TY - JOUR
T1 - Leukotriene receptor antagonists as add-on therapy to antihistamines for urticaria
T2 - Systematic review and meta-analysis of randomized clinical trials
AU - Rayner, Daniel G.
AU - Liu, Ming
AU - Chu, Alexandro W.L.
AU - Chu, Xiajing
AU - Guyatt, Gordon H.
AU - Oykhman, Paul
AU - Cao, Daniel J.
AU - Moellman, Joseph
AU - Ben-Shoshan, Moshe
AU - Baker, Diane R.
AU - Waserman, Susan
AU - Lang, David
AU - Sheikh, Javed
AU - Mathur, Sameer K.
AU - Beck, Lisa A.
AU - Khan, David A.
AU - Oliver, Eric T.
AU - Asiniwasis, Rachel N.
AU - Cole, Emily F.
AU - Wheeler, Kathryn E.
AU - Runyon, Lauren
AU - Chan, Jeffrey
AU - Trayes, Kathryn P.
AU - Eftekhari, Sanaz
AU - Gardner, Donna D.
AU - Winders, Tonya
AU - Saini, Sarbjit S.
AU - Bernstein, Jonathan A.
AU - Chu, Derek K.
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/10
Y1 - 2024/10
N2 - Background: The benefits and harms of adding antileukotrienes to H1 antihistamines (AHs) for the management of urticaria (hives, itch, and/or angioedema) remain unclear. Objective: We sought to systematically synthesize the treatment outcomes of antileukotrienes in combination with AHs versus AHs alone for acute and chronic urticaria. Methods: As part of updating American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters urticaria guidelines, we searched Medline, Embase, Central, LILACS, WPRIM, IBECS, ICTRP, CBM, CNKI, VIP, Wanfang, US Food and Drug Administration, and European Medicines Agency databases from inception to December 18, 2023, for randomized controlled trials (RCTs) evaluating antileukotrienes and AHs versus AHs alone in patients with urticaria. Paired reviewers independently screened citations, extracted data, and assessed risk of bias. Random effects models pooled effect estimates for urticaria activity, itch, wheal, sleep, quality of life, and harms. The GRADE approach informed certainty of evidence ratings. The study was registered at the Open Science Framework (osf.io/h2bfx/). Results: Thirty-four RCTs enrolled 3324 children and adults. Compared to AHs alone, the combination of a leukotriene receptor antagonist with AHs probably modestly reduces urticaria activity (mean difference, −5.04; 95% confidence interval, −6.36 to −3.71; 7-day urticaria activity score) with moderate certainty. We made similar findings for itch and wheal severity as well as quality of life. Adverse events were probably not different between groups (moderate certainty); however, no RCT reported on neuropsychiatric adverse events. Conclusion: Among patients with urticaria, adding leukotriene receptor antagonists to AHs probably modestly improves urticaria activity with little to no increase in overall adverse events. The added risk of neuropsychiatric adverse events in this population with leukotriene receptor antagonists is small and uncertain.
AB - Background: The benefits and harms of adding antileukotrienes to H1 antihistamines (AHs) for the management of urticaria (hives, itch, and/or angioedema) remain unclear. Objective: We sought to systematically synthesize the treatment outcomes of antileukotrienes in combination with AHs versus AHs alone for acute and chronic urticaria. Methods: As part of updating American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters urticaria guidelines, we searched Medline, Embase, Central, LILACS, WPRIM, IBECS, ICTRP, CBM, CNKI, VIP, Wanfang, US Food and Drug Administration, and European Medicines Agency databases from inception to December 18, 2023, for randomized controlled trials (RCTs) evaluating antileukotrienes and AHs versus AHs alone in patients with urticaria. Paired reviewers independently screened citations, extracted data, and assessed risk of bias. Random effects models pooled effect estimates for urticaria activity, itch, wheal, sleep, quality of life, and harms. The GRADE approach informed certainty of evidence ratings. The study was registered at the Open Science Framework (osf.io/h2bfx/). Results: Thirty-four RCTs enrolled 3324 children and adults. Compared to AHs alone, the combination of a leukotriene receptor antagonist with AHs probably modestly reduces urticaria activity (mean difference, −5.04; 95% confidence interval, −6.36 to −3.71; 7-day urticaria activity score) with moderate certainty. We made similar findings for itch and wheal severity as well as quality of life. Adverse events were probably not different between groups (moderate certainty); however, no RCT reported on neuropsychiatric adverse events. Conclusion: Among patients with urticaria, adding leukotriene receptor antagonists to AHs probably modestly improves urticaria activity with little to no increase in overall adverse events. The added risk of neuropsychiatric adverse events in this population with leukotriene receptor antagonists is small and uncertain.
KW - Chronic urticaria (hives)
KW - leukotriene receptor antagonists
KW - meta-analysis
KW - montelukast
KW - systematic review
KW - zafirlukast
UR - http://www.scopus.com/inward/record.url?scp=85197808023&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2024.05.026
DO - 10.1016/j.jaci.2024.05.026
M3 - Article
C2 - 38852861
AN - SCOPUS:85197808023
SN - 0091-6749
VL - 154
SP - 996
EP - 1007
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 4
ER -