A 34-year-old woman with asthma and nasal polyposis reports repeated episodes of intense facial flushing, rhinorrhoea and bronchospasm within 30 minutes of taking ibuprofen or naproxen. Which drug is most appropriate to reduce the frequency of these reactions?
- A Cetirizine
- B Montelukast ✓
- C Low-dose daily prednisolone
- D Sodium cromoglycate
Correct answer: B. Montelukast
Explanation
This is aspirin-exacerbated respiratory disease. NSAIDs inhibit cyclooxygenase, diverting arachidonic acid toward the cysteinyl leukotriene pathway, and these patients have pre-existing leukotriene overproduction. Leukotriene receptor antagonists such as montelukast blunt both the upper and lower airway reactions. Cetirizine blocks histamine, which plays little part in this reaction, and sodium cromoglycate is a mast cell stabiliser with no effect on the leukotriene pathway, which kills those distractors.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.