Reviewer's report
Title:Montelukast in the treatment of duodenal eosinophilia in children with
dyspepsia: Effect on eosinophil density and activation in relation to
pharmacokinetics
Version: 1Date:27 January 2009
Reviewer: Stephen Attwood
Reviewer's report:
This study is well thought out and executed with a good protocol. The findings
are within expectations based on previous reports of the clinical efficacy of
Montelukast in diseases of excess esinophilic inflammation without demonstrable
changes in Eosinophil density or eosinophilic granulation activation.
The authors correctly identify (discussion page 16) that the methods of activation
of eosinophils and their degranulation are complex and the tests employed in this
study may be insensitive to detect a real effect.
It would be useful in future studies to consider the wider mast cell and eosinophil
activation pathway described by Blanchard et al and test for a wider range of
eosinophil related effects in order to look for the mechanism of clinical benefit of
montelukast. (Blanhard C, Wang N, Stringer KF et al Eotaxin-3 and a uniquely
conserved gene expression profile in eosinophilic esophagitis. J Clin Immunol
2006: 116: 536 – 47.
Suggested minor essential revisions
Abstract line 4: Please define patients as “Twenty four dyspeptic patients…”
In the previous study they found elimination half life of montelukast to be 1.8
hours. The used a dose of 10mg once daily in the current study. Would it be
worthwhile dosing the patients b.d (5mg b d) in order to maintain a more
continuous therapeutic effect? This might also have a more measurable effect on
eosinophil function or activation. Please comment
Methods Subjects paragraph 2 last line: 20 cell/hpf. Define hpf ( I assume = high
power field) and state the surface area that your pathologist considers is a high
power field. There is much variation in the size of high power fields and a
description of the precise surface are in square millimeters is required.
Discretionary revisions
Background paragraph 2 line 2 consider stating “..we found duodenal mucosal
eosinophilia in 71%.....”
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Montelukast in the treatment of duodenal eosinophilia in children with
dyspepsia: Effect on eosinophil density and activation in relation to
pharmacokinetics
Version: 1Date:27 January 2009
Reviewer: Stephen Attwood
Reviewer's report:
This study is well thought out and executed with a good protocol. The findings
are within expectations based on previous reports of the clinical efficacy of
Montelukast in diseases of excess esinophilic inflammation without demonstrable
changes in Eosinophil density or eosinophilic granulation activation.
The authors correctly identify (discussion page 16) that the methods of activation
of eosinophils and their degranulation are complex and the tests employed in this
study may be insensitive to detect a real effect.
It would be useful in future studies to consider the wider mast cell and eosinophil
activation pathway described by Blanchard et al and test for a wider range of
eosinophil related effects in order to look for the mechanism of clinical benefit of
montelukast. (Blanhard C, Wang N, Stringer KF et al Eotaxin-3 and a uniquely
conserved gene expression profile in eosinophilic esophagitis. J Clin Immunol
2006: 116: 536 – 47.
Suggested minor essential revisions
Abstract line 4: Please define patients as “Twenty four dyspeptic patients…”
In the previous study they found elimination half life of montelukast to be 1.8
hours. The used a dose of 10mg once daily in the current study. Would it be
worthwhile dosing the patients b.d (5mg b d) in order to maintain a more
continuous therapeutic effect? This might also have a more measurable effect on
eosinophil function or activation. Please comment
Methods Subjects paragraph 2 last line: 20 cell/hpf. Define hpf ( I assume = high
power field) and state the surface area that your pathologist considers is a high
power field. There is much variation in the size of high power fields and a
description of the precise surface are in square millimeters is required.
Discretionary revisions
Background paragraph 2 line 2 consider stating “..we found duodenal mucosal
eosinophilia in 71%.....”
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Montelukast in the treatment of duodenal eosinophilia in children with
dyspepsia: Effect on eosinophil density and activation in relation to
pharmacokinetics
Version: 1Date:27 January 2009
Reviewer: Stephen Attwood
Reviewer's report:
This study is well thought out and executed with a good protocol. The findings
are within expectations based on previous reports of the clinical efficacy of
Montelukast in diseases of excess esinophilic inflammation without demonstrable
changes in Eosinophil density or eosinophilic granulation activation.
The authors correctly identify (discussion page 16) that the methods of activation
of eosinophils and their degranulation are complex and the tests employed in this
study may be insensitive to detect a real effect.
It would be useful in future studies to consider the wider mast cell and eosinophil
activation pathway described by Blanchard et al and test for a wider range of
eosinophil related effects in order to look for the mechanism of clinical benefit of
montelukast. (Blanhard C, Wang N, Stringer KF et al Eotaxin-3 and a uniquely
conserved gene expression profile in eosinophilic esophagitis. J Clin Immunol
2006: 116: 536 – 47.
Suggested minor essential revisions
Abstract line 4: Please define patients as “Twenty four dyspeptic patients…”
In the previous study they found elimination half life of montelukast to be 1.8
hours. The used a dose of 10mg once daily in the current study. Would it be
worthwhile dosing the patients b.d (5mg b d) in order to maintain a more
continuous therapeutic effect? This might also have a more measurable effect on
eosinophil function or activation. Please comment
Methods Subjects paragraph 2 last line: 20 cell/hpf. Define hpf ( I assume = high
power field) and state the surface area that your pathologist considers is a high
power field. There is much variation in the size of high power fields and a
description of the precise surface are in square millimeters is required.
Discretionary revisions
Background paragraph 2 line 2 consider stating “..we found duodenal mucosal
eosinophilia in 71%.....”
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
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