Urticária crônica exacerbada por anti-inflamatórios não esteroidais e resposta aos antileucotrienos
Nonsteroidal anti-inflammatory drug-exacerbated chronic urticaria and response to antileukotrienes
Mariele Morandi Lopes; Pâmela Diogo-Salles; Paula Dantas; Jorge Kalil; Antonio Abílio Motta; Rosana Câmara Agondi
Resumo
Introdução: Pacientes com urticária crônica espontânea (UCE) frequentemente exacerbam com o uso de anti-inflamatórios não esteroidais (AINEs), que são medicamentos que inibem a ciclooxigenase 1 (COX-1) e levam a um desvio para produção de leucotrienos. Os antileucotrienos seriam uma opção terapêutica para aqueles que não respondam aos anti-histamínicos (AH1). Objetivo: O objetivo deste estudo foi avaliar a eficácia dos antileucotrienos nos pacientes com UCE exacerbada ou não pelos AINEs que não responderam apenas aos AH1. Método: Estudo retrospectivo com análise de prontuários eletrônicos de pacientes com UCE em seguimento ambulatorial. Todos os pacientes foram interrogados sobre a história de exacerbação ou não da UCE por AINEs. Além dos AH1, o montelucaste foi introduzido para todos os pacientes, em algum momento do acompanhamento. Foram avaliadas a resposta ao antileucotrieno e a presença da associação desta resposta à história de exacerbação com AINE. Resultados: Sessenta e dois pacientes participaram do estudo. A média de idade foi de 48,4 anos, sendo 82,3% do sexo feminino. Destes, 35 pacientes (56,5%) referiam piora da urticária com uso de AINEs, e, destes, 77,1% responderam ao antileucotrieno associado ao AH1. Dentre os 27 pacientes que não apresentavam UCE exacerbada por AINE, 48,1% obtiveram boa resposta ao uso de antileucotrieno associado ao AH1. Conclusão: A resposta ao antileucotrieno foi superior e estatisticamente significante (p = 0,031) no grupo de pacientes com UCE exacerbada por AINE. Portanto, a associação dos antileucotrienos aos AH1 seria uma opção eficaz e segura, sendo que essa associação se torna ainda mais relevante em pacientes que UC exacerbada por AINEs.
Palavras-chave
Abstract
Introduction: Patients with chronic spontaneous urticaria (CSU) frequently show symptom exacerbation after the use of nonsteroidal anti-inflammatory drugs (NSAIDs) – drugs that inhibit cyclooxygenase-1 (COX-1) and affect leukotriene production. Antileukotrienes are considered a therapeutic option for patients who do not respond to antihistamines (AH1). Objective: The aim of this study was to assess the effectiveness of antileukotrienes in patients with CSU exacerbated or not by NSAIDs. Methods: In this retrospective study, the electronic charts of CSU outpatients were analyzed. All patients were inquired about history of CSU exacerbation or not by NSAIDs. In addition to AH1, treatment with montelukast was introduced to all patients at some point during follow-up. Response to antileukotriene treatment and association between treatment response and history of NSAID exacerbation were evaluated. Results: A total of 62 patients participated in the study. Mean age was 48.4 years, and 82.3% were female. Thirtyfive patients (56.5%) reported worsening of urticaria with the use of NSAIDs; 77.1% of these patients responded to antileukotriene combined with AH1. Of the 27 patients with no history of CSU exacerbation with NSAIDs, 48.1% showed a favorable response to antileukotrienes associated with AH1. Conclusion: Response to antileukotriene treatment was higher and statistically significant (p=0.031) in patients with NSAID-exacerbated CSU. Therefore, the association of antileukotrienes with AH1 could be a safe and effective treatment option, especially for patients with NSAIDexacerbated CSU.
Keywords
Referências
1. Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau A, et al. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64:1417-26.
2. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69:868-87.
