Merck Sharpe Dohme have been promoting Montelukast (Singulair) recently specifically for patients with Asthma and Seasonal Allergic Rhinitis (SAR).
The promotion is supported by papers detailing the link between poorly controlled asthma and SAR - however the data in this paper were taken from the GP Practice database system a number of years ago and asthma care should have improved since then. In this paper more than half of the patients were not on a steroid inhaler for example.
As a consequence of this is seems more prudent to ensure that a patients asthma is well controlled before focussing on SAR symptoms, after all SAR is not a fatal disease. Asthma control should be attained by implementing and using the BTS Asthma Guidelines.
This view is support by a small study in children comparing Montelukast with inhaled Budesonide. In this study the efficacy of each therapy was assessed in terms of prevention of relapse was assessed following exposure to an allergen. The level of Bronchial Hyper-responsiveness to methacholine was unchanged in the Budesonide arm but rose significantly in the Montelukast arm.
Action: Patients with Asthma and SAR who suffer from poor asthma control while exposed to allergens should have their Asthma management optimised as per the BTS Asthma Guidelines before tackling SAR symptoms. This may involve Montelukast if the patient is at the appropriate BTS Step.
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