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) in some patients.

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.


Singulair is indicated for the prevention and chronic treatment of asthma. It has also been approved for the relief of symptoms of allergic rhinitis, both seasonal and perennial, when those symptoms have not been well-controlled with other therapies.

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.

Because the benefits may not outweigh the risk for possible neuropsychiatric side effects, the FDA recommends against treating allergic rhinitis with Singulair unless a person has failed alternative treatments.

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 blocks the effects of histamine, a chemical released by certain cells in the body in response to allergens. Rather, Singulair blocks another mediator of inflammation called a leukotriene.

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. 

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. 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 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. 

Frequently Asked Questions

  • Is Singulair an antihistamine?

    No. Rather than blocking histamines to prevent allergy symptoms, Singular blocks leukotrienes, a chemical some people’s bodies release when exposed to something they're allergic to. The leukotrienes cause allergy symptoms like coughing, inflammation in the airways, and trouble breathing.

  • Is Singulair usually recommended for seasonal allergies?

    No. The FDA recommends that doctors avoid prescribing Singulair (montelukast) for allergic rhinitis or mild asthma symptoms because the medication seems to increase the risk of agitation, depression, sleeping problems, and suicidal thoughts and actions. In 2020, a black box warning was added to Singulair to call out these risks.

  • Can montelukast be used to treat COVID?

    There has been some limited evidence showing that montelukast may help prevent people hospitalized with COVID-19 from developing more severe symptoms. More research is needed to confirm how beneficial the medication is.

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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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  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. Updated June 2, 2021.

  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. Published March 04, 2020.

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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.