Allergy to Montelukast Sodium Treated Effectively by Protracted Oral Desensitization: First case report

Moufag Mohammed Saeed Tayeb

ABFM, Allergy Diploma (NRTC – UK), Assistant Professor and Consultant, King Abdul-Aziz University, Jeddah, Saudi Arabia.

E-mail moufagta@yahoo.com  

Accepted 11 April, 2013

Abstract

Antileukotrines such as Montelukast Sodium play a significant role in asthma control. IgE mediated hypersensitivity reactions to Montelukast is very rarely reported. To explore the efficacy of oral desensitization in Montelukast hypersensitivity. A 30 year old Saudi woman with uncontrolled asthma despite maximum pharmacological therapy presented to allergy clinic with recurrent symptoms of lip swelling, maculopapular skin rash and shortness of breath a few minutes after taking Montelukast 10 mg orally. Eventually, she was diagnosed as a case of hypersensitivity reaction type I to Montelukast. As a consequence of her uncontrolled asthma symptoms and as no other alternative Antileukotrine was available, it was decided to start an oral desensitization with Montelukast. Phase I desensitization was conducted in the clinic by gradually increasing doses of oral Montelukast starting from 0.001 mg up to 1 mg. Phase II desensitization was conducted at home with increasing doses starting from 1mg up to 10 mg/day. Patient was followed by frequent clinic visits, emails and phone calls. Desensitization phases I was successful over a period of 3 hours with minimal reactions. Desensitization phase II was prolonged due to the occurrence of several allergy symptoms of shortness of breath, dizziness and itching, which were controlled partially with oral antihistamines, prednisolone and maintaining the same dose until clear. Finally, after 12 weeks, the patient was able to tolerate pharmaceutical doses of Montelukast at 10 mg safely and managed to gain a better asthma control. To our knowledge, this is the first case report of effective oral Montelukast desensitization in an asthmatic patient with hypersensitivity type 1 to Montelukast. Although such allergic reaction to antileukotrines is rare, it should be recognized by healthcare providers. If no alternative therapy is available to control asthma symptoms, oral desensitization could stand as a valid effective therapeutic option.

Keywords: Montelukast sodium, Oral Desensitization, asthma