***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: This was a prospect i ve double blind comparative study on 40 patients . It compared the effects of the leukotriene receptor antagonist montelukast and beclomethasone nasal spray on the post-operative course of patients with sinonasal polyps . All patients underwent endoscopic sphenoethmoidectomy  and were r and omized post-operatively into two groups . Group I : 20 patients ( 9 females and 11 males ) age 17 to 67 ( 32.4 ± 9.5 years ) , receiving 10 mg montelukast orally daily and Group II : 20 patients ( 6 females and 14 males ) age 17 years to 57 years ( 33.5 ± 11.9 years ) , receiving 400 ug beclomethasone local sprays daily . All patients were followed up for 1 year and a symptom score was recorded throughout this period . There was a significant reduction in symptom scores in both groups throughout the study period . In the montelukast group improvement was more marked in itching , post-nasal discharge and headache . The control of sneezing and rhinorrhea was comparable in both groups with a marginal advantage of montelukast . Steroids had a more marked effect on smell disturbances and obstruction . There was no difference in the recurrence rate or in the need for rescue medications between both groups . Both drugs seem to have a complementary action and further studies are needed to determine which patients should receive which treatment BACKGROUND Leukotrienes , especially LTC4 , are important inflammatory mediators in allergic and nonallergic inflammation of the entire airways . Of particular interest are numerous theories regarding the pathogenesis of aspirin intolerance with subsequent hyperproduction of leukotrienes and inhibition of cyclooxygenase . OBJECTIVE To examine the influence of the cysteinyl-leukotriene receptor antagonist montelukast on clinical symptoms and inflammatory markers in nasal lavage fluid in patients with bronchial asthma and nasal polyps , and determine its dependency on aspirin sensitization . METHODS Twenty-four patients ( 7 women , 17 men ; median age , 55.5 years ) with nasal polyps and controlled asthma ( n=12 with aspirin intolerance ) were treated with 10 mg montelukast once daily for 6 weeks in a blinded , placebo-controlled fashion . The placebo phase was r and omly assigned 4 weeks before ( n=12 ) or after treatment ( n=12 ) . Symptom score , rhinoendoscopy , rhinomanometry , smears for eosinophils , and nasal lavages for the determination of different mediators were performed . RESULTS Compared to placebo , there were significant improvements in the nasal symptom score and airflow limitation as well as a reduction in the inflammatory mediators in nasal lavage fluid after treatment . Furthermore , reduced eosinophils in nasal smears and peripheral blood were observed 2 and 6 weeks after treatment . CONCLUSION Leukotriene 1 receptor blockade led to a significant decrease in eosinophil inflammation accompanied by a reduction in other mediators such as neurokinin A and substance P in the nasal lavage fluid of patients with nasal polyps and asthma , with or without aspirin intolerance Objective To examine the potential of montelukast , a leukotriene receptor antagonist , as an adjunct to oral and inhaled steroid in subjects with chronic nasal polyps . Study Design Prospect i ve , r and omized controlled trial . Subjects and Methods Thirty-eight consecutive adult patients with bilateral nasal polyps were r and omized into two groups . Eighteen subjects were treated with oral prednisolone for 14 days and budenoside nasal spray for 8 weeks . Twenty subjects received similar treatment with additional oral montelukast for 8 weeks . Subjects completed a modified nasal ICSD symptom score at 8 and 12 weeks after beginning treatment and the SF-36 quality of life question naire at 12 weeks . Results Symptom scores improved in both groups after treatment . Subjects treated with montelukast reported significantly less headache ( P = 0.013 ) , facial pain ( P = 0.048 ) and sneezing ( P = 0.03 ) than controls . Four weeks after completing treatment , no significant differences were recorded . Conclusion Montelukast therapy may have clinical benefit as an adjunct to oral and inhaled steroid in chronic nasal polyposis , but effects are not maintained after cessation of treatment The leukotrienes are known to be important mediators of bronchial asthma . The ability of montelukast , a potent and selective CysLT1 leukotriene receptor antagonist , to cause a dose-related