Antileukotrienes addition to H1-antihistamines may improve urticaria outcomes, reveals research

A recent study conducted by Daniel Rayner and team was found that the combination of a leukotriene receptor antagonist (LTRA), such as montelukast, with an H1-antihistamine might be considered in the treatment of urticaria, as there appears to be little to no raised likelihood of adverse effects. The findings of this study was published in The Journal of Allergy and Clinical Immunology.

The advantages and disadvantages of combining antileukotrienes with H1-antihistamines for the treatment of urticaria (hives, itch, and/or angioedema) remain unknown. As a result, in this study aimed to comprehensively compare the treatment results of antileukotrienes in conjunction with H1-antihistamines to H1-antihistamines alone for chronic and acute urticaria.

As part of updating the American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters urticaria guidelines, multiple databases (MEDLINE, CENTRAL, Embase, WPRIM, LILACS, IBECS, CBM, ICTRP, VIP, CNKI,FDA, Wanfang and EMA) were meticulously searched until December 18th, 2023. This included randomized controlled trials (RCTs) which evaluated antileukotrienes and H1-antihistamines versus H1-antihistamines.

Out of 34 RCTs  that involved a total of 3,324 participants (both children and adults), the study found that the combination of a leukotriene receptor antagonist (LTRA) with H1-antihistamines probably provides a modest reduction in urticaria activity. The primary metric used was the 7-day Urticaria Activity Score, where the combination therapy showed a mean difference of -5.04 points when compared to just H1-antihistamines with a confidence interval (CI) ranging from -6.36 to -3.71.

Similar modest improvements were observed for itch and wheal severity, as well as the quality of life for patients. Also, the study found no significant difference in the overall adverse events between the two treatment groups, also with moderate certainty.

Overall, the finding suggest that the combination of LTRAs and H1-antihistamines would modestly improve urticaria symptoms with little to no increase in overall adverse events. While the combination appears to offer some improvement in urticaria symptoms, the benefits are modest. This extensive review underline the need for more comprehensive studies that measure symptomatic relief and also monitor for less obvious side effects.

Source:

Rayner, D. G., Liu, M., Chu, A. W. L., Chu, X., Guyatt, G. H., Oykhman, P., Cao, D. J., Moellman, J., Ben-Shoshan, M., Baker, D. R., Waserman, S., Lang, D., Sheikh, J., Mathur, S. K., Beck, L. A., Khan, D. A., Oliver, E. T., Asiniwasis, R. N., Cole, E. F., … Chu, D. K. (2024). Leukotriene receptor antagonists as add-on therapy to antihistamines for urticaria: a systematic review and meta-analysis of randomized clinical trials. In Journal of Allergy and Clinical Immunology. Elsevier BV. https://doi.org/10.1016/j.jaci.2024.05.026