Intranasal corticosteroids are the most effective
pharmacotherapy for allergic rhinitis in children. They control
all the major symptoms, including sneezing, itching and nasal
congestion. Currently available intranasal corticosteroids
preparations are only approved for use in children aged 3 years
and over. Montelukast may have a role in treatment of allergic
rhinitis in children, particularly for those with concurrent
asthma, those taking high-dose ICS therapy for asthma in whom it
would be beneficial to avoid additional corticosteroids,
children under 3 years, and children who refuse or are unable to
tolerate intranasal corticosteroid sprays.
Several randomised placebo-controlled trials in
adults with allergic rhinitis have shown that montelukast
effectively reduces symptoms of sneezing, itching and nasal
congestion. Comparative studies show that therapeutic benefits
are equivalent to those of antihistamines but less than those of
intranasal corticosteroid therapy.34–36
In a randomised placebo-controlled trial in
children aged 7–14 years with seasonal allergic rhinitis, a
2-week course of montelukast significantly improved nasal and
ocular symptoms, and reduced inflammation, compared with
placebo.37 A randomised placebo-controlled trial in
children aged 2–6 years with perennial allergic rhinitis
demonstrated that montelukast and cetirizine both effectively
improved measures of nasal airway resistance, inflammation,
quality of life and symptom score. Cetirizine, but not
montelukast, was also effective against nasal itching. However,
neither treatment was effective in controlling symptoms of
throat itching and tear secretion. Sleep quality was
significantly better with montelukast than with cetirizine.38
Non-specific cough
Non-specific cough, defined as non-productive
cough in the absence of identifiable respiratory disease or
known aetiology, is common among children. Given that the
mechanism of neurogenic chronic cough is thought to involve the
leukotriene pathway, the use of LTRAs has been studied as a
potential treatment. However, there are currently very limited
data evaluating their efficacy in the treatment of children with
non-specific cough.39
Use in infants
Montelukast is currently registered for use in
children aged 2 years and older. There is also evidence that it
is well tolerated in children aged under 2 years,40
and may improve lung function, airway inflammation and symptom
scores in very young children with early childhood asthma.41
