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One of the most important questions we should be asking as parent...

Posted at 9:48 AM on Apr 18, 2008 by concernedcitizen, #29705
One of the most important questions we should be asking as parents is: How does Singulair - a leukotriene receptor antagonist (blocks the receptors) affect the normal function of the mast cell? The mast cell is the FRONT LINE DEFENSE against invading micro-organisms. When Singulair was invented, there was limited knowledge regarding the mechanisms by which the mast cell performed it's function. In my opinion, the focus was very narrow - those interested zeroed in on how the leukotriene receptor performed a role in the cause of asthma attacks and how ashma attacks could be prevented. Well, that's good preventing asthma attacks. But what happens to the mast cell if that receptor is blocked on a long term basis. I am not suggesting that blocking the receptor is bad but what if the long term effect is different than what we are are lead to believe-which is this is a safe medication with no known long term effects. What if the leukotriene receptor was just blocked short term a week or two to allow the body to clean up the mess from the last attack? I seriously question what is going on with all of these infections. Are they related to crippling the mast cell? Parents should be allowed to question. If Merck doesn't want to answer questions regarding what happens to the mast cell (including are the numbers of mast cell decreased on Singulair), then something really BIG is missing. If by any chance (unknown at the moment) that the mast cell is significantly changed and therapy by montelukast is proper on a short but not long term basis, so freakin' what if Singulair is not a huge money maker any more. Parents deserve every answer possible when decisions regarding their child's growth and development is on the line. I hope that we get some answers. Of course, what was there in 2002 were new questions-not necessarily answers about the mast cell. Did anybody apply this to Singulair studies? May 2002 From Journal of Clinical Investigation Pattern recognition receptors on mast cells The Toll-like receptors (TLRs) fit the definition of pattern-recognition molecules, which were originally postulated to allow the innate immune system to detect the 'molecular signatures' of various infectious agents. Although the innate immune system has no memory, it shows a degree of specificity, in part because the various TLRs recognize different sets of pathogen-associated molecules. Dermal mast cells are usually associated, not with the innate immune system, but with atopic dermatitis, but Supajatura et al. have found that these cells also express TLRs. They report here that TLR4, which binds the gram-negative product lipopolysaccharide (LPS), and TLR2, which binds peptidoglycan (PGN) from gram-positive organisms like Staphylococcus aureus, induce distinct mast cell responses. Staphylococcus is known to exacerbate allergic dermatitis, but it has generally been thought to act by inducing antibacterial IgE's, which trigger mast cell degranulation by stimulating the IgE receptor. Interestingly, the authors show that the interaction between PGN and TLR2 can provoke mast cell degranulation directly, sidestepping the need for IgE receptor engagement.
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Reply about 1 year ago on Apr 18, 2008 by kimsuewinks, #7426

I think you are becoming over involved in this. I feel you are loosing your credibility. I no longer read your entries. Sometimes, less is more. I think you have some good points, but I question your motives at this point.

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Reply about 1 year ago on Apr 19, 2008 by concernedcitizen, #7431

It doesn't really matter whether you think that I have any credibility or not. I just post what I find that I think is written clearly enough that others can get something out of it. Most academic work is written as though outsiders need a code book to understand.

There are some very intelligent people here who care about what is happening to their children. I don't have any answers but I see the need to ask many questions. People can read and then make up their minds.

I don't have any agenda. I think that everyone can agree that Merck aggressively marketed Singulair. There is no such thing as a perfectly safe medication for everybody-- for everything.

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Reply about 1 year ago on Apr 19, 2008 by sp2008, #7443

I for one appreciate the time you have spent and posting the different info you have found. For the people that don't choose to read your entries well isn't it nice they they are able to CHOOSE whether or not they want to! Seems to me that this medication has been out there long enough and people have been complaining over the years. The possible side effects where not given quick enough and made known to the general public so we as parents could make a CHOICE on whether or not to risk effects on our childrens brains. Thanks again for your effort!

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Reply about 1 year ago on Apr 20, 2008 by concernedcitizen, #7457

If anybody is going to pursue how suppressing the cystLT1 (singulair) receptor affects the normal functioning of the mast cell. There are Harvard researchers who study this.

I am interested in this topic because people who have developed asthma have a different set of immunological problems than people who simply have some seasonal allergies. There are studies that show that high levels of IgE will sustain the mast cell even in the presence of factors that are signally the mast cell that it's time to die. Harvard researchers have shown that the cystLT1 receptor plays a roll in mast cell proliferation. So it's possible that suppressing that receptor is desirable for some people and not desirable for others. I would like to see somebody study whether Singulair works on normal people like an anti-histamine just because it is limiting the number of mast cells available to provide histamine -- that would be a disaster for the immune system leaving the patient wide open to all kinds of bacterial infections in any tissue that should be protected by the mast cells --nasal, lungs, intestines, skin etc.

J Immunol. 2006 Sep 1;177(5):2755-9. Links
Cutting edge: Interleukin 4-dependent mast cell proliferation requires autocrine/intracrine cysteinyl leukotriene-induced signaling.Jiang Y, Kanaoka Y, Feng C, Nocka K, Rao S, Boyce JA.
Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.

Reactive mastocytosis (RM) in epithelial surfaces is a consistent Th2-associated feature of allergic disease. RM fails to develop in mice lacking leukotriene (LT) C4 synthase (LTC4S), which is required for cysteinyl leukotriene (cys-LT) production. We now report that IL-4, which induces LTC4S expression by mast cells (MCs), requires cys-LTs, the cys-LT type 1 receptor (CysLT1), and Gi proteins to promote MC proliferation. LTD4 (10-1000 nM) enhanced proliferation of human MCs in a CysLT1-dependent, pertussis toxin-sensitive manner. LTD4-induced phosphorylation of ERK required transactivation of c-kit. IL-4-driven comitogenesis was likewise sensitive to pertussis toxin or a CysLT1-selective antagonist and was attenuated by treatment with leukotriene synthesis inhibitors. Mouse MCs lacking LTC4S or CysLT1 showed substantially diminished IL-4-induced comitogenesis. Thus, IL-4 induces proliferation in part by inducing LTC4S and cys-LT generation, which causes CysLT1 to transactivate c-kit in RM.

Why would doctors be told to prescribe a drug that suppresses the leukotriene receptor for seasonal allergies? Singulair is not an anti-histamine.

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