthma, which is able to control bronchial hyperreactivity associated with exercise, cold air, and other nonspecific irritants (smoke, odors, etc.). Planning of baseline therapy for children with mild asthma aged 5 years old and younger is particularly problematic for paediatricians due to high incidences of acute respiratory viral diseases and viral-induced exacerbations of bronchial asthma among them. In these children, allergen-specific immunotherapy, long-acting B-agonists, the use of many metered-dose inhaled glucocorticosteroids. are not recommended.Montelukast, an oral antileukotriene drug, has advantages in the treatment of children with mild asthma with virus-induced exacerbations, with asthma of physical exertion and severe bronchial hyperreactivity, especially when combined with allergic rhinitis, as well as in special clinical cases, when parents refuse to use ICS for treatment children with mild asthma or inability to use them for some reason. The use of montelukast for mild asthma in children in the current context of the COVID-19 pandemic also has advantages that pediatricians can use when observing these children in the pediatric area, taking into account contraindications.

Комплексный подход к лечению детей с аллергическим ринитом

Allergic rhinitis (AR) is a common childhood disease. At the same time, there is an underdiagnosis of this condition in the clinical practice and its significant impact on the life quality of the patient and his family. The article describes a modern stepwise approach in complex AR therapy in children. This approach involves the choice of drug therapy in accordance with the disease course. In this case, it is necessary, in particular, to take into account the clinically significant sensitization profile, the presence of concomitant allergic and non-allergic pathology, the patterns of the expected exposure of relevant allergens, the disease course severity, the patient’s age, response to therapy, etc. The current problems of conservative treatment are discussed. Information on the pharmacological drug groups for the AR treatment is presented: H1-antagonists, antileukotriene drugs, intranasal glucocorticosteroids. The main effects and the most common adverse events of their usage are considered. Practical issues of AR treatment tactics, relevant for pediatricians, allergists and otorhinolaryngologists, are highlighted. The prescription of drug combinations of different groups is substantiated, providing a simultaneous effect on different links of the pathogenetic process. The importance of elimination measures and allergen-specific immunotherapy is noted. KEYWORDS: allergic rhinitis, sensitization, H1-antagonists, leukotriene receptor antagonists, glucocorticosteroids, children. FOR CITATION: Asmanov A.I., Konyukova N.G., Pivneva N.D. et al. Comprehensive treatment method for children with allergic rhinitis. Russian Medical Inquiry. 2021;5(5):348–352 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-348-352.