Neuropsychiatric adverse effects of montelukast in children

Asthma is the most common chronic disease of childhood. It is associated with significant morbidity and costs including missed time from school and work for children and their parents. For those children ≥5 years of age with persistent symptoms or frequent exacerbations, inhaled corticosteroids (ICS) provide an effective and safe treatment, at least at low doses. However, parents are often concerned about their systemic absorption. Common adverse drug reactions with ICS include oropharyngeal thrush and slowing in growth; the latter results, on average, in a 1-cm decrement in adult height [1]. Partly as a result of the fear of adverse events with corticosteroids, ICS may be underprescribed and adherence to sustained treatment with these agents is poor. Furthermore, adolescents may find that one pill a day is less obtrusive and easier to remember. In this context, leukotriene receptor antagonists such as montelukast are attractive. Montelukast, as a daily controller medication, provides efficacy similar, although less potent, than ICS with the possibility of improved adherence such that the overall clinical benefit may be equal [2]. Montelukast is therefore frequently used as the initial controller therapy as well as in addition to low-dose ICS. The latter indication is the one recognised by asthma guidelines [3]. Neuropsychiatric ADRs of montelukast are common and difficult to recognise in children