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Montelukast helps chronic urticaria

Question Is montelukast (Singulair) effective in the treatment of chronic idiopathic urticaria?

Synopsis Chronic idiopathic urticaria is a frustrating entity that is sometimes refractory to antihistamines or avoidance therapy. Leukotriene inhibitors, such as montelukast, have been shown to have some effectiveness in treating asthma and allergic rhinitis. The authors identified 30 adults with a diagnosis of chronic idiopathic urticaria, defined as the presence of wheals almost daily or at least three times weekly for at least six consecutive weeks. In addition, all of the patients were poorly responsive to previous therapies including antihistamines. Patients were randomised to one of two study groups to receive either 10 mg of montelukast or placebo once daily and 10 mg of cetirizine (Zyrtec) as needed. After a two week wash out period, each group was crossed over to the other treatment arm. Improvement was monitored by using an urticaria activity score, estimated daily by each patient. Patients also recorded the number of antihistamine tablets they took per week during each study period. Although the investigators were aware of study group assignment, an independent blinded observer recorded data. Urticaria activity scores and weekly antihistamine counts differed significantly and favoured the active treatment with montelukast (P<0.001). Eighteen patients (60%) receiving montelukast but none receiving placebo reported complete clearance from urticaria and needed no antihistamine at the end of six week therapy (NNT=1.7). No patients were lost to follow up at the end of six weeks.

Bottom line Montelukast (Singulair) is beneficial in the treatment of chronic idiopathic urticaria.

Level of evidence Individual randomised controlled trials (with narrow confidence interval).

©infoPOEMs 1992-2003 www.infopoems.com/informationmastery.cfm * Patient-Oriented Evidence that Matters. See editorial (BMJ 2002;325:983)[Free Full Text]    

References

1.	Erbagci Z. The leukotriene receptor antagonist montelukast in the treatment of chronic idiopathic urticaria: a single-blind, placebo-controlled, crossover clinical study. J Allergy Clin Immunol 2002; 110: 484-488[CrossRef][ISI][Medline].