The Use of Singulair for Allergies

Contrary to popular belief, it's not an antihistamine

Singulair (montelukast) is a medicine that can be prescribed for managing asthma. Some people also use it to treat allergic rhinitis, also known as hay fever or allergies.

This article takes a closer look at Singulair, including its uses and side effects. It also covers how it works differently than medicines typically used to treat allergic rhinitis.

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Singulair Uses


Doctors can prescribe Singulair to prevent symptoms of chronic asthma. In some people, the drug might even prevent exercise-induced asthma.

Singulair can also relieve symptoms of allergic rhinitis.

There are two main types of allergic rhinitis: seasonal and perennial:

  • Pollen from trees, grasses, and weeds can trigger seasonal allergic rhinitis. Seasonal allergies are typically highest in the spring and summer when pollen levels are high. Symptoms can occur in the fall, especially for people who are allergic to weed pollen.
  • Perennial allergic rhinitis causes symptoms all year. Common triggers are indoor allergens: dust mites, cockroaches, mold, or animal dander.

Off-Label Uses of Singulair

Doctors might prescribe Singulair for off-label use for some conditions. Off-label means the Food and Drug Administration (FDA) hasn't approved the drug for that use, but it can still be an effective treatment.

For example, some people use Singulair off-label to treat chronic urticaria (recurrent hives) or hives caused by using non-steroidal anti-inflammatory drugs (NSAIDs).

What to Know Before Using Singulair

Symptoms of allergic rhinitis include:

  • Sneezing
  • Runny nose
  • Nasal congestion
  • Itchy eyes, nose, throat, and inner ear
  • Feeling weak or tired
  • Cough

Allergic rhinitis can also affect other dimensions of your life. Research shows that allergic rhinitis negatively impacts:

  • Sleep
  • Quality of life
  • Concentration
  • Productivity at school or work

You can control allergic rhinitis by avoiding allergens or taking medicine. If you choose to take medicine, doctors often recommend a step-up approach. That means that you'll start with less powerful medicine with a low risk of side effects. If that doesn't work or symptoms get worse, your doctor might prescribe a different medicine.

Here's an example of treatments that your doctor might recommend:

If you've tried other treatments for allergic rhinitis and they don't work, your doctor might prescribe Singulair. But it's usually not the first-line treatment. That's because it might cause mental health side effects in some people, including suicidal thoughts and actions.

Due to these side effects, the FDA usually recommends using Singulair for allergic rhinitis only if other treatments don't work. That said, some people respond well to Singulair, and it may be the most effective treatment for their allergies or asthma. 

Recap

Doctors often prescribe antihistamines or nasal steroid sprays to treat allergies, not Singulair. That's because Singulair might cause mental health side effects.

How Singulair Works

Cells in your body react to allergens by making a chemical called histamine. This chemical is involved in the body's immune response, and it triggers the symptoms known as allergies.

Many of the medications that are commonly used to treat allergic rhinitis are antihistamines. These drugs block the effects of histamine. Popular antihistamines include Claritin or Allegra.

Singulair isn't an antihistamine. Instead, Singulair blocks leukotrienes, which are another type of chemical involved in the inflammation of allergic rhinitis and asthma.

Side Effects off Singulair

Overall, Singular is a safe medicine, but side effects may occur.

Some common negative effects are: 

  • Skin rash
  • Mood changes
  • Headache or dizziness
  • Stomach pain
  • Heartburn or indigestion
  • Nausea, diarrhea, or constipation
  • Toothache or infection
  • Ear pain or infection
  • Muscle weakness
  • Conjunctivitis (pink eye)
  • Fatigue
  • Flu-like symptoms

Talk to your doctor if you take Singulair and experience any symptoms that worry you.

A rare side effect of Singulair is a severe allergic reaction to the drug. If you start to feel swelling in your throat or have difficulty breathing, get medical treatment right away.

Recap

Get medical care right away if you feel your throat closing or have trouble breathing.

Summary

Singulair can be used to prevent asthma symptoms. Some doctors might prescribe it to treat seasonal or year-round allergies. But it's usually not the first choice because it can cause serious mental health side effects.

If you have allergies, know that Singulair isn't your only option. You can take antihistamines or nasal sprays before trying Singulair.

A Word From Verywell

Talk to your doctor about your treatment plan. Tell them if your symptoms aren't getting better or if they affect your quality of life. There are many ways to treat allergies. Rest assured that you can find a therapy to help you feel better. But it may take some trial and error to find the best treatment for you. 

Frequently Asked Questions

  • Is Singulair an antihistamine?

    No. Singular blocks leukotrienes, not histamines. Leukotrienes cause allergy symptoms like coughing, inflammation in the airways, and trouble breathing.

  • Is Singulair usually recommended for seasonal allergies?

    No. The FDA recommends trying other medications before turning to Singulair (montelukast) for allergic rhinitis or mild asthma symptoms. It can increase the risk of agitation, depression, sleeping problems, and suicidal thoughts and actions. In 2020, Singulair added a black box warning label to call out these risks.

  • Can montelukast be used to treat COVID?

    Maybe. Some evidence shows that montelukast can help prevent people hospitalized with COVID-19 from developing more serious symptoms. But more research needs to be done.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. American College of Allergy, Asthma and Immunology. Allergic rhinitis.

  3. Harvard Health Publishing. Harvard Medical School. Allergic rhinitis: your nose knows.

  4. Cingi CC, Muluk NB, Hanci D, Sahim E. Impacts of allergic rhinitis in social communication, quality of life and behaviours of the patients. J Allergy Disord Ther. 2015;2(1):002. doi:10.24966/ADT-749X/100002

  5. Benninger M, Waters H. Montelukast: Pharmacology, safety, tolerability and efficacy. Clinical Medicine Insights: Therapeutics. 2009. doi:10.4137/CMT.S1147

  6. Aypak C, Türedi Ö, Solmaz N, Yıkılkan H, Görpelioğlu S. A rare adverse effect of montelukast treatment: ecchymosis. Respir Care. 2013;58(9):e104-6. doi:10.4187/respcare.02298

  7. Cleveland Clinic. Leukotriene modifiers.

  8. U.S. Food and Drug Administration. FDA requires stronger warning about risk of neuropsychiatric events associated with asthma and allergy medication Singulair and generic montelukast.

  9. Khan AR, Misdary C, Yegya-Raman N, et al. Montelukast in hospitalized patients diagnosed with COVID-19. Journal of Asthma. March 4, 2021:1-7. doi:10.1080/02770903.2021.1881967

By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.