Is Montelukast Benefical in Children With Atopic Dermatitis?

279 Atopic dermatitis (AD) has a wide range of clinical symptoms with a tendency toward chronic relapse. Patients with mild AD can be managed with use of emollients after bathing and use of topical corticosteroids or calcineurin inhibitors. On the other hand, those with moderate to severe AD often require systemic treatment, which could induce adverse effects and demand careful monitoring, particularly in long-term use. In fact, sys-temic steroids are recommended for limited cases of acute flare-up as a short therapeutic course due to an overall unfavorable risk-benefit profile. According to meta-analysis evaluating the efficacy and safety of systemic treatment in moderate-to-severe AD, cyclosporin A is recommended as a first-line treatment for short-term use, and azathioprine and methotrexate are also recommended as a second-or a third-line treatment. 1 However, long-term use of cyclosporine A was not recommended due to a lack of long-term safety data. In addition, there are patients who show a lack of response to these drugs. Therefore, approaches to develop and/or evaluate systemic treatment modalities based on appropriate assessment of efficacy and safety should be continued. A thorough understanding of the etiology and pathogenesis of AD is crucial to the appropriate management of AD. Based on emerging evidences that skin barrier dysfunction predisposes to AD development, approaches have been directed toward correction of the primary abnormality in barrier function. However , additional factors are necessary for AD development, and a role of immune dysregulation has been strongly supported. 2,3 In fact, cyclosporine A, a gold standard of systemic therapy in AD, is a representative drug for immunomodulation. For immune dysregulation, Th1/Th2-cell dysregulation, IgE production , dendritic cell signaling, and mast cell hyperactivity have been considered largely attributed to the pathogenesis of AD. 2 Leukotrienes are arachidonic acid metabolites generated from many cells, including mast cells and lymphocytes. 4 Based on important biological effects of cysteinyl leukotrienes, such as potent bronchoconstriction and proinflammatory mediators, in asthma development, 5 their antagonists have been introduced as antiasthmatic medications in the late 1990s. Leukotri-ene receptor antagonists have also been successfully used in other conditions, particularly in allergic rhinitis. Although the exact mechanism of leukotriene receptor antagonists in AD is uncertain, evidence of enhanced leukotriene production in the pathogenesis of AD provide a theoretical rationale for the use of leukotriene receptor antagonists in AD patients. Montelukast is a cysteinyl-leukotriene-1 receptor antagonist, which is the most commonly prescribed leukotriene receptor antagonist worldwide with …