Q:

9/29/2012
How long can Montelukast be given as a prophylaxis? Which is better, Intranasal corticosteroids or oral Montelukast?

A:

Thank you for your inquiry.

Montelukast can be used indefinitely. There is no set time limitation on its use.

Perhaps the best way to approach the question of intranasal steroids versus montelukast in the treatment of allergic rhinitis is to extract select quotes from the Joint Council of Allergy, Asthma, and Immunology Parameters on Allergic Rhinitis (1).

Below you will see quotes dealing directly with intranasal corticosteroids in the treatment of rhinitis, and also a quote regarding the use of montelukast in the special situation of rhinitis related to aspirin-exacerbated respiratory tract disease.

You can see from the quotes copied below that intranasal corticosteroids are considered the most effective medicine in the routine therapy of allergic rhinitis patients, and that leukotriene antagonists (LTRA) in most situations are generally considered less effective than intranasal corticosteroids.

“LTRA are less effective than intranasal corticosteroids.”

“Intranasal corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis.”

“In most studies, intranasal corticosteroids have been shown to be more effective than the combined use of an antihistamine and leukotriene (LT) antagonist in the treatment of seasonal allergic rhinitis.”

“Subjective improvement in nasal polyp symptoms has been observed in patients administered the LT modifiers montelukast, zafirlukast, and zileuton as add-on therapy to intranasal corticosteroids. After sphenoidal ethmoidectomy, recurrence rates and rescue medication requirements in patients treated with montelukast were equivalent to those observed in patients receiving postoperative nasal beclomethasone.”

Thank you again for your inquiry and we hope this response is helpful to you.

Reference:
1. The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clin Immunol 2008;122:S1-84.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology