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Montelukast treatment response according to eosinophil-derived neurotoxin level in children with allergic rhinitis
Yong Ju Lee1, Hyo-Sun Ma2, Zak Callaway2,3
1Department of Pediatrics, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea.
Insights
Montelukast effectively reduced allergic rhinitis symptoms in children. Higher initial eosinophil-derived neurotoxin (EDN) levels correlated with a better response to Montelukast treatment, suggesting EDN can guide therapy.
Area of Science:
- Pediatric Allergy and Immunology
- Pharmacology and Therapeutics
- Biomarker Research
Background:
- Eosinophil-derived neurotoxin (EDN) is a key indicator of eosinophilic inflammation.
- Perennial allergic rhinitis (PAR) significantly impacts children's quality of life.
Purpose of the Study:
- To assess Montelukast treatment efficacy in children with PAR based on baseline EDN levels.
- To determine if EDN concentration can predict treatment response in pediatric PAR.
Main Methods:
- Fifty-two children with PAR received Montelukast alone or with Levocetirizine for 4 weeks.
- Rhinitis symptoms and EDN concentrations were measured before and after treatment.
- Children were stratified into High EDN (≥53 ng/mL) and Low EDN (<53 ng/mL) groups for secondary analysis.
Main Results:
- Both treatment groups showed significant reductions in daytime nasal symptom scores (DNSS).
- EDN concentrations decreased significantly post-treatment in both groups.
- Children with higher initial EDN levels demonstrated greater symptom improvement and EDN reduction.
Conclusions:
- Montelukast is an effective treatment for pediatric PAR, particularly in children with elevated EDN levels.
- EDN concentration can serve as a predictive biomarker for Montelukast response in PAR patients.
- Utilizing EDN levels may optimize treatment strategies and improve patient outcomes in allergic rhinitis.
Background:
Eosinophil-derived neurotoxin (EDN) is an important biomarker of eosinophilic inflammation.
Methods:
This study evaluated Montelukast treatment response according to EDN concentration in children with perennial allergic rhinitis (PAR). Fifty-two children with PAR were recruited and took a combination of Montelukast (5mg) and Levocetirizine (5mg) "Mont/Levo Group" or only Montelukast (5mg) "Mont Group" for 4 weeks. All caregivers were instructed to record rhinitis symptoms for 4 weeks. EDN was measured before and after treatment.
Results:
Daytime nasal symptom scores (DNSS) significantly decreased in both the Mont/Levo (p = 0.0001; n = 20) and Mont Group (p < 0.0001; n = 20), but there were no significant differences between the two groups. EDN concentration also significantly decreased after treatment in both groups (p < 0.0001 and p < 0.001, respectively). For secondary analysis, children with a high initial EDN concentration (EDN ≥ 53 ng/mL) were placed in the "High EDN Group", while those with a lower initial EDN concentration (EDN < 53 ng/mL) were put in the "Low EDN Group". Both groups experienced significant reductions in DNSS after either treatment regimen (p < 0.0001 and p = 0.0027, respectively) but the High EDN Group had greater reductions. EDN concentrations in the High EDN Group decreased significantly from either treatment (p < 0.0001).
Conclusion:
We found that children with AR and a high serum EDN concentration may respond well to Montelukast treatment. A therapeutic strategy using EDN concentrations in patients with AR to evaluate therapeutic response may help improve quality of care.
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