Montelukast Use in Seasonal Allergic Rhinitis: Evidence‑Based Guidance

Treatment Position

• Intranasal corticosteroids are strongly recommended as the initial therapy for seasonal allergic rhinitis in patients ≥ 15 years, because they provide superior symptom reduction compared with montelukast. 1
• Multiple randomized trials have demonstrated that intranasal corticosteroids achieve clinically meaningful greater decreases in nasal symptom scores than montelukast. 2
• Montelukast shows inferior efficacy for seasonal allergic rhinitis despite the convenience of oral administration that some patients prefer. 3

Situations When Montelukast May Be Considered

• Montelukast can be used when a patient cannot tolerate or refuses intranasal corticosteroids. 1
• In patients with concurrent mild persistent asthma, montelukast may provide a dual benefit for both conditions, although it remains suboptimal as the preferred agent for either disease when used alone. 3
• Certain sub‑populations may exhibit enhanced responsiveness to leukotriene‑receptor antagonists, mirroring response patterns observed in asthma. 1

Safety Considerations

• Evidence regarding use in pregnancy or lactation is lacking; the available data do not specifically address safety in these populations. 2

Key Clinical Pitfalls

• Montelukast should not be prescribed as first‑line therapy for seasonal allergic rhinitis when intranasal corticosteroids are tolerated, as this represents suboptimal care. 1