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Science tells us that they’re useless, but they’re prescribed to almost everyone who has allergies: is this a case of dysfunctional National Health Service or personal gain? My opinions on the use of these anti-leukotrienes stem from the results of scientific studies on them.
Originally, these drugs were meant to substitute cortisone or antihistamines for the treatment of allergies. However, they were mostly studied in vitro: if the leukotrienes (an inflammatory substance that contributes to allergy) cause a disturbance, a product that opposes them will solve the problem!
However, this syllogism doesn’t always function in nature, especially if the allergy is a warning sign that comes from the entire body and not always and exclusively an illness.
Evidently the body as a whole has regulatory mechanisms that are more evolved. As a matter of fact, the first field trials showed that these costly drugs weren’t able to reduce the use of antihistamines and cortisone. Instead of rejecting them, however, procedures for their prescription were put into action thereby protecting the producers.
Today the guidelines for therapy call for the simultaneous use of cortisone (local or ingested) and antihistamines, just like before, together with anti-leukotrienes.
So, now a drug that was invented to substitute two others is simply added along with them (to make sure that the warehouse stock doesn’t get “moldy”) without offering any specific advantage from a clinical perspective.
In my personal experience with these drugs, I have found that in rare cases they can substitute an antihistamine with the result of causing more indefinite and less distinct harm. As a practical doctor, I prefer to use the latter; they’ve been in use for many years, unlike the others about which we may discover more harmful side effects in the future.
What’s more, in my opinion anti-leukotrienes make the faces of children and adults who take them turn “grey”. But because as a doctor I can only report an impression, that may be totally unsound, I must make reference to scientific research.
I repeat the fact that many studies in vitro attest to the positive action of these drugs, but our reality as humans is not a test tube, but an open field full of pollen!!
Thus, back in 2002 an important study already showed that when puffs of cortisone associated with salmeterol (a long-lasting beta agonist) were used there was an enormous difference in relation to people who used puffs of inhaled cortisone together with anti-leukotrienes.
In 2 years of study (Stempel DA et al., J Allergy Clin Immunol 2002;109:433-9) it was shown that those people who used anti-leukotrienes had 40% more need to use rapid action beta agonists (like Ventolin), they had 2,5 times more probability of being hospitalized for asthma , and finally the total cost of treatment for people who used anti-leukotrienes was 65% greater than that of people who didn’t use them.
Similar results were found in a Danish study from 2003 that was performed upon asthmatic children between the ages of 2 and 14 years (Meyer KA et al., J Allergy Clin Immunol 2003;111:757-62). The research didn’t show any specific characteristic in the children that might indicate the usefulness of Montelukast or any other positive clinical result in the course of the treatment.
In yet another area such as urticaria , the extremely detailed study performed by Maria Luisa Pacor’s group of researchers in Verona and from the department of Clinical Medicine in Palermo confirmed the absolute uselessness of these anti-leucotriene preparations.
A comparison was made between an antihistamine (Desloratadine) and Montelukast as well as an association of the two preparations in order to find a possible positive interaction. The group that used solely Montelukast proved to be in all effects absolutely equal to the placebo group, without any evident clinical effect.
When combined with desloratadine, it didn’t bring about results that were different from desloratadine when used alone. Thus it is apparently useless and costly (Di Lorenzo G. et al, J Allergy Clin Immunol 2004;114:619-25). This last research was financed by a fund from the Italian Ministry of University and Research, and not by the pharmaceutical companies.
But it seems like the Ministry of Health and the Ministry of University don’t communicate very much with each other since even today Montelukast, for which the Regional Health Services pay a high price, continues to be widely prescribed.
In the face of non-existent results and exorbitant social costs, it might be better to use a different paradigm . We should try to understand the causes and find natural treatment methods (DRIA respiration, DRIA urticaria, the use of specific minerals), even if academic medicine doesn’t agree and prefers to give children Montelukast instead of a few drops of Ribes nigrum.
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