improvement in chronic asthma  was investigated in a placebo-controlled , multicentre , parallel-group study . After a two week placebo run-in period , chronic asthmatic patients with a forced expiratory volume in one second ( FEV1 ) 40 - 80 % predicted with > or = 15 % increase ( absolute value ) after beta2-agonist were r and omly assigned to one of four treatment groups ( placebo or montelukast 2 , 10 , or 50 mg once daily in the evening ) for a three week , double-blind treatment period . For patient-reported end-points ( daytime symptom score , use of as needed inhaled beta2 agonist , asthma-specific quality of life ) and frequency of asthma exacerbations , montelukast 10 and 50 mg caused similar responses , superior to 2 mg and significantly ( p<0.05 ; linear trend test ) different from placebo . All three doses caused improvements in FEV1 and morning and evening peak expiratory flow rate ( PEFR ) that were significantly ( p<0.05 ) different from placebo . Differences ( least square mean ) between the pooled 10 and 50 mg montelukast treatment groups and placebo were : 7.1 % change from baseline in FEV1 , 19.23 L x min(-1 ) in morning PEFR , -0.29 in daytime asthma symptom score ( absolute value ) , and -0.82 in beta2-agonist use ( puff x day(-1 ) ) . The incidence of adverse experiences was neither dose-related nor different between montelukast and placebo treatments . We conclude that montelukast causes a dose-related improvement in patient-reported asthma end-points over the range 2 - 50 mg . Montelukast causes benefit to chronic asthmatic patients by improving asthma control end-points Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE : To investigate the hypothesis that eosinophil major basic protein is released in high concentrations in the nasal mucus of patients with polypoid chronic rhinosinusitis . STUDY DESIGN : Single center , open , prospect i ve trial . SETTING : Medical University of Graz , Austria . SUBJECTS AND METHODS : Patients with polypoid chronic rhinosinusitis ( n = 23 ) were compared to three different control groups : patients with chronic rhinosinusitis-like symptoms but without general mucosal thickening , patients who underwent functional endoscopic sinus surgery for reasons other than chronic rhinosinusitis , and patients without sinus disease ( total n = 21 ) .  Mucus was harvested from each patient using a st and ardized technique and analyzed for eosinophil major basic protein with an enzyme-linked immunosorbent assay . RESULTS : In the patient group with polypoid chronic rhinosinusitis , 20 of 23 ( 87 % ) were positive for eosinophil major basic protein . In contrast , only one control patient was positive , whereas the remainder had no detectable amount of eosinophil major basic protein in the mucus ( P = 0.001 vs chronic rhinosinusitis ) . CONCLUSION : Toxic eosinophil major basic protein levels are elevated in polypoid chronic rhinosinusitis patients compared to control groups that have similar clinical presentations but upon closer examination turn out not to have chronic rhinosinusitis . In the future , the detection of eosinophil major basic protein in nasal mucus may become a sensitive and specific marker for chronic rhinosinusitis and a helpful diagnostic tool . © 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation . All rights reserved Eosinophils are the principal effector cells involved in the pathogenesis of allergic inflammation . We conducted a study to investigate the validity of the nasal smear examination for detecting eosinophilia in patients with allergic rhinitis . Our study group was made up of 50 patients with allergic rhinitis and 50 age- and sex-matched controls without allergic rhinitis .  Smears were obtained from nasal secretions in both groups and then fixed , stained , and studied under light microscopy . Statistical analysis revealed that the odds ratio for eosinophilia positivity in nasal smears in the rhinitis group was 25.61 with a 95 % confidence interval of 8 to 78 . The sensitivity , specificity , positive predictive value , and negative predictive value of this test were 74 , 90 , 88 , and 77 % , respectively . We conclude that the nasal eosinophilia test is highly specific and moderately sensitive in diagnosing allergic rhinitis , and that it therefore can be used as an easy , noninvasive , and inexpensive procedure for screening patients and for conducting epidemiologic studies of this disorder Background We assessed the course of treatment in patients with persistent