Second Chances: Results of My Second Trial of Singulair For Rhinitis

Disclaimer (Updated July 26, 2022 - 2:15 PM ET):Singulair has a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). It has this warning because it may cause mood or behavior changes. Because of these possible changes, the benefits of Singulair may not outweigh the risks in some people. Singulair should only be used by people with allergic rhinitis (hay fever) who have not responded to or cannot take other treatments. If you have any mood or behavior changes when taking Singulair, stop taking the drug and contact your doctor right away. For more information about Singulair and to access prescribing information, please visit this page.4

I've written recently about allergic rhinitis treatment options, and the role of Singulair (montelukast) in treating allergic rhinitis. I spent about three years on Singulair a couple years after I was diagnosed, but it appeared to have made no difference with my asthma so my then-allergist and I decided to discontinue it.

Well, I've been back on Singulair for two weeks now, seeing how or if it helps with my allergic rhinitis, in combination with daily nasal steroids and saline (I've hit my stride at about 6 weeks of actual compliance on that stuff now). And, while I was super doubtful when I started, because Singulair didn't help my asthma at all back in the day (nor do I feel a difference in my asthma now), my sinuses feel the best they have in years (I mean, seriously, the drug went generic in Canada and the US in the time I was off of it!).

Retrial: Singulair, revisited.

Because Singulair didn't help with my asthma, I presumed it wouldn't help with my rhinitis symptoms. After all, your response to montelukast-as I learned from Dr. Jason Lee-is dependent on a genetic polymorphism that makes you receptive to blockers of the leukotriene pathway 1. This presumes that leukotrienes are the source of your inflammation (as many things cause inflammation in asthma and rhinitis, which leads to symptoms) 2, and that you respond to the drug's effects on the leukotriene pathway, which seems to be genetically determined. 1

So, as I'd experienced an unremarkable response on my asthma from the leukotriene receptor antagonist Singulair previously, I presumed based on this that I did not have the genetic polymorphism that would respond to the drug.
Often, revisiting a medication once it hasn't worked isn't, in my opinion, worth trying again when it comes to asthma. However, in this case, I was willing to give Singulair another go, for a different need.

Results: Two weeks in on Singulair

At the time I restarted Singulair, my sinuses were probably the worst they'd been in years. Despite nearly a month adhering to my sinus treatments, I was still virtually unable to breathe through my nose-to an extent that was even more noticeable to me, even though I'd had "impaired" nose breathing ability for years prior. As my rhinitis symptoms are present year-round (thanks, dust mites!), it made total sense to restart montelukast in mid-December, a good month in to proper Winter in Central Canada.

Shockingly, by two to three days in I felt a difference. I could breathe through my nose decently, mostly, for the first time in at least five years. As the days went on, this effect got better. Around this time, I read that 70% of the anticipated benefit of Singulair can be experienced within the first 2 days of use. 3
While I've had some very minor hiccups along the way sinus-wise, they're just that-minor. Seriously, the mild incidences of symptoms I've experienced since building up the Singulair are still considerably milder than what I was dealing with before. Right now, I even have a terrible cough and possibly may be getting a cold, and I can still breathe through my nose totally fine (this is why I can't even tell if I have a cold or not!)

Second chances: Worth a shot?

I'm still shocked to write this but here it is: I'm happy I decided to trial going back on Singulair again. I was so pessimistic towards it and was doubtful it could work, but, it's been super helpful this time around-same drug, different purpose. I'm also wondering if my rhinitis perhaps had responded to it all those years ago, and because I was pre-diagnosis of that aspect of respiratory weirdness, maybe I just didn't notice the impact it had? I'll never know, but I'm surprisingly happy to have added it back into my arsenal for allergic rhinitis treatment!

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