3. Pacor ML, Di Lorenzo G, Corrocher R. Efficacy of leukotriene receptor antagonist in chronic urticaria. A double-blind, placebocontrolled comparison of treatment with montelukast and cetirizine in patients with chronic urticaria with intolerance to food additive and/or acetylsalicylic acid. Clin Exp Allerg. 2001;31:1607-14.
4. Kaplan AP. Treatment of chronic spontaneous urticaria. Allergy Asthma Immunol Res. 2012;4:326-31.
5. Smith LJ. Leukotrienes in asthma. Arch Intern Med. 1996;156:2181-9.
6. Mastalerz L, Setkowicz M, Szczeklik A. Mechanism of chronic urticaria exacerbation by aspirin. Curr Allergy Asthma Rep. 2005;5:277-83.
7. Singh RK, Gupta S, Dastidar S, Ray A. Cysteinyl leukotrienes and their receptors: molecular and functional characteristics. Pharmacology. 2010;85:336-49.
8. Capra V, Thompson MD, Sala A, Cole DE, Folco G, Rovati GE. Cysteinyl-leukotrienes and their receptors in asthma and other inflammatory diseases: critical update and emerging trends. Med Res Rev. 2007;27:469-527.
9. Di Lorenzo G, D’Alcamo A, Rizzo M, et al. Leukotriene receptor antagonists in monotherapy or in combination with antihistamines in the treatment of chronic urticaria: a systematic review. Journal of Asthma and Allergy. 2009;2:9-16.
10. Kowaslki ML, Asero R, Bavbek S, Blanca M, Blanca-Lopez N, Bochenek G, et al. Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy. 2013;68:1219-32.
11. Kosnik M, Tjasa Subic T. Add-on montelukast in antihistamineresistant chronic idiopathic urticaria. Respiratory Medicine. 2011;105(Suppl 1):S84-8.
12. Erbagci Z. The leukotriene receptor antagonist montelukast in the treatment of chronic idiopathic urticaria: a single-blind, placebocontrolled, crossover clinical study. J Allergy Clin Immunol. 2002;110:484-8.
13. Nettis E, Colanardi MC, Paradiso MT, Ferrannini A. Desloratadine in combination with montelukast in the treatment of chronic urticaria: a randomized, double-blind, placebo-controlled study. Clin Exp Allergy. 2004;34:140-7.
14. Bagenstose SE, Levin L, Bernstein JA. The addition of zafirlukast to cetirizine improves the treatment of chronic urticaria in patients with positive autologous serum skin test results. J Allergy Clin Immunol. 2004;113:134-40.
15. Wan KS. Efficacy of leukotriene receptor antagonist with an anti-H1 receptor antagonist for treatment of chronic idiopathic urticaria. J Dermatol Treat. 2009;20:194-7.
16. Tintinger GR, Feldman C, Theron AJ, Anderson R. Montelukast: more than a cysteinyl leukotriene receptor antagonist? Scientific World Journal. 2010;10:2403-13.
17. de Silva NL, Damayanthi H, Rajapakse AC, Rodrigo C, Rajapakse S. Leukotriene receptor antagonists for chronic urticaria: a systematic review. Allergy, Asthma Clin Immunol. 2014,10:24.
18. Vestergaard C, Toubi E, Maurer M, Triggiani M, Ballmer-Weber B, Marsland A, et al. Treatment of chronic spontaneous urticaria with an inadequade response to H1-antihistamines: an expert opinion. Eur J Dermatol. 2017;27:10-9.
19. Kowalski ML, Woessner K, Sanak M. Approaches to the diagnosis and management of patients with a history of nonsteroidal antiinflammatory drug-related urticaria and angioedema. J Allergy Clin Immunol. 2015;136:245-51.
20. Walters KM, Woessner KM. An overview of nonsteroidal antiinflammatory drug reactions. Immunol Allergy Clin N Am. 2016;36:625-41.
Submetido em:
14/04/2017
Aceito em:
29/04/2017
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