Montelukast in the treatment of children with moderate-to-severe atopic dermatitis: A pilot study

The primary action of leukotrienes includes contraction of human airway mus cle, chemotaxis, and increased vascular permeability, with secondary effect s of inhibiting allergen-induced early and late responses. Although there i s limited available information and research regarding leukotrienes in atop ic dermatitis (AD), there is evidence to support their role in the pathogen esis of the disease. We conducted a pilot study to test the efficacy of mon telukast, a cysteinyl-leukotriene-1 receptor antagonist, in 15 patients (6- 16 years of age) with moderate-to-severe AD, using a randomized double-blin d placebo-controlled crossover study. These patients had chronic moderate-t o-severe AD, despite being on conventional therapy. They were randomized ei ther to placebo for 4 weeks and then the study drug for 4 weeks, or vice ve rsa. There was a 2-week run-in period for all participants before commencem ent of the study, and a 2-week washout before crossover. At enrollment and on each follow-up visit, every patient was assessed by a single observer an d objectively scored for disease extent and severity. A subjective score wa s given for the impact of eczema on daily living. There was statistical imp rovement in patents on active treatment compared with placebo in the severi ty of AD (p <0.05). Our findings suggest that leukotriene receptor antagoni st as an adjunct treatment has an anti-inflammatory effect on moderate-to-s evere AD. A larger trial is needed to ascertain its efficacy fully.