The effect of montelukast on allergen-induced cutaneous responses in house dust mite allergic children

The benefits of a leukotriene modifier on allergen-induced cutaneous responses have not been studied in children. We hypothesized that a leukotriene-receptor antagonist would provide protection against allergen-induced early and/or late phase cutaneous responses in susceptible children. In a randomized, double-blind, placebo-controlled, cross-over study in 6- to 15-year-old house dust mite allergic children, we compared the benefit of either montelukast or a matching placebo for 2 days on cutaneous responses induced by intradermal injection of house dust mite extract. Responses were measured as the mean of the longest diameter and its longest perpendicular of the induration response after 10, 20 min, 4 h and 6 h of the challenge. A total of 30 children were randomized to placebo or montelukast. The mean decline from baseline was significantly greater (p = 0.04) in the montelukast-treated children [-5.20 mm (-12.03-1.63)][median (95% CI)] than in the placebo-treated children [0.13 mm (-6.46-6.73] at 6th hour of the challenge, as was the mean diameter (p = 0.04), but did not differ in the remaining time points. We concluded that in house dust mite allergic children, montelukast 5 mg provided significant improvement in allergen-induced cutaneous late-phase responses, suggesting its contribution to allergic skin responses and its potential therapeutic value.