Allergic Rhinitis Management

Introduction to Treatment Options

The combination of antihistamines and leukotriene receptor antagonists (LTRAs) may provide additive benefits for allergic rhinitis symptoms, as noted in rhinitis management guidelines 1
For patients with both allergic rhinitis and asthma, the combination of antihistamines and LTRAs can be particularly beneficial as montelukast is approved for both conditions 1

The American Academy of Allergy, Asthma, and Immunology notes that montelukast has a safety profile that includes potential neuropsychiatric events (mood changes, behavior changes, suicidal thoughts), as indicated by the FDA Boxed Warning added in March 2020 2
The combination of antihistamines and LTRAs has not shown any significant adverse drug interactions in clinical studies, although specific data on Bilastine and Montelukast is limited to studies ignoring ref

The American Thoracic Society and other guideline societies imply that if you have asthma along with allergic rhinitis, the combination of antihistamines and LTRAs may be particularly beneficial, as montelukast is approved for both conditions and can help manage combined upper and lower airway symptoms 1

The American Academy of Allergy, Asthma, and Immunology suggests that if the combination of antihistamine and LTRA doesn't provide adequate symptom control, intranasal corticosteroids are generally more effective than the combination of antihistamine and LTRA for allergic rhinitis 1

Bilastine (Blexten) is typically administered at 20mg once daily, while Montelukast is administered at 10mg once daily (for adults) 1