Montelukast, a prescription-only medication, is mainly used as add on therapy in the treatment of asthma, usually in patients who cannot control their condition with an inhaled steroid and who cannot control their asthma with ‘short acting’ inhaler such as Ventolin (Salbutamol). Today I will explore a different use of montelukast and answer the main question: can you use montelukast for allergies?
- What is montelukast
- Licensed use of montelukast
- Montelukast: mechanism of action
- Availability of different forms of montelukast
- Can you use montelukast for allergies?
- Montelukast vs antihistamines: what is the difference
- Legal classification
- Can you take montelukast with antihistamines?
What is montelukast?
Montelukast is primarily used in the management of asthma, as add-on therapy when inhaled corticosteroid and short-acting beta-2 agonist such as Ventolin do not provide sufficient control of the condition.
Montelukast is also licensed to help with symptoms of seasonal allergic rhinitis, a hayfever characterised by the inflammation inside the nose) and exercise-induced asthma.
Classified as a leukotriene receptor antagonist (LTRA), montelukast has a distinct mechanism of action compared to other drugs, including those used to treat asthma. Leukotriene receptor antagonists produce widening of airways (bronchodilation) and have anti-inflammatory effect (Dempsey, 2000). Leukotrienes are molecules which react with ‘binding sites’ (receptors found in the lungs causing bronchoconstriction (narrowing of airways). In plain language, montelukast stops leukotriene from working (antagonise their effect).
Montelukast: availability of different form
Montelukast 10mg tablets are usually prescribed for adults; however, montelukast also comes in 4mg and 5mg chewable tablets for children.
Can you use montelukast for allergies?
We already learnt that montelukast is licensed to manage seasonal allergic rhinitis. Current evidence suggests that montelukast reduces nasal symptoms, however not as effective as steroid nasal sprays or antihistamines. It is recommended to use montelukast as a secondary option in treating allergic rhinitis, preferably in combination with an antihistamine (Grainger & Drake-Lee, 2006). This recommendation is scientific rather than medical.
What about other conditions? Can montelukast be used for allergic skin conditions or other skin conditions such as eczema or psoriasis?
Although montelukast is not licensed for the conditions in question, a doctor can prescribe medicines outside its license. What would be the rationale to use montelukast for allergic skin conditions?
We already established that montelukast stops certain chemicals called leukotrienes (mediators) from working. Leukotrienes have physiological roles in other conditions, not just asthma or allergic rhinitis, for example (Liu & Yokomizo, 2015):
- Atopic dermatitis (eczema) in which they contribute to allergic inflammation and induce itching.
- Allergic conjunctivitis causing the release of different cells (mast cells and neutrophils), contributing to allergic eye reactions and eye scratching.
From a pharmacological point of view, it makes sense to use montelukast for allergies as it blocks one of the chemicals responsible for symptoms of allergies.
Use of montelukast for allergies: what is the evidence?
Many small studies confirm the effectiveness of montelukast in treating conditions for which montelukast is not licensed at the moment.
Effectiveness of montelukast for treating perennial allergic rhinitis
In this study, over 1300 patients suffering from all-year-round allergic rhinitis received random treatment with either montelukast 10mg, cetirizine (antihistamine) or a placebo (a dummy pill). It was concluded that taking montelukast resulted in improved daytime symptoms and significant improvement in the quality of life. Treatment with montelukast during six weeks trial showed to be consistent as opposed to the treatment with an antihistamine – cetirizine (Philip et al., 2007). Furthermore, existing evidence suggests that antihistamines and leukotriene antagonists (montelukast) are equally effective in relieving the symptoms of allergic rhinitis but less effective than steroid nasal sprays for hayfever (Van Hoecke et al., 2007).
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Montelukast with desloratadine or levocetirizine in treatment of persistent allergic rhinitis
The aim of this study was to investigate the effectiveness of treatment with montelukast alone or in combination with either desloratadine or levocetirizine (antihistamines) in the treatment of persistent allergic rhinitis. This study has its limits mainly due to a small number of participating patients. It was concluded that combination treatment with montelukast and desloratadine or levocetirizine is more effective than treatment with either of the drugs alone (Ciebiada et al., 2006).
Effectiveness of montelukast in the treatment of severe atopic dermatitis (eczema) in children
This small study investigated the effect of treatment with montelukast in children with severe eczema. The condition was defined as severe when 10% or more of the skin was affected and patients failed to get a response from standard treatment, for example, the use of antihistamine tablets and topical steroids.
