Chia Siang Kow1, Syed Shahzad Hasan2. 1. School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia. 2. Department of Pharmacy, University of Huddersfield, Huddersfield, UK.
We compliment the discussion by Brindisi et al
on the management of allergic rhinitis in children amid novel coronavirus disease 2019 (COVID‐19) pandemic. Brindisi et al
presented a well‐reasoned discussion on the use of intranasal corticosteroids and allergen immunotherapy in children with allergic rhinitis amid COVID‐19 pandemic where they recommend continuation of the former while withholding of the latter upon risk‐benefit assessment.Besides the two approaches described by the authors, we feel that montelukast can be useful in paediatric patients who could not tolerate or demonstrate a satisfactory technique for or refused corticosteroid nasal sprays. In the management of allergic rhinitis, montelukast is similarly effective to oral antihistamines though less effective than corticosteroid nasal sprays. Nevertheless, montelukast is a potent cysteinyl leukotriene receptor antagonist where it not only acts by directly blocking leukotriene receptors but also possesses anti‐inflammatory effects and suppressive actions on cytokine production. Therefore, it may be effective in mitigating cytokine storm associated with COVID‐19. In fact, computational model indicated a possible role of montelukast in binding to the catalytic site of the main protease of severe acute respiratory syndrome coronavirus 2, the pathogen responsible for COVID‐19, which may modulate and inhibit viral replication.It has been recently reported that elderly asthmatic patients receiving montelukast had a significant reduction in the acquisition of COVID‐19 compared to those without receiving montelukast.
Whether montelukast can be effective to decrease the risk of acquisition or to prevent severe outcomes from COVID‐19 among paediatric patients needs to be confirmed in clinical trials. We nonetheless feel that montelukast should be considered by paediatricians to manage allergic rhinitis amid the COVID‐19 pandemic considering its potential anti‐inflammatory action and anti‐viral activity.