Antileukotrienes Improve Naso-Ocular Symptoms and Biomarkers inPatients With NARES and Asthma

Abstract

Objective: The aim of our study was to analyze the montelukast effectiveness in improving oculonasal symptoms, patient-reported outcomes (PROs), and eosinophilic biomarkers in patients with nonallergic rhinitis eosinophilic syndrome (NARES).Methods: We enrolled prospectively 80 symptomatic patients treated with 10 mg once a day of montelukast in mono-therapy for 2 months. All patients were investigated before and after treatment. Nasal symptoms (nasal obstruction, rhinor-rhoea, sneezing, nasal itching), ocular symptoms (redness/puffiness, watery eyes), and other PROs (olfactory dysfunction,difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening) were scored by visual analogic scale. Thefollowing clinical scores were assessed: Total Nasal Symptom Score (T4NSS), Total Ocular Symptom Score (T2OSS), TotalSymptom Score of Patient-Reported Outcomes (TSS-PROs), and a Composite Symptoms Score (CSS). Patients were classified asresponders when a reduction of at least 50% of the CSS was observed. Before and after treatment, the eosinophilic biomarkersin nasal lavage were analyzed: nasal eosinophilia (number of eosinophils per high power field), eotaxin-1 and eotaxin-2.Results: Aft er tre atment, s ig nificant reductions were observed for all the symptom scores. Forty-two of 78 patients were con-sidered responders. A significant reduction of eosinophils in nasal mucosa and of levels of eotaxin-1 and eotaxin-2 in nasal lavagewere observed after treatment in responder patients. Patients with asthma had an increased probability to be responders.Conclusion: NARES patients may benefit from treatment with montelukast. In particular, the presence of concomitantasthma may be predictive of a greater efficacy.