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Antileukotrienes in Upper Airway Inflammatory Diseases

  • Rhinosinusitis (J Mullol, Section Editor)
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Abstract

Leukotrienes (LTs) are a family of inflammatory mediators including LTA4, LTB4, LTC4, LTD4, and LTE4. By competitive binding to the cysteinyl LT1 (CysLT1) receptor, LT receptor antagonist drugs, such as montelukast, zafirlukast, and pranlukast, block the effects of CysLTs, improving the symptoms of some chronic respiratory diseases, particularly bronchial asthma and allergic rhinitis. We reviewed the efficacy of antileukotrienes in upper airway inflammatory diseases. An update on the use of antileukotrienes in upper airway diseases in children and adults is presented with a detailed literature survey. Data on LTs, antileukotrienes, and antileukotrienes in chronic rhinosinusitis and nasal polyps, asthma, and allergic rhinitis are presented. Antileukotriene drugs are classified into two groups: CysLT receptor antagonists (zafirlukast, pranlukast, and montelukast) and LT synthesis inhibitors (5-lipoxygenase inhibitors such as zileuton, ZD2138, Bay X 1005, and MK-0591). CysLTs have important proinflammatory and profibrotic effects that contribute to the extensive hyperplastic rhinosinusitis and nasal polyposis (NP) that characterise these disorders. Patients who receive zafirlukast or zileuton tend to show objective improvements in, or at least stabilisation of, NP. Montelukast treatment may lead to clinical subjective improvement in NP. Montelukast treatment after sinus surgery can lead to a significant reduction in eosinophilic cationic protein levels in serum, with a beneficial effect on nasal and pulmonary symptoms and less impact in NP. Combined inhaled corticosteroids and long-acting β-agonists treatments are most effective for preventing exacerbations among paediatric asthma patients. Treatments with medium- or high-dose inhaled corticosteroids, combined inhaled corticosteroids and LT receptor antagonists, and low-dose inhaled corticosteroids have been reported to be equally effective. Antileukotrienes have also been reported to be effective for allergic rhinitis.

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Acknowledgments

With exception of data collection, preparation of this paper including design and planning was supported by Continuous Education and Scientific Research Association.

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Conflict of Interest

Drs. Cingi, Mulak, Ipci, and Sahin declare no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department for ORL Head and Neck Surgery, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey

    Cemal Cingi

  2. Department for ORL Head and Neck Surgery, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey

    Nuray Bayar Muluk

  3. ENT Department, Ankara Koru Hospital, Ankara, Turkey

    Kagan Ipci

  4. ENT Clinics, Bayındır Içerenköy Hospital, Istanbul, Turkey

    Ethem Şahin

  5. ENT Department, Eskisehir Osmangazi University, Eskisehir, Turkey

    Cemal Cingi

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Correspondence to Cemal Cingi.

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This article is part of the Topical Collection on Rhinosinusitis

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Cingi, C., Muluk, N.B., Ipci, K. et al. Antileukotrienes in Upper Airway Inflammatory Diseases. Curr Allergy Asthma Rep 15, 64 (2015). https://doi.org/10.1007/s11882-015-0564-7

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  • DOI: https://doi.org/10.1007/s11882-015-0564-7

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