Nasal cytokine modulation by montelukast in allergic children: a pilot study.

■ Background: Allergic rhinitis and asthma are characterized by chronic inflammation due to a Th2 cytokine polarization. Leukotrienes receptor antagonists have been shown to be effective in both diseases. ■ Objective: Aim of the study was to evaluate the modulation by the antileukotriene montelukast on Th2 and Th1 cytokines in allergic rhinitis. ■ Methods: Fourteen school children affected by persistent allergic rhinitis (PAR) and exercise-induced asthma (EIA) underwent a nasal lavage before and after a two-week treatment with montelukast. A panel of cytokines, including IL4, IL13, and IFNγ, was measured by immunoassay on nasal lavage samples. ■ Results: Montelukast treatment induced a significant decrease of IL4 and IL13 levels (p<0.001, for both comparisons), and a significant increase of IFNy (p<0.001). ■ Conclusions: Montelukast treatment reversed a typical Th2 cytokine pattern (IL4 and IL13) toward a Th1 (IFNy) predominance in children with PAR and EIA. This effect could be considered reevant for long term allergic inflammation control and of interest when treating EIA with concomitant PAR.