Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter To Editor
doi: 10.4103/0378-6323.26735
PMID: 16880585

Oral montelukast monotherapy is ineffective in chronic idiopathic urticaria: A comparison with oral cetirizine

Kiran V Godse
 Shree Skin Centre, 21 and 22, L Market, Sector 8 Nerul, Navi Mumbai - 400 706, India

Correspondence Address:
Kiran V Godse
Shree Skin Centre, 21 and 22, L Market, Sector 8, Nerul, Navi Mumbai - 400 706
How to cite this article:
Godse KV. Oral montelukast monotherapy is ineffective in chronic idiopathic urticaria: A comparison with oral cetirizine. Indian J Dermatol Venereol Leprol 2006;72:312-314
Copyright: (C)2006 Indian Journal of Dermatology, Venereology, and Leprology


Chronic idiopathic urticaria (CIU) is a common cutaneous disorder, for which there is usually no identifiable cause.[1] H 1 -receptor antagonists are recommended as the first-line treatment in CIU. Chronic urticaria, which cannot be classified in any of the known causes, is described as chronic idiopathic urticaria. Recently, antileukotriene receptors such as montelukast, have been used, either as monotherapy, or in combination with H 1 -receptor antagonists.

We conducted a study to compare the efficacy of oral montelukast with oral cetirizine in the treatment of chronic idiopathic urticaria. Twenty patients (12 females and 8 males) in the age group of 20 to 60 years (mean age 31.2 years) with chronic urticaria, were enrolled in the study after an informed written consent. Exclusion criteria were physical urticaria, urticarial vasculitis, pregnant or lactating women, a history of sensitivity to aspirin or NSAIDs, a history of aggravation of symptoms by pressure, and a positive cutaneous test to autologous serum. Routine investigations like complete blood count, and urine and stool examination were done to rule out infections.

The patients were randomly allocated into two age- and sex-matched groups of 10 patients each [Table - 1]. Randomization was achieved with the help of randomization software. One group was given montelukast 10 mg and the other, cetirizine 10 mg daily in the evening for two weeks. Patients were evaluated at baseline, after a week. and at the end of two weeks.

Improvement was monitored by using the urticaria activity score (UAS) which was estimated at weekly intervals. The UAS consisted of the sum of the wheal number score and the itch severity score. The wheal numbers were graded from 0 to 3 as follows: 0, less than 10 small wheals (diameter, < 3 cm); 1, 10 to 50 small wheals. or less than 10 large wheals (diameter,> 3 cm); 2, greater than 50 small wheals or 10 to 50 large wheals; and 3, almost the whole body is covered. The severity of the itching was also graded daily from 0 to 3 (0, none; 1, mild; 2, moderate; and 3, severe). Thus, the UAS ranged from 0 to 6 per week for each patient. Baseline average UAS was 4.6 in the montelukast group and 4.5 in the cetirizine group.

Eight out of ten patients in the montelukast group, reported within seven days of starting treatment due to worsening of itching and lesions, with UAS average score going up to 5.5 in eight patients, while two patients did not follow up. These eight patients were started on cetirizine, 10 mg daily in the evening, for control of urticaria. Treatment with montelukast as monotherapy failed to control the urticarial symptoms such as pruritus and hives. All patients in the cetirizine group showed control of symptoms, with UAS average score coming down to average of 2.2.

The effects of leukotriene receptor antagonists (LT-RA) in patients with CIU have been evaluated mostly, in a heterogeneous population of patients. The majority are anecdotal reports of chronic urticaria cases, and only a few placebo-controlled studies are reported.[2],[3],[4],[5],[6] Of these studies, four demonstrated a beneficial effect of LT-RAs,[2],[4],[5],[6] whereas one demonstrated that LT-RAs did not benefit the patients.[5] A clinical trial from Italy found that a combination of desloratadine and montelukast does not seem to offer a substantial advantage to desloratadine monotherapy in patients affected by moderate CIU.[7] In this trial, Di Lorenzo and coworkers reported the results of a placebo-controlled, double-blind examination of desloratadine, montelukast, both, or neither in 160 patients with moderate CIU. Desloratadine was clearly the most effective treatment. All of the 80 subjects who received desloratadine, completed the study. There was no additional benefit for any outcome, with the addition of montelukast to desloratadine. Monotherapy with montelukast was more effective than placebo, but montelukast was consistently less effective than desloratadine. Furthermore, 27 of the 40 subjects on montelukast monotherapy failed to complete the 6-week study, as did 35 of the 40 subjects receiving placebo. The results of this study do not support the use of LTRAs as either monotherapy or add-on therapy in moderate CIU, in patients with negative autologous serum skin tests, whose urticaria is not worse when challenged with aspirin or NSAIDs.[7] Moreover, montelukast has been reported to cause urticaria in a case report.[8]

This study could not be completed as the montelukast group of patients showed no control of symptoms, and patients demanded the rescue medication i.e., cetirizine. There are no published studies from India about use of montelukast in urticaria. While monotherapy with montelukast is probably not advisable, it needs to be validated in the Indian population, whether addition of montelukast to an antihistamine offers any additional advantage. Larger and better-designed studies are required to settle this question.

Tharp MD. Chronic urticaria: Pathophysiology and treatment approaches. J Aller Clin Immunol 1996;98:325-30.
[Google Scholar]
Pacor ML, Di Lorenzo G, Corrocher R. Efficacy of leukotriene receptor antagonist in chronic urticaria. A double-blind, placebo-controlled comparison of treatment with montelukast and cetirizine in patients with chronic urticaria with intolerance to food additive and/or acetylsalicylic acid. Clin Exp Aller 2001;31:1607-14.
[Google Scholar]
Nettis E, Dambra P, D'Oronzio L, Loria MP, Ferrannini A, Tursi A. Comparison of montelukast and fexofenadine for chronic idiopathic urticaria. Arch Dermatol 2001;137:99-100.
[Google Scholar]
Erbagci Z. The leukotriene receptor antagonist montelukast in the treatment of chronic idiopathic urticaria: A single-blind, placebo-controlled, crossover clinical study. J Aller Clin Immunol 2002;110:484-8.
[Google Scholar]
Reimers A, Pichler C, Helbling A, Pichler WJ, Yawalkar N. Zafirlukast has no beneficial effects in the treatment of chronic urticaria. Clin Exp Aller 2002;32:1763-8.
[Google Scholar]
Bagenstose SE, Levin L, Bernstein JA. The addition of zafirlukast to cetirizine improves the treatment of chronic urticaria in patients with positive autologous serum skin test results. J Aller Clin Immunol 2004;113:134-40.
[Google Scholar]
Lorenzo GD, Pacor ML, Mansueto P, Pellitteri EM, Bianco CL, Ditta V, et al . Randomized placebo-controlled trial comparing desloratadine and montelukast in monotherapy and desloratadine plus montelukast in combined therapy for chronic idiopathic urticaria J Aller Clin Immunol 2004;114:619-25.
[Google Scholar]
Minciullo PL. Montelukast-induced generalized urticaria. Ann Pharmacother 2004;38:999-1001.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections