Is montelukast monotherapy effective for the management of allergic rhinitis in children?

A 4-year-old boy presents at the allergy clinic with severe refractory allergic rhinitis. Antihistamine therapy has not satisfactorily improved his symptoms, and he has not tolerated a trial of intranasal corticosteroids. You wonder if montelukast monotherapy might be effective in managing his symptoms. In a child with allergic rhinitis [patient] is montelukast monotherapy [intervention], compared with other treatments or placebo [comparison], effective in reducing symptoms [outcome]? MEDLINE and Embase up to April 2021 were searched using the following search terms: ( allergic rhinitis) AND (montelukast) AND (paediatric OR child* [child, children] ). Reference lists were subsequently searched to identify additional studies. A total of 419 abstracts with keywords as described in the search criteria were identified. Three literature reviews were identified,1–3 with none considering all the available evidence to April 2021. Studies that did not include a montelukast monotherapy group were excluded. Seven studies were considered as being relevant to the clinical question. These studies are summarised in table 1. View this table: Table 1 Summary of included studies Allergic rhinitis (AR) is a chronic condition that is reported to affect one in eight children worldwide.4 In AR, inhaled allergens (such as pollen, pet dander or dust mites) irritate the …