Is montelukast (Singulair) appropriate for treating allergies?

From the Guidelines

Montelukast (Singulair) is an appropriate treatment option for allergies, particularly allergic rhinitis, although it is not the first-line treatment. According to the most recent and highest quality study 1, for initial treatment of seasonal allergic rhinitis in persons aged 15 years or older, an intranasal corticosteroid is recommended over a leukotriene receptor antagonist, such as montelukast. However, montelukast can be considered for patients who also have asthma, as it can treat both conditions simultaneously. The typical dosage of montelukast is 10mg tablet taken once daily for adults and adolescents 15 years and older, with lower doses available for children (5mg chewable tablets for 6-14 years, 4mg chewable tablets or oral granules for 2-5 years) 1. Some key points to consider when prescribing montelukast include:

• It works by blocking leukotriene receptors, which helps reduce allergy symptoms like nasal congestion, sneezing, and itchy, watery eyes.
• It is less effective than intranasal corticosteroids, but can be used in combination with antihistamines for added benefit.
• It is a safe and effective treatment for the management of allergic rhinitis in children, and is approved for perennial allergic rhinitis in children as young as 6 months and for seasonal allergic rhinitis in children as young as 2 years.
• Patients should be aware of potential side effects, including headache, gastrointestinal disturbances, and rarely, neuropsychiatric effects such as mood changes or behavior disturbances. Overall, while montelukast is not the first-line treatment for allergic rhinitis, it can be a useful option for certain patients, particularly those with coexisting asthma.

From the FDA Drug Label

SINGULAIR is indicated for the relief of symptoms of allergic rhinitis (seasonal allergic rhinitis in adults and pediatric patients 2 years of age and older, and perennial allergic rhinitis in adults and pediatric patients 6 months of age and older). SINGULAIR is used to help control the symptoms of allergic rhinitis (sneezing, stuffy nose, runny nose, itching of the nose) SINGULAIR is used to treat seasonal allergic rhinitis (outdoor allergies that happen part of the year) in adults and children ages 2 years and older, and perennial allergic rhinitis (indoor allergies that happen all year) in adults and children ages 6 months and older.

Montelukast (Singulair) is appropriate for treating allergies, specifically for the relief of symptoms of allergic rhinitis, including seasonal and perennial allergic rhinitis in adults and pediatric patients. 2 2

• Key points:
  • Indicated for relief of symptoms of allergic rhinitis
  • Used to treat seasonal and perennial allergic rhinitis
  • Approved for use in adults and pediatric patients ages 2 years and older for seasonal allergic rhinitis, and ages 6 months and older for perennial allergic rhinitis

From the Research

Montelukast for Allergies

• Montelukast (Singulair) is a selective and orally-active leukotriene-receptor antagonist (LTRA) that inhibits the cysteinyl leukotriene 1 (CysLT1) receptor 3.
• It is an effective and well-tolerated preventative treatment for asthma and allergic rhinitis in adults and children 3.
• Montelukast reduces the Daily Rhinitis Symptoms score, including daytime nasal symptoms and nighttime symptoms, in patients with seasonal allergic rhinitis and active asthma 4.
• The medication provides significant relief from symptoms of seasonal allergic rhinitis, while also conferring a benefit for asthma, in patients with both allergic rhinitis and asthma 4.

Efficacy of Montelukast

• Montelukast is a viable alternative for the treatment of seasonal allergic rhinitis, with benefits equivalent to antihistamines when used as monotherapy 5.
• The addition of an antihistamine to montelukast may have added benefits and can be equivalent to intranasal corticosteroids 5.
• Montelukast inhibits the actions of cysteinyl-leukotrienes, which are endogenous mediators of inflammation, by blocking type 1 CysLT receptors found on immunocytes, smooth muscle, and endothelium in the respiratory mucosa 6.
• Patients treated with montelukast had significantly greater improvements in their symptoms of seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) than did patients who were given a placebo 6.

Safety and Tolerability

• Montelukast is well tolerated and has a favorable safety profile, with adverse events occurring at similar frequencies in patients taking either montelukast or placebo 6, 7.
• The medication provides an effective and well-tolerated oral treatment for allergic airway inflammation in patients with SAR or PAR without asthma, and in patients in whom AR is comorbid with asthma 6.
• Montelukast and loratadine showed a safety profile comparable to that of placebo in a randomized, double-blind, placebo-controlled trial 7.