allergic rhinitis ( AR ) treated with montelukast , levocetirizine , or desloratadine alone or combinations of antihistamine and montelukast . Methods A 32-week r and omized , double-blind , placebo-controlled , crossover , double-armed study in 40 adult patients with history of persistent AR , clinical allergy to house-dust mites , and a total nasal symptom score of at least 5 ( congestion of at least 2 ) has been performed . Patients with asthma , chronic obstructive pulmonary disease , nonallergic rhinitis with clinical allergy associated with seasonal allergens , and other serious diseases were excluded . There were four 6-week treatment periods separated by 2-week washout periods . Twenty patients received either montelukast or antihistamine , a combination of montelukast and antihistamine , or placebo . The sequence of treatment was r and omly assigned . Nasal symptoms were assessed using a 4-point scale at baseline , daily during the 1st week and on days 14 , 21 , 28 , 35 , and 42 of treatment . Results Montelukast alone , levocetirizine alone , desloratadine alone , and the montelukast/antihistamine combinations significantly improved nasal symptoms during the first 24 hours . Improvement gradually increased during the 6 weeks of treatment , especially in patients receiving montelukast alone or in combination therapy with the antihistamine in both arms . Improvement at 42 days of treatment was significantly greater than that achieved on the 1st day of therapy in patients treated with the combination of montelukast and levocetirizine . Conclusion Montelukast alone or in combination with antihistamines gave a gradual increase in nasal symptom improvement within 6 weeks of treatment in patients with persistent AR OBJECTIVES In this study we investigated the effect of adding montelukast to the treatment of nasal polyposis patients with bronchial asthma on quality of life . PATIENTS AND METHODS Thirty consecutive subjects with nasal polyposis accompanying bronchial asthma treated in our clinic were prospect ively evaluated . Subjects with aspirin hypersensitivity and seasonal allergic rhinitis were excluded . Patients were evaluated using the Turkish version of rhinosinusitis disability index ( RSDI ) and visual analog scores before the montelukast therapy , one and three months after the therapy started . It must be noted that in addition to being treated with anti-leukotriene therapy , all of these subjects continued to receive routine nasal steroid treatment . In all subjects paranasal sinus tomography scans were obtained during the study . Lund-Mackay staging system , which is a radiological scoring system , was used in the staging of the disease severity . RESULTS Rhinosinusitis disability index scores improved during the study period . Functional , emotional and physical sub-scales of RSDI were compared separately . But 1st and 3rd month scores are not statistically significant when compared with scores previous to montelukast therapy ( p>0.05 ) . Visual analog scale also showed a statistically significant decrease during the study period ( p<0.01 ) . Lund-Mackay staging did not show a statistically significant difference during the study period ( p>0.05 ) . CONCLUSION This study showed that montelukast therapy might have a clinical benefit as an adjunct to nasal steroids in subjects with nasal polyposis accompanying bronchial asthma We have studied the immunohistology of the nasal mucosa in allergen-induced rhinitis . Sixteen grass pollen-sensitive patients were challenged twice by r and omly allocated allergen or control solutions applied on filter paper disks to the inferior turbinate . All had immediate nasal responses , but late-phase responses were equivocal and only evident as nostril blockage . When cell counts in the nasal submucosa were compared with control values 24 h after allergen , there were no changes in CD45 + ( total leukocytes ) , CD3 + , or CD8 + cells . Significant increases were found in the numbers of CD4 + T-helper cells ( p less than 0.05 ) and CD25 + [ interleukin- 
    Output:
    
Improvement was described by all studies in symptoms , clinical outcomes , and /or immune parameters after LTA treatment , with greater improvements in a subset of symptoms beyond that observed with INCSs .
Concomitant asthma , aspirin-exacerbated respiratory disease , and atopy did not significantly or consistently affect these results .
Conclusion LTAs are an effective tool for treating CRSwNP , with limited benefit as an adjunctive therapy .