Montelukast (Singulair) blocks a chemical called “leukotriene D4,” which causes bronchial spasm and mucus secretion in the lungs and mucosal swelling and mucus secretion in the nose. Montelukast was approved several years ago for the treatment of bronchial asthma in chil-dren and adults, and more recently for children and adult patients with seasonal and year-round nasal allergies. While in theory the medication would be expected to work best for nasal congestion and discharge, it has been shown to reduce all nasal symptoms, including sneezing and itching. Clinical trials have demonstrated that mon-telukast is comparable in effect to oral antihistamines such as loratadine.
Montelukast is taken once daily at a dose of 4 mg in children younger than 2 years of age, 5 mg for children between 3 and 14 years, and 10 mg in adolescents older than 14 years and in adults. The side effect profile of this drug has been quite favorable, without any central nervous system side effects such as sedation or anxiety. Recently, the FDA reviewed postmarketing surveillance data that revealed a possible link between montelukast and an increase in suicidal behavior in children. How-ever, careful analysis of all available data from clinical studies does not confirm these findings. Montelukast is best suited for patients with mild rhinitis and can be taken on either a regular or an as-needed basis.
Mon-telukast provides an alternative to oral antihistamines in patients who either do not tolerate antihistamines or whose symptoms are not effectively relieved by these drugs. Some patients with allergic rhinitis may also benefit from a combination of montelukast plus an oral antihistamine, as the two drugs block different chemicals (i.e., histamine and leukotriene D4) and their clinical effects may be additive. Montelukast should also be considered in patients who have mild persistent asthma along with their allergic rhinitis; in these patients, montelukast may provide satisfactory relief of both upper and lower airway symptoms.
Montelukast provides an alternative to oral antihista-mines in patients who either do not tolerate antihista-mines or whose symptoms are not effectively relieved by these drugs.