Leukotriene antagonists

If there is no response to a higher dose of less-sedating antihistamine, or the patient does not tolerate the less-sedating antihistamine, change to a short-term trial of leukotriene antagonist (eg montelukast). However, if there is some response to a higher dose of less-sedating antihistamine but symptoms still persist, consider adding a short-term trial of leukotriene antagonist.

For urticaria, use:

montelukast1 montelukast montelukast montelukast

adult: 10 mg orally, daily

child 6 to 14 years: 5 mg orally, daily

child 2 to 5 years: 4 mg orally, daily.

If symptoms still persist, consider referring to a specialist (eg dermatologist, allergist, immunologist) for omalizumab and other specialist treatments. While waiting for specialist referral (or instead of specialist referral, if preferred), consider trialling a histamine H2-receptor antagonist and/or doxepin (in adults only) (either as an addition to existing therapy, or as an alternative to existing therapy).

1 Neuropsychiatric adverse effects (eg behavioural changes, depression, suicidality) have been reported in all age groups taking montelukast. Adverse effects are generally mild and may be coincidental; however, symptoms may be serious and continue if treatment is not stopped. Advise patients, parents and carers to be alert for changes in behaviour and new psychiatric symptoms. Stop treatment if these effects occur. In some cases, symptoms may persist after stopping treatment; patients should be monitored and provided supportive care until symptoms resolve. See the Australian Therapeutic Goods Administration (TGA) safety alert for more information.Return