Effective after two weeks for some people - not effective for oth...

Read all Singulair side effects

Posted at 8:53 AM on Apr 22, 2008 by concernedcitizen, #29820

Effective after two weeks for some people - not effective for others. Side effects for some people - others do not report side effects. So why does Merck have to grow their market before they have any idea what's going on? This isn't a big group of people in the study but it makes sense from what we are reading here. These researchers did examine the mast cells. We need to know about mast cells (while suppressed by montelukast) on a longer term basis. J Asthma. 2008 Apr;45(3):243-50. Links The efficacy of montelukast and airway mast cell profiles in patients with cough variant asthma.Kawai S, Baba K, Matsubara A, Shiono H, Okada T, Yamaguchi E. Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi, Japan. Background. Cough variant asthma (CVA) is characterized by chronic cough without apparent wheezing; its pathophysiology is considered to be similar to that of classic asthma. Objective. The clinical effects of montelukast, a cysteinyl-leukotriene receptor antagonist, on cough variant asthma were assessed, and the activation profile of airway mast cells was examined. Methods. Montelukast (10 mg/day) was given orally to 36 CVA patients (25 women and 11 men; median age, 37.5 years). Before treatment, the patients' bronchial mucosa underwent a biopsy with a fiberoptic bronchoscope. The biopsy specimens were double stained with anti-CD63 antibody and anti-human tryptase antibody. Results. After 2 weeks of montelukast treatment, cough symptoms improved in 22 patients (the effective group) but did not improve in 14 patients (the ineffective group); in the ineffective group, the symptoms disappeared 2 weeks after they were switched to fluticasone propionate (400 mug/day) inhalation therapy. In the effective group, the time interval from the onset of symptoms to the initiation of treatment was significantly shorter than in the ineffective group. The bronchial mucosa biopsy specimens showed that the proportion of CD63-positive cells in tryptase-positive mast cells was significantly higher in the effective group than in the ineffective group; although the total numbers of mast cells were not different between the two groups. Conclusion. There is a subgroup of CVA patients in whom leukotrienes are closely involved in the pathogenesis of their chronic cough; activation of airway mast cells may be an essential feature in these patients. PMID: 18415834 [PubMed - in process]

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Reply about 1 year ago on Apr 22, 2008 by concernedcitizen, #7524

When I asked the question regarding how long before those with seasonal allergies got any response from Singulair, I was thinking about this study which shows that those with leukotriene pathogenesis would probably see results right away and those not in that category would not see results in two weeks.

The mast cell generally functions and can activate several times for at least one month before it dies. If a patient doesn't respond right away, then what changes are occurring with the mast cells. Are they functionally changed or are they becoming reduced in number so that those without leukotriene pathogenesis get the results because of a different reason -- possibly significant decrease in mast cell numbers?

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Reply about 1 year ago on Apr 27, 2008 by joes1717, #7659

Leukotriene Modifiers (like Singulair) do not decrease or 'down regulate' mast cells. Mast cells, when activated (usually by an allergen--pollen etc.) release preformed mediators--histamine chief among them. Anti histamines (Zyrtec. Claritin etc) block the histamine receptor in the body to decrease the nasty effects of the histamine. Mast cells also release leukotrienes which contribute to the symptoms of allergy. Leukotriene Modifiers (like Singulair) block the Leukotriene receptor in the nose and lungs to decrease the nasty effects from leukotrienes.
By the way, when exploring the possible side effects of any one medication a patient may be taking, it would be prudent to look at the possible side effects of all the medications that patient may be taking. Did you know that both Zyrtec, and Clarinex list psychological disorders including 'suicidal thinking' as possible side effects? Not to mention mood swings and aggressive behavior. As for the Inhaled steroids (another effective and relatively safe asthma/allergy tx) possible side effects include glaucoma, growth suppression, depression, agression, irritability, anxiety and psychosis.
With all of these drugs thes adverse incidents are minute, and a causal relationship has not been established. The vast majority of patients enjoy improved health and quality of life.
When it comes to asthma, pateints are much more at risk from the adverse effects of untreated asthma (over 4000 people a year die from asthma in the US) than the possible side effects of taking the medication.

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Reply about 1 year ago on Apr 28, 2008 by concernedcitizen, #7689

Joe, Your explanation of leukotriene modifiers sounds just like Merck's PROMOTIONAL materials. I use the word promotional because that's exactly what Merck's marketing department did to the patient and doctor information. The information is selective and incomplete.

I will be reporting on the new studies of the mast cell. Some of them have not made the journals in their entirety yet just the abstracts.

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