The Journal of Pediatrics
Volume 156, Issue 5 , Pages 749-754, May 2010

A Randomized Intervention of Montelukast for Post-Bronchiolitis: Effect on Eosinophil Degranulation

  • Chang-Keun Kim, MD

      Affiliations

    • Department of Pediatrics and Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea
    • ,
  • Jungi Choi, MD

      Affiliations

    • Department of Pediatrics and Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea
    • ,
  • Hyo Bin Kim, MD

      Affiliations

    • Department of Pediatrics and Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea
    • ,
  • Zak Callaway, MPHTM

      Affiliations

    • Department of Pediatrics and Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea
    • ,
  • Bo Moon Shin, MD

      Affiliations

    • Department of Laboratory Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
    • ,
  • Jin-Tack Kim, MD

      Affiliations

    • Department of Pediatrics, Catholic University Uijongbu St. Mary's Hospital, Kyonggi-do, Korea
    • ,
  • Takao Fujisawa, MD

      Affiliations

    • Institute for Clinical Research, Mie National Hospital, Tsu, Japan
    • ,
  • Young Yull Koh, MD

      Affiliations

    • Department of Pediatrics and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
    • Corresponding Author InformationReprint requests: Dr Young Yull Koh, Department of Pediatrics, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.

Received 11 March 2009; received in revised form 8 October 2009; accepted 1 December 2009. published online 22 February 2010.

Objective

To investigate the effect of montelukast on eosinophil degranulation and recurrent wheezing episodes in post-respiratory syncytial virus (RSV) bronchiolitis.

Study design

Two hundred infants (age, 6-24 months) who were hospitalized with their first episode of acute RSV bronchiolitis were randomized in a double-blind, placebo-controlled, parallel comparison of 4-mg montelukast granules (RSV-MONT group) or matching placebo (RSV-PLC group) administered for 3 months. Serum eosinophil-derived neurotoxin (EDN) levels were measured (primary outcome), and recurrent wheezing was documented (secondary outcome) for 12 months. Comparisons were made with control subjects (control group, n = 50).

Results

At the end of the 3-month treatment period, the RSV-PLC group (n = 71) exhibited significantly elevated EDN levels (P < .0001), and the RSV-MONT group (n = 79) showed significantly decreased EDN levels (P < .01) when compared with the initial levels. As a result, EDN levels in the 2 RSV groups significantly differed at this point (P < .0001) and remained different for the entire 12-month follow-up period. Cumulative recurrent wheezing episodes at 12 months were significantly lower in the RSV-MONT group (P = .039).

Conclusion

Montelukast treatment reduces eosinophil degranulation and is associated with a decrease in recurrent wheezing episodes in post-RSV bronchiolitis.

CysLT, Cysteinyl leukotriene, ECP, Eosinophil cationic protein, EDN, Eosinophil-derived neurotoxin, EPX, Eosinophil protein X, IL, Interleukin, LTRA, Leukotriene receptor antagonist, MONT, Montelukast, PLC, Placebo, RSV, Respiratory syncytial virus

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 Supported in part by a Korean Research Foundation grant to C-K.K. funded by the Korean Government (MOEHRD; KRF-2005-042-E00078) and in part by a research grant from the Investigator-Initiated Studies Program of Merck. Merck & Co., provided the inactive, oral, look-alike granules identical to 4-mg montelukast granules. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck. The authors declare no conflicts of interest.

PII: S0022-3476(09)01224-4

doi:10.1016/j.jpeds.2009.12.001

The Journal of Pediatrics
Volume 156, Issue 5 , Pages 749-754, May 2010

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