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Montelukast treatment may alter the early efficacy of immunotherapy in children with asthma

Volume 125, Issue 6, Pages 1220-1227 (June 2010) Pawel Majak, MD, PhD et al.

After 12 months of SIT, a reduction of the median daily ICS dose, necessary to control asthma symptoms, was 16.7% grater in patients from the placebo group than in patients from the montelukast group. Intervention with montelukast significantly impaired the induction of regulatory T lymphocytes. During the build-up phase of SIT, patients in the placebo group frequently experienced an increase in asthma symptoms leading to exclusions from the per protocol population.


Although the only clinically relevant result was a slightly greater reduction in ICS (about 15%) in the placebo group and the difference between groups in immunologic outcomes was not large, in our opinion, routine use of montelukast during SIT is not justified. The benefit/risk ratio can be more favorable for montelukast in children with seasonal viral-induced asthma exacerbation, or in children with asthma with exercise-induced bronchoconstriction or with concomitant allergic rhinitis.


Montelukast or Singulair is quite popular in the field of pediatric asthma and allergy. This study, while small in scope, points out an interesting and probably unexpected finding. The use of Singulair during allergy injections may make them less effective. This is the conclusion “compared with placebo, montelukast intervention led to less effectiveness of SIT [allergy injections]”.

Negative findings like this are rare in the medical literature, but should encourage all physicians and patients to question the need for all medications.


The routine use of montelukast needs to be considered when starting anyone on allergy shots. Really a new idea.