The Use of Singulair for Allergies

Contrary to popular belief, it's not an antihistamine

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Singulair (montelukast) is a once-daily prescription medication that was originally developed to treat asthma. Since then, however, it's been discovered that Singulair is also an effective treatment for allergic rhinitis (also known as hay fever).

Let's take a closer look at Singulair, including its indications and side effects, and how its mechanism of action is unique to traditional medications for allergic rhinitis.

Common side effects of singulair
Illustration by JR Bee, Verywell 


Singulair is indicated for the prevention and chronic treatment of asthma and for the relief of symptoms of allergic rhinitis, both seasonal and perennial.

Seasonal allergic rhinitis is generally triggered by pollen from trees, grasses, and weeds. In other words, a person with seasonal allergic rhinitis will develop symptoms predictably every year around spring and summer when pollen levels are high.

On the other hand, perennial allergic rhinitis occurs year-round and is commonly triggered by indoor allergens like dust mites, cockroaches, mold spores, or animal dander. Interestingly, Singulair may also be used to prevent exercise-induced asthma.

Off-Label Uses

Singulair is sometimes used off-label (meaning it's not approved by the Food and Drug Administration, or FDA) for chronic urticaria (hives) or nonsteroidal anti-inflammatory drug-induced urticaria.

Before Taking

The symptoms of allergic rhinitis include sneezing, runny nose, and nasal congestion. Some people also experience itchy eyes, nose, throat, and inner ear, as well as fatigue and cough. 

In addition to these burdensome physical symptoms, allergic rhinitis may affect other dimensions of a person's life. For instance, research suggests that allergic rhinitis negatively impacts sleep, quality of life, cognitive function, and productivity at school or work.

This is why allergen avoidance and medication is key to controlling allergic rhinitis. With medication, doctors use a step-up approach, meaning as symptoms worsen, a doctor will prescribe a different medication.

For example, for mild symptoms of allergic rhinitis, a doctor may recommend an antihistamine. If symptoms persist and/or affect a person's quality of life, a doctor may "step-up" their therapy and recommend an intranasal corticosteroid. For severe, persistent symptoms, a doctor may prescribe both an antihistamine and an intranasal corticosteroid.

The American Academy of Otolaryngology recommends doctors not prescribe Singulair as first-line therapy for treating allergic rhinitis unless that person also has asthma.

How It Works

Unlike other medications used to treat allergic rhinitis (for example, Claritin or Allegra), Singulair is not an antihistamine. An antihistamine is a medication that reduces your body's production of histamine, your body's natural first defense against allergens. Rather, Singulair blocks another mediator of inflammation, called leukotrienes.

Singulair, by itself, is not a great treatment for allergic rhinitis and asthma, although it can treat both diseases to some degree. That said, some people respond well to Singulair, and it may be the only medication needed to treat their allergies or asthma. 

  • Singular seems to be best at treating nasal congestion.

  • Various studies have also shown that the combination of Singular and an antihistamine is nearly as effective as nasal steroid sprays for the treatment of allergic rhinitis.

  • Singulair doesn't always work as well as antihistamines when it comes to treating itchy eyes, itchy nose, sneezing, and runny nose.

  • Unlike antihistamines, Singulair can't be taken as needed. It typically needs about three to seven days to start working.

Side Effects

Overall, Singular is considered a relatively safe medication, although side effects may occur.

Some of the more common adverse effects reported include: 

  • Skin rash
  • Mood changes
  • Headache or dizziness
  • Abdominal pain, heartburn indigestion, nausea, or a change in bowel movements
  • Toothache or infection
  • Ear pain or infection
  • Muscle weakness
  • Conjunctivitis ("pink eye")
  • Fatigue
  • Flu-like symptoms

If you take Singulair and experience any symptoms that concern you, speak with your physician or allergist. Do not hesitate to seek immediate care for any serious side effects, such as throat closing or difficulty breathing.

A Word From Verywell

If you have allergies, it's important to remember that Singulair is not your only option. As mentioned earlier, you can also take an antihistamine.

Other medication options include steroid nasal sprays, over-the-counter nasal sprays, oral decongestants, combination decongestant antihistamines, and anticholinergic and antihistamine nasal sprays. 

Be sure to talk to your primary care doctor or allergist about your treatment plan if your symptoms are not getting better and/or they are affecting your quality of life. There are a number of therapy approaches, so rest assured that you can feel better, but it may be a trial-and-error process. 

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Article Sources
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  2. American College of Allergy, Asthma and Immunology. Allergic rhinitis. Updated February 6, 2018.

  3. Harvard Health Publishing. Harvard Medical School. Allergic rhinitis: your nose knows. Updated May 21, 2018.

  4. Cingi CC, Muluk NB, et al. 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

Additional Reading
  • deShazo RD, Kemp SF. Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis. Corren J, ed. UpToDate, Waltham, MA: UpToDate Inc.
  • Meltzer EO et al. Sleep, quality of life, and productivity impact of nasal symptoms in the United States: findings from the Burden of Rhinitis in America survey. Allergy Asthma Proc. 2009 May-Jun;30(3):244-54.
  • Seidman et al. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg. 2015 Feb;152(1 Suppl): S1-43
  • Sur DKC, Plesa ML. Treatment of allergic rhinitis. Am Fam Physician. 2015 Dec 1;92(11):985-92.
  • Wallace DV, Dykewicz MS, editors. Diagnosis and Management of Rhinitis: An Updated Practice Parameter. J Allergy Clin Immunol. 2008;122 : S1-84.