Allergic rhinitis

Montelukast reduces inflammation and improves nasal and ocular symptoms in children with seasonal allergic rhinitis, compared with placebo.44, 45 Comparative studies in children with seasonal or perennial allergic rhinitis suggest its efficacy is comparable to that of antihistamines.^{45, 46}

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 might be considered for:

• those with concurrent asthma
• those taking high-dose ICS therapy for asthma in whom it would be beneficial to avoid additional corticosteroids
• children aged between 2 and 3 years
• children who refuse or are unable to tolerate intranasal corticosteroid sprays.

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.⁴⁷

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,48 and may improve lung function, airway inflammation and symptom scores in very young children with early childhood asthma.⁴⁹

However, montelukast does not improve symptoms of acute bronchiolitis in infants.⁵⁰