Allergy, Asthma & Immunology Research

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
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Montelukast Reduces Serum Levels of Eosinophil-Derived Neurotoxin in Preschool Asthma

  • Kim, Chang-Keun (Asthma & Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Callaway, Zak (Asthma & Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Park, Jin-Sung (Asthma & Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Nishimori, Hisashi (Department of Pediatrics, Mie Prefectural General Medical Center) ;
  • Ogino, Tikatoshi (Niko Niko Child Clinic) ;
  • Nagao, Mizuho (Institute for Clinical Research, Mie National Hospital) ;
  • Fujisawa, Takao (Institute for Clinical Research, Mie National Hospital)
  • Received : 2018.02.21
  • Accepted : 2018.08.07
  • Published : 2018.11.01
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Abstract

Purpose: Several markers for eosinophilic inflammation have been proposed to predict response to asthma treatment. However, definitive criteria for treatment decisions have not yet been established. We investigate a potentially useful relatively non-invasive biomarker, eosinophil-derived neurotoxin (EDN), to predict favorable responses to budesonide or montelukast, common treatment for children with asthma. Methods: Young children (1 to 6 years old) were enrolled in this randomized, parallel, 2-group, open-label trial. Criteria for eligibility included: 1) being symptomatic during the run-in period; and 2) having a serum EDN (sEDN) level ${\geq}53ng/mL$, with positive specific immunoglobulin E to house dust mite. Eligible patients were randomly placed into 2 groups: the BIS group received budesonide inhalation suspension (BIS) 0.5 mg once daily; the MONT group received montelukast 4 mg once daily. Ineligible patients were invited to receive montelukast 4 mg once daily (OBS group). Treatment period was 12 weeks. Results: Asthma control days increased significantly in the BIS and MONT groups (P < 0.000) over the 12-week study period. There was no significant change in sEDN in the BIS group but there was a significant decrease in the MONT group (P < 0.000). Patients in the OBS group with high EDN levels (> 53 ng/mL) showed a significant decrease due to MONT treatment (P = 0.023). Rescue medication usage significantly decreased in the BIS and MONT groups (P < 0.000). Conclusions: EDN is a useful relatively non-invasive biomarker for predicting responses to montelukast and budesonide treatment of preschool children with beta2-agonist responsive recurrent wheeze and multiple-trigger wheeze (Trial registry at UMIN Clinical Trials Registry, UMIN000008335).

Keywords

References

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