Allergy Asthma Respir Dis.  2015 Jul;3(4):255-260. 10.4168/aard.2015.3.4.255.

The role of leukotriene modifier in pediatric allergic disease

• Choi BS
• Sohn MH
• Kim KE

• KMID: 2218654
• DOI: http://doi.org/10.4168/aard.2015.3.4.255

Abstract

Leukotriene (LT) modifiers are composed of leukotriene receptor antagonists and 5-lipoxygenase inhibitors. LTs, C4, D4, and E4 are collectively termed cysteinyl LTs and best are the characterized receptors for cysLTs are cysLT1 and cysLT2. cysLT1 ligation mediates sustained bronchial contraction, mucosal secretion, and edema, which are central to the pathogenesis of asthma. cysLT2 ligation is thought to contribute to edema, inflammation, and tissue fibrosis in asthma. LT modifiers attenuate bronchoconstriction responses and exert anti-inflammatory effects, reflected by reduced eosinophil counts in the peripheral blood, sputum, and bronchoalveolar lavage fluid of asthmatic patients. Inhaled corticosteroids are generally superior to LT modifiers as a first-line controller. However, LT modifiers are easy to administer, have good compliance, and have excellent safety. LT modifiers are recommended for asthmatic children aged < or =5 years as a first-line controller. The Japanese Guideline for Childhood Asthma recommends LT modifiers, as a first-line controller prior to inhaled corticosteroid for children aged <2 years. LT modifiers can improve asthma control as add-on therapy with ICS. They can also be effective for exercise-induced asthma. LT modifiers are recommended for the treatment of allergic rhinitis in combination with H1-antihistamines or as a first-line drug for patients who cannot or do not wish to use intranasal corticosteroids. LT modifiers can also be considered for add-on therapy in the treatment of chronic urticaria, atopic dermatitis, and other allergic diseases.

Keyword

Leukotriene antagonist; Asthma; Allergic rhinitis; Atopic dermatitis; Urticaria

MeSH Terms

Adrenal Cortex Hormones
Asian Continental Ancestry Group
Asthma
Asthma, Exercise-Induced
Bronchoalveolar Lavage Fluid
Bronchoconstriction
Child
Compliance
Dermatitis, Atopic
Edema
Eosinophils
Fibrosis
Humans
Inflammation
Leukotriene Antagonists
Ligation
Lipoxygenase Inhibitors
Rhinitis
Sputum
Urticaria
Adrenal Cortex Hormones
Leukotriene Antagonists
Lipoxygenase Inhibitors

Figure

• 

  Fig. 1 Major pathways for leukotriene and lipoxin formation. 5-HPETE, 5-hydroperoxyeicosatetraenoic acid; 5-HETE, 5-hydroxyeicosatetraenoicacid; LT, leukotriene; LX, lipoxins.

• 

  Fig. 2 Stepwise approach for asthma management in childhood. SABA, short acting β2 agonist; prn, pro re nata; ICS, inhaled corticosteroid; LTM, leukotriene modifier; LABA, long acting β2 agonist (2008 Guideline for childhood asthma. Korean Academy of Pediatric Allergy and Respiratory Disease).

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