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Montelukast: Use in Pediatric Patients With Eosinophilic Gastrointestinal Disease

Vanderhoof, Jon A.; Young, Rosemary J.; Hanner, Terri L.; Kettlehut, Brett

Journal of Pediatric Gastroenterology and Nutrition: February 2003 - Volume 36 - Issue 2 - p 293-294
Letters to the Editor
Free

University of Nebraska Medical Center,

Omaha, Nebraska, U.S.A.

To the Editors:

Eosinophilic inflammation in the gastrointestinal tract is characterized histologically by the presence of increased numbers of eosinophils in gastrointestinal biopsies (1). Causes of eosinophilia vary depending on the location of the eosinophilia and include food allergies, chronic gastroesophageal reflux (when occurring in the esophagus), helminths, some connective tissue diseases (scleroderma), and drug injury (2). Often, no specific cause can be identified. Previously described treatments used for eosinophilic diseases of the gastrointestinal tract have included dietary restrictions primarily of cow milk protein (3), anti-inflammatory therapy utilizing suplatast, budesonide and corticosteroids (4–5), cromolyn sodium (6), antihistamines (7), and oral inhalable steroids (8). We describe 8 children with eosinophilic inflammation in the gastrointestinal tract unresponsive to standard therapies who exhibited marked improvement with use of montelukast (Singulair) (Table 1).

TABLE 1

TABLE 1

Our decision to use montelukast in our patients was based largely on the demonstrated efficacy of this agent in other eosinophilic conditions such as asthma (9). Cysteinyl leukotrienes (LTC4, LTD4, LTE4) are products of arachidonic metabolism released from mast cells and eosinophils. Cys LT1 selective antagonists, such as montelukast, inhibit physiologic actions of LTD4 without any agonist activity (10,11). Therefore, one could postulate a variety of abnormalities that occur in eosinophilic disorders in both the respiratory and GI tract that could be alleviated with the use of montelukast.

The use of montelukast has previously been described in an adult with eosinophilic gastroenteritis and in an adolescent female (12,13). The exact role of montelukast in the treatment of patients with gastrointestinal symptoms and gut eosinophilia cannot be determined from our series of patients. Most of our patients had received other, less-successful therapy directed at their specific disease process by the same team of physicians and health care personnel, which makes placebo effect a less likely explanation for the observed clinical improvement. A carefully designed and conducted double-blind, placebo-controlled study of montelukast for treating gastrointestinal eosinophilic disorders in children should be the next step to verify the excellent clinical response so far witnessed.

Jon A. Vanderhoof

Rosemary J. Young

Terri L. Hanner

Brett Kettlehut

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REFERENCES

1. Winter HS, Antonioli DA, Fukagawa N, Marcial M, Goldman H. Allergy-related proctocolitis in infants: diagnostic usefulness of rectal biopsy. Mod Pathol 1990; 3:5–10.
2. Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr 2000; 30(Suppl):S28–35.
3. Vanderhoof JA, Krueger RL, Hanner TL, Young RJ. Eosinophilic esophagitis: a report of dietary therapy used in older children. J Pediatr Gastroenterol Nutr 2001; 33:418 (abstract).
4. Shirai T, Hashimoto D, Suzuki K, Osawa S, Aonahata M, Chida K, Nakamura H. Successful treatment of eosinophilic gastroenteritis with suplatast tosilate. J Allergy Clin Immunol 2001; 107:924–25.
5. Tann AC, Kruimel JW, Naber TH. Eosinphilic gastroenteritis treated with non-enteric-coated budesonide tablets. Eur J Gastroenterol Hepatol 2001; 13:425–27.
6. Friesen CA, Zwick DL, Sandridge L, Roberts CC. Pediatric dyspepsia responsive to oral cromolyn: a report of eleven cases. J Pediatr Gastroenterol Nutr 1993; 17:326–28.
7. Eigenmann PA, Pastore FD, Zamora SA. An Internet-based survey of anaphylactic reactions to foods. Allergy 2001; 56:540–43.
8. Faubion WA, Perrault J, Burgart LJ, Zein NN, Clawson ML, Freese DK. Treatment of eosinophilic esophagitis with inhaled corticosteroids. J Pediatr Gastroenterol Nutr 1998; 27:90–93.
9. Garcia-Marcos L, Schuster A. New perspectives for asthma treatment: anti-leukotriene drugs. Pediatr Allergy Immunol 1999; 10:77–88.
10. Heise CE, O'Dowd BF, Figueroa DJ, et al. Characterization of the human cysteinyl leukotriene 2 receptor. Am Soc Biochem Mol Biol 2000; 275:30531–36.
11. Lynch KR, O'Neill GP, Liu Q, et al. Characterization of the human cysteinyl leukotriene CysLT1 receptor. Nature 1999; 399:789–93.
12. Schwartz DA, Pardi DS, Murray JA. Use of montelukast as steroid-sparing agent for recurrent eosinophilic gastroenteritis. Dig Dis Sci 2001; 46:1787–90.
13. Neustrom MR, Friesen C. Treatment of eosinophilic gastroenteritis with montelukast. J Allergy Clin Immunol 1999; 104(2 Pt 1):506.
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