Research in the past two decades has shown that patients with
asthma and
rhinitis have
inflammation of the involved tissues. This perception has been reflected in recent treatment guidelines, which stress the decreased use of symptom-based
therapy and increased use of antiinflammatory
therapies to control underlying
inflammation.
Corticosteroids are the most effective drugs currently in use; however, their use may be limited by potential problems with safety and patient/family adherence, which includes the "fear factor." In addition, the use of high doses of topical
corticosteroids (especially when used in both the nose and airways) may have adverse effects when used continuously for long periods. The inflammatory response is complex, involving numerous inflammatory mediators and cells that interact in complicated and interrelated pathways. This provides researchers with numerous interactions at which molecular intervention may result in the attenuation of
inflammation, and thus clinical disease. The
leukotrienes, a group of important inflammatory mediators, cause vascular leakage and tissue
edema; they also promote mucus secretion and a potent bronchoconstriction in patients with
asthma. Currently a number of antileukotriene drugs have been developed and preliminary research indicates that they may provide clinicians with a non-steroidal antiinflammatory
therapy that may provide
steroid-sparing effects. This review examines the
leukotrienes and the effects of antileukotriene agents in patients with
asthma and
allergic rhinitis.