Major Finding: Adding a leukotriene receptor antagonist to intranasal steroids had no significant effect on nasal symptoms in perennial allergic rhinitis patients.
Data Source: Small randomized, double-blind, placebo-controlled add-on trial.
Disclosures: Dr. Esteitie had no financial conflicts to disclose. The study was funded by Merck, which markets montelukast, and the McHugh Otolaryngology Research Fund.
NEW ORLEANS — Adding a leukotriene receptor antagonist to fluticasone propionate had no significant effect on nasal symptoms in patients with perennial allergic rhinitis, based on results of a small randomized trial.
Previous clinical trials have shown that approximately half of patients with perennial allergic rhinitis obtain excellent symptom control with intranasal steroids alone, leaving the other half looking for additional relief, said Dr. Rania Esteitie of the University of Chicago.
In the study, 102 patients with perennial allergic rhinitis completed a baseline Rhinitis Quality of Life Questionnaire (RQLQ), and then received fluticasone propionate nasal spray (50 mcg per spray). The patients were instructed to use two sprays in each nostril once daily for 2 weeks (a total of 200 mcg per day).
The patients ranged in age from 18 years to 55 years (mean, 34 years), and 35% were male. The study results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
After 2 weeks, the 54 patients whose Total Symptom Scores (including non-nasal symptoms) were greater than 4 out of a total possible score of 24 (with higher scores representing worse symptoms) were randomized to use either 10 mg/day of montelukast (28 patients) or placebo (26 patients) as add-on to continuing therapy with fluticasone, the researchers reported.
Over the next 2 weeks, the patients' symptoms and quality of life continued to improve, but there was no significant difference between the montelukast and placebo groups. The median changes in Total Nasal Symptom Scores from baseline for montelukast and placebo, respectively, were −0.22 and −0.25 for sneezes, −0.52 and −0.29 for runny nose, −0.41 and −0.47 for stuffy nose, and −0.24 and −0.14 for other symptoms, Dr. Esteitie and her associates wrote.
“We expected to see an improvement in symptoms after the addition of montelukast. However, we did not see any added benefit,” Dr. Esteitie said in an interview.
Although montelukast did not seem to provide additional relief for allergic rhinitis symptoms, the study was limited by the small number of patients, and additional research is needed to evaluate clinical benefits, she added.