From the FDA Drug Label
The efficacy of SINGULAIR for the treatment of seasonal allergic rhinitis in pediatric patients 2 to 14 years of age and for the treatment of perennial allergic rhinitis in pediatric patients 6 months to 14 years of age is supported by extrapolation from the demonstrated efficacy in patients 15 years of age and older with allergic rhinitis as well as the assumption that the disease course, pathophysiology and the drug’s effect are substantially similar among these populations.
Treatments for environmental allergies in children include montelukast (PO).
- The safety and efficacy of montelukast have been established in pediatric patients with asthma 6 to 14 years of age, and for the treatment of seasonal allergic rhinitis in pediatric patients 2 to 14 years of age and perennial allergic rhinitis in pediatric patients 6 months to 14 years of age.
- The recommended dosage for pediatric patients varies by age:
- 6 to 23 months of age: 4-mg oral granule formulation
- 2 to 5 years of age: 4-mg chewable tablets
- 6 to 14 years of age: 5-mg chewable tablets
- Monitoring for adverse events, such as somnolence, and eosinophilic conditions is recommended 1.
From the Research
Treatments for environmental allergies in children should prioritize regular use of nasal corticosteroids, such as fluticasone, over as-needed use, due to its greater improvement in nasal peak inspiratory flow and tendency towards greater improvement in total nasal symptom score, as shown in the most recent study 2.
Key Considerations
- Identifying and avoiding triggers, such as dust mites, pet dander, pollen, or mold, is crucial in managing environmental allergies in children.
- Non-sedating antihistamines like cetirizine, loratadine, or fexofenadine are first-line treatments for medication management.
- Nasal corticosteroids, such as fluticasone or mometasone, effectively reduce nasal inflammation and congestion.
- Antihistamine eye drops like ketotifen can provide relief for eye symptoms.
- Leukotriene modifiers like montelukast may help in more severe cases, but require monitoring for potential mood changes.
- Allergen immunotherapy (allergy shots) may be considered under specialist care for children with persistent allergies unresponsive to medications.
Supporting Evidence
- A study from 2021 2 compared the efficacy of as-needed and regular use of fluticasone furoate nasal spray in patients with moderate to severe perennial allergic rhinitis, finding that regular use tended towards greater improvement in total nasal symptom score and had a higher mean change in nasal peak inspiratory flow.
- An earlier study from 2003 3 compared the effectiveness of fluticasone nasal spray and the combination of loratadine and montelukast in seasonal allergic rhinitis, finding that both treatments provided clinically meaningful responses, but the overall results favored fluticasone propionate.
- A study from 1993 4 highlighted the importance of allergen avoidance in the prevention and treatment of pediatric allergic disease, particularly for indoor allergens.
Environmental Modifications
- Using allergen-proof bedding covers, regular vacuuming with HEPA filters, keeping windows closed during high pollen seasons, and maintaining low humidity to prevent mold growth can significantly complement medical treatment.