In conclusion, children who took montelukast had experienced reduced itching, extent and intensity of the condition, reduced number of eosinophil (white blood cells) and IgE (trigger release of the chemical that causes an allergic response) and improved sleeping (ibid).
Montelukast vs antihistamines: what is the difference?
Antihistamines are the first-line treatment of hayfever and are commonly bought over the counter to help with allergic rhinitis. As the name suggests, antihistamines reduce the actions of histamine, which is the leading compound (mediator) released by cells contributing to symptoms of allergies. Histamine and leukotrienes have a distinct role in allergies and allergic response, hence the availability of two classes of drugs: antihistamines and leukotriene receptor antagonists.
Montelukast vs antihistamines: legal classification
The majority of antihistamines are available over the counter, without a prescription. Fexofenadine, currently prescription-only antihistamine, will be soon available also without a prescription. Generally, antihistamines are divided into sedative (first-generation antihistamines) and non-sedative (second-generation antihistamines). Sedative antihistamines are mainly used as over the counter sleeping pills; however, some sedative products can also be used to manage allergies.
Two prescription-only leukotriene receptor antagonists are currently licensed in the UK: montelukast and zafirlukast (not commonly prescribed).
Can you take montelukast with antihistamines?
Montelukast can be taken with other antihistamines. There are no interactions listed between montelukast and antihistamines.
Although not commonly used, montelukast can be used for allergies. In particular, it is licensed to help with seasonal allergic rhinitis, with evidence to support its effectiveness. Many small studies explored the use of montelukast in the treatment of other allergic conditions like eczema. Although not licensed to treat other allergic conditions, the use of leukotriene receptor antagonists should be investigated with more extensive studies.
Ciebiada M, Górska-Ciebiada M, DuBuske LM, Górski P (2006). Montelukast with desloratadine or levocetirizine for the treatment of persistent allergic rhinitis. Ann Allergy Asthma Immunol. 2006 Nov;97(5):664-71. doi: 10.1016/S1081-1206(10)61098-8. PMID: 17165277.Available at: https://doi.org/10.1016/s1081-1206(10)61098-8 Accessed on 18/04/2021
Dempsey (2000). Leukotriene receptor antagonist therapy. Postgraduate Medical Journal 2000;76:767-773. Available at: http://dx.doi.org/10.1136/pgmj.76.902.767 Accessed on 17/04/2021
Ehlayel MS, Bener A, Sabbah A. Montelukast treatment in children with moderately severe atopic dermatitis. Eur Ann Allergy Clin Immunol. 2007 Sep;39(7):232-6. PMID: 18236999. Available at: https://pubmed.ncbi.nlm.nih.gov/18236999/ Accessed on 18/04/2021
Grainger J, Drake-Lee A (2006). Montelukast in allergic rhinitis: a systematic review and meta-analysis. Clin Otolaryngol. 2006 Oct;31(5):360-7. doi: 10.1111/j.1749-4486.2006.01276.x. PMID: 17014443. Available at: https://doi.org/10.1111/j.1749-4486.2006.01276.x Accessed on 18/04/2021
Liu M, Yokomizo T (2015). The role of leukotrienes in allergic diseases. Allergol Int. 2015 Jan;64(1):17-26. doi: 10.1016/j.alit.2014.09.001. Epub 2014 Nov 22. PMID: 25572555. Available at: https://doi.org/10.1016/j.alit.2014.09.001 Accessed on 18/04/2021
Philip G, Williams-Herman D, Patel P, Weinstein SF, Alon A, Gilles L, Tozzi CA, Dass SB, Reiss TF (2007). Efficacy of montelukast for treating perennial allergic rhinitis. Allergy Asthma Proc. 2007 May-Jun;28(3):296-304. doi: 10.2500/aap.2007.28.3000. PMID: 17619558. Available at: https://doi.org/10.2500/aap.2007.28.3000 Accessed on 17/04/2021
Van Hoecke H, Vandenbulcke L, Van Cauwenberge P(2007). Histamine and leukotriene receptor antagonism in the treatment of allergic rhinitis: an update. Drugs. 2007;67(18):2717-26. doi: 10.2165/00003495-200767180-00006. PMID: 18062720. Available at: https://doi.org/10.2165/00003495-200767180-00006 Accessed on 18/04/2021