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Míriam Araújo1; Sara Prates1; Paula Leiria Pinto1,2

1. Immunoallergology Department, Hospital Dona Estefânia, CHULC, EPE, Lisbon, Portugal
2. CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisbon, Portugal

Reunião Internacional, apresentação sob a forma de comunicação oral e poster – EAACI Congress, 1 a 5 de Junho de 2019, Lisboa

Caso Clínico: 
Introduction: A significant proportion of patients with chronic urticaria respond inadequately to first line treatment with antihistamines. Leukotriene receptor antagonists (LTRA) have been used for chronic urticaria but, according to the latest guidelines, the evidence for prescribing this drug class is weak.
Case Report: We present a 41 year-old female with daily urticarial lesions for 3 years, sometimes associated with facial edema. In 2014 she had a full laboratorial work-up that was negative for auto-immune, thyroid and complement disorders, as well as for infectious diseases. She had been prescribed daily treatment with different anti-histamines (anti-H1 double dose plus anti-H2) and corticosteroids, with no possibility of reducing the dose due to recurrence of symptoms. In 2016 she was also prescribed cyclosporine (100+100 mg/day) with no response. In 2017 she was referred to our clinic and by then she was under prednisolone 20mg/day and bilastine 40mg/day, with symptoms recurring every time she tried to reduce the dose of either drug. Before considering step-up to omalizumab, we decided to try levocetirizine 15mg/day plus montelukast 10mg/day together with prednisolone tapering. After two months treatment, the patient’s urticaria was controlled, with no further need for prednisolone. Later, by mistake, the patient stopped taking montelukast and 4-6 weeks later she needed to restart therapy with prednisolone, due to urticaria recurrence. We advised her to restart montelukast and she was once more able to withdraw corticosteroid therapy. Presently, she remains symptom free, under montelukast 10mg/day and levocetirizine 10mg/day.
Conclusions: This case is in accordance with other reports in literature, showing that montelukast can be considered an appropriate second-line agent in selected cases of chronic spontaneous urticaria, especially in patients with angioedema-associated disease.

Palavras Chave: chronic urticaria, montelukast