The role of leukotriene modifier in pediatric allergic disease

Bong Seok Choi; Myung Hyun Sohn; Kyu-Earn Kim

doi:10.4168/aard.2015.3.4.255

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Choi, Sohn, and Kim: The role of leukotriene modifier in pediatric allergic disease

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Allergy, Asthma & Respiratory Disease 2015; 3(4): 255-260.

Published online: 28 July 2015

DOI: https://doi.org/10.4168/aard.2015.3.4.255

The role of leukotriene modifier in pediatric allergic disease

Bong Seok Choi¹, Myung Hyun Sohn², Kyu-Earn Kim²

¹Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea.

²Department of Pediatrics and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.

Correspondence to: Kyu-Earn Kim. Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: +82-2-2019-3353, Fax: +82-2-3461-9473, kekim@yuhs.ac

Received 7 February 2015 Revised 24 February 2015 Accepted 24 February 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

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 ≤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.

Keywords: Leukotriene antagonist, Asthma, Allergic rhinitis, Atopic dermatitis, Urticaria

Figures and Tables

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).

Notes

This study was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number : HI11C1404).

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ORCID iDs: Kyu-Earn Kim
https://orcid.org/http://orcid.org/0000-0002-5730-3331
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