Incidence of Neuropsychiatric Complications in Patients With Rhinitis and Its Relationship With Leukotriene Receptor Antagonist

Introduction: Although leukotriene receptor antagonists (LTRAs) are one of the effective treatments for allergic rhinitis, their neuropsychiatric (NP) complications, such as behavior and mood related changes, have been reported with controversy. This study aimed to find the incidence of NP events in patients with allergic rhinitis and to evaluate their relation with LTRA.

Methods: As a retrospective cohort study, this study included patients with rhinitis who started the first medical treatment from January 1, 2015 to December 31, 2022 in Bundang CHA medical center. It excluded patients who had already been diagnosed of NP disorder before the first treatment. The types of the medicines were classified into intranasal corticosteroid (INCS), oral and intranasal antihistamine (OAH and IAH), and LTRA. The duration of the medicines were also reviewed. The incidence of NP diagnosis under the International Classification of Diseases-10 after the initial treatment for rhinitis was investigated and the relationship with LTRA was evaluated.

Results: A total of 20,154 patients were included with mean age 32.5 ± 23.5 years; 10,033 male and 10,121 female patients. The overall incidence of NP disorder was 4.5%. LTRA was prescribed to 11,882 (59%) patients for their initial treatment. The incidences of NP disorder in the patients with and without LTRA were 3.7% and 5.6% (p < 0.001). In multiple logistic regression analysis with adjustment of sex and age, the incidence of NP showed a negative relation with LTRA (p = 0.006, OR 0.992, 95% CI 0.986 – 0.998). Furthermore, no association was found between LTRA and the incidence of NP disorder, especially in patients with age < 60 (p > 0.05); the incidence was 4.04% and 2.86% in the patients with and without LTRA, respectively.

Conclusions: Our 8-year clinical data with large population presented that LTRA had no related with NP events. When clinicians prescribe LTRA, they shouldn’t be overwhelmed by the reported NP complications of LTRA and could give proper information to the patients.