Should You Use Singulair for Allergies?

Singulair is a common asthma medication that can also be used for allergies

Man rubbing eye
Singulair works differently than antihistamines to treat allergies. Image Source/Digital Vision/Getty Images

Singulair (montelukast) is a once-daily prescription medication that was originally developed to treat asthma. Since then, however, it's been discovered that Singulair is also an effective treatment for allergic rhinitis (also known as hay fever).

Let's take a closer look at Singulair, including its indications and side effects, and how its mechanism of action is unique to traditional medications for allergic rhinitis.

The Skinny on Singulair's Indications

Singulair is indicated for the prevention and chronic treatment of asthma and for the relief of symptoms of allergic rhinitis, both seasonal and perennial.

To back up a bit, remember, seasonal allergic rhinitis is generally triggered by pollen from trees, grasses, and weeds. In other words, a person with seasonal allergic rhinitis will develop symptoms predictably every year around spring and summer when pollen levels are high.

On the other hand, perennial allergic rhinitis occurs year-round and is commonly triggered by indoor allergens like dust mites, cockroaches, mold spores, or animal dander. 

Interestingly, Singulair may also be used to prevent exercise-induced asthma

Lastly, Singulair is sometimes used off-label (meaning it's not approved by the Food and Drug Administration, or FDA) for chronic urticaria (hives) or nonsteroidal anti-inflammatory drug-induced urticaria.

The Side Effects of Singulair 

Overall, Singular is considered a relatively safe medication, although side effects may occur.

Some of the more common adverse effects reported include: 

  • Skin rash
  • Mood changes
  • Headache or dizziness
  • Abdominal pain, heartburn indigestion, nausea, or a change in bowel movements
  • Toothache or infection
  • Ear pain or infection
  • Muscle weakness
  • Conjunctivitis ("pink eye")
  • Fatigue
  • Flu-like symptoms

If you take Singulair and experience any symptoms that concern you, speak with your physician or allergist. Do not hesitate to seek immediate care for any serious side effects, such as throat closing or difficulty breathing. 

The Treatment of Allergic Rhinitis With Singulair

The symptoms of allergic rhinitis include sneezing, runny nose, and nasal congestion. Some people also experience itchy eyes, nose, throat, and inner ear, as well as fatigue and cough. 

In addition to these burdensome physical symptoms, allergic rhinitis may affect other dimensions of a person's life. For instance, research suggests that allergic rhinitis negatively impacts sleep, quality of life, cognitive function, and productivity at school or work. 

This is why allergen avoidance and medication is key to controlling allergic rhinitis. With medication, doctor's use a step-up approach, meaning as symptoms worsen, a doctor will prescribe a different medication.

For example, for mild symptoms of allergic rhinitis, a doctor may recommend an antihistamine. If symptoms persist and/or affect a person's quality of life, a doctor may "step-up" their therapy and recommend an intranasal corticosteroid.

For severe, persistent symptoms, a doctor may prescribe both an antihistamine and an intranasal corticosteroid. 

Singulair's Mechanism of Action

Unlike other medications used to treat allergic rhinitis (for example, Claritin or Allegra), Singulair is not an antihistamine. Remember, an antihistamine is a medication that reduces your body's production of histamine, your body's natural first defense against allergens.

Rather, Singulair blocks another mediator of inflammation, called leukotrienes.

In my opinion, Singulair, by itself, is not a great treatment for allergic rhinitis and asthma, although it can treat both diseases to some degree.

This opinion fits with the guidelines of the American Academy of Otolaryngology—a professional group that recommends doctors not prescribe Singulair as first-line therapy for treating allergic rhinitis unless that person also has asthma. 

That said, some people respond well to Singulair, and it may be the only medication needed to treat their allergies or asthma. 

Other Pluses and Minuses to Singulair

In my practice, I’ve found that Singulair does not work as well as other antihistamines when it comes to treating itchy eyes, itchy nose, sneezing, and runny nose. In addition, unlike antihistamines, Singulair cannot be taken as needed, and typically needs about three to seven days to start working.

What Singulair does seem to be best at is treating nasal congestion. Even more, various studies have shown that the combination of Singulair along with an antihistamine is nearly as effective as nasal steroid sprays for the treatment of allergic rhinitis. 

A Word From Verywell

If you have allergies, it's important to remember that Singulair is not your only option. As mentioned earlier, you can also take an antihistamine.

Other medication options include steroid nasal sprays, over-the-counter nasal sprays, oral decongestants, combination decongestant antihistamines, and anticholinergic and antihistamine nasal sprays. 

Be sure to talk to your primary care doctor or allergist about your treatment plan if your symptoms are not getting better and/or they are affecting your quality of life. There are a number of therapy approaches, so rest assured that you can feel better, but it may be a trial-and-error process. 

Sources:

deShazo RD, Kemp SF. Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis. Corren J, ed. UpToDate, Waltham, MA:UpToDate Inc.

Meltzer EO et al. Sleep, quality of life, and productivity impact of nasal symptoms in the United States: findings from the Burden of Rhinitis in America survey. Allergy Asthma Proc. 2009 May-Jun;30(3):244-54.

Seidman et al. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg. 2015 Feb;152(1 Suppl):S1-43

Sur DKC, Plesa ML. Treatment of allergic rhinitis. Am Fam Physician. 2015 Dec 1;92(11):985-92.

 

Wallace DV, Dykewicz MS, editors. Diagnosis and Management of Rhinitis: An Updated Practice Parameter. J Allergy Clin Immunol. 2008;122:S1-84.

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