Singulair/Montelukast: Not just for asthma? Part 2

As I wrote previously, for whatever reason, I suck at keeping up with my nasal corticosteroids. But I do take pills as well as inhalers a couple (or more) times a day, and I rarely failed to take Singulair—who knows what gives on that, I could’ve also just been a greener, not burned-out asthmatic, or… it could just be less burdensome therapeutically. So, I began to look at the research, contemplating if it was worthwhile to present to Dr. Smartypants at my December appointment that we consider revisiting Singulair for my perennial (year-round) allergic rhinitis. It didn’t work for my asthma, but given that was before my rhinitis was identified, I didn’t know if it had positively impacted my sinuses.

Well, my sinuses answered the question for me—after yet another Nasonex hiatus, I returned from Switzerland and got stuffy. I actually presumed I was getting sick after two transatlantic flights and a cumulative twenty-four hours on planes in five days. Except, nope. I restarted the nasal steroids and I think probably due to the amount of gunk in my nose, they took a long time to take effect (to the point where, since antihistamines didn’t help, I was trying to clear my nose by way of eating Sweet Chilli Heat Doritos. Anything is worth a shot (especially when it is also delicious), but it also made an attempt at Singulair worth a shot again, too.

Consulting the literature: Singulair for Allergic Rhinitis

Singulair has many other uses than just asthma, and allergic rhinitis, like I have, is one of them.

In a Twitter conversation (more on that in a moment), Dr. Jason Lee stated montelukast is barely more effective than placebo. Remember, we must be mindful that simply taking a treatment may affect our perception of symptoms).

In one study, the randomized group taking a standard dose of 10 mg montelukast without any other meds for allergic rhinitis experienced a decrease in nasal symptoms, with a mean score decrease of -0.36 from baseline. However, the placebo group score also decreased -0.25, meaning the change between placebo and montelukast was not that great.¹ Interestingly, a higher dose of montelukast, at 20 mg, actually scored worse on nasal symptom improvement than the group on only 10 mg, coming in at a mean score point difference of -0.29.¹

In two studies of montelukast for allergic rhinitis, results weren’t too promising: total nasal symptom scores improved on montelukast just 1.2 and 5.4% over placebo.² I’m no statistician, but those numbers aren’t terribly promising combined with my previous experience. Of course, that doesn’t mean I won’t give it another try.

Chatting with the doctor(s)

Before I even headed to my appointment with Dr. Smartypants, I found myself by chance, consulting not just the medical literature, but allergists inside the internet—hello, Twitter!

Singulair for Allergic Rhinitis: Will it work?
Will Singulair work is a good question. Given I know it did not have a significant impact on my asthma, I’m doubtful it will have a significant impact on my rhinitis symptoms. However, the only way to know for sure is to try. Given I have now been compliant on my nasal steroids for close to four weeks with partial improvement, it will be interesting to see if I feel a difference. Typically, montelukast reaches 70% of peak effectiveness by end of day 2, and maximum effectiveness at 2 weeks.³ As I write this three days in, I do feel a bit of a difference, but I’ll definitely be assessing the impact over the coming days—and weeks.

Disclaimer (Updated July 26, 2022 - 2:38 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