Leukotriene Modifiers and Allergies

Medically Reviewed by Minesh Khatri, MD on October 31, 2021

Leukotriene modifiers (leukotriene antagonists) are medicines used to manage allergic rhinitis or allergies, as well as prevent asthma. These novel drugs work by blocking the action of leukotrienes. They are typically not used as the first mode of treatment.

Leukotrienes are inflammatory chemicals the body releases after coming in contact with an allergen or allergy trigger. Leukotrienes cause tightening of airway muscles and the production of excess mucus and fluid. These chemicals play a key role in allergies, allergic rhinitis, and asthma, also causing a tightening of your airways, making it difficult to breathe.

How do leukotriene modifiers manage allergy symptoms?

Typical symptoms of allergies include sneezing, itchy nose, clear mucus, and nasal congestion. In addition, allergies cause itchy, swollen, and watery eyes (allergic conjunctivitis) and frequent throat clearing. Studies show that up to 85% of people with asthma also have symptoms of allergies. In addition, untreated allergies often cause sinusitis, sore throats, cough, sleep problems, irritability, and low productivity at school and in the workplace.

Leukotriene modifiers work by blocking the action of leukotrienes, one cause of the inflammation and nasal congestion associated with allergies. For those with allergies and asthma, leukotriene modifiers help keep bronchial tubes, airways to your lungs, from constricting.

According to the American Academy of Allergy Asthma & Immunology, leukotriene modifiers can block both the early response to allergic triggers (sneezing and itching) as well as the delayed response to allergens that result in nasal congestion.

How are leukotriene modifiers used in treating asthma?

Leukotriene modifiers are also used to prevent asthma and exercise-induced asthma. These medicines should not be used alone to treat an acute asthma attack. Leukotriene modifiers decrease the body's production of the leukotrienes that worsen both asthma and allergic reactions.

Which leukotriene modifiers are recommended for allergies?

While zafirlukast (Accolate), montelukast (Singulair), and zileuton (Zyflo) are the leukotriene modifiers available for asthma, only montelukast is approved for the management of allergic rhinitis or allergies. Montelukast also provides relief for allergic conjunctivitis.

Research has shown that when compared to placebo, montelukast provided relief of symptoms that was similar to loratadine (Claritin), yet less relief than provided with nasal inhaled steroids. Intranasal steroids should be tried prior to any recommendation for leukotriene modifiers.

How are leukotriene modifiers taken to manage allergies and asthma?

Leukotriene modifiers are available in granules, tablets, and chewable tablets. Allow about three days to two weeks for leukotriene inhibitors to offer full benefit for management of allergies and asthma.

Are there side effects with leukotriene modifiers?

Possible side effects with leukotriene modifiers include flu-like symptoms, feeling nervous or excitable, headache, stomachache, nausea or vomiting, and nasal congestion. With montelukast, there is a risk of risk of severe mental health side effects, including thoughts of suicide.

Who should not use leukotriene modifiers for allergies?

The safety and effectiveness of using leukotriene inhibitors for treatment of asthma in children under age 12 months or the treatment of perennial allergic rhinitis in infants under 6 months has not been established. Women who are pregnant or breastfeeding should discuss these medicines with their physicians before taking them.


Show Sources


American Academy of Allergy, Asthma and Immunology: “Control Your Allergies & Asthma: Therapies for Allergic Rhinitis," "Allergy & Asthma Medication Guidelines." Chervinsky, P. Annals of Allergy, Asthma and Immunology, 2004.  

Cylly, A. Respiratory Medicine; 2003.  Jeanenne, V. PharmNotes; 2003. 

Philip, G. Clinical & Experimental Allergy; 2002. 

Kids Health from Nemours web site: Allergy-Triggered Asthma

Michigan Medicine web site: Leukotriene Modifiers for Allergic Rhinitis

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