More than 40 million people in the U.S. endure the sneezing, nasal congestion, and runny nose that characterize allergic rhinitis . Several prescription and over-the-counter medications help relieve allergy symptoms. These include leukotriene receptor antagonists such as montelukast (Singulair), as well as antihistamines such as hydroxyzine (Claritin), which are often used in combination with decongestants such as pseudoephedrine (Sudafed).

In an article published in the February 2006 Archives of Otolaryngology – Head & Neck Surgery , researchers compared the prescription drug montelukast with over-the-counter pseudoephedrine (not in combination with an antihistamine) for the treatment of ragweed allergy. As expected, pseudoephedrine relieved nasal congestion more effectively than montelukast. Surprisingly, however, pseudoephedrine also relieved other allergy symptoms and improved quality of life as well as montelukast.

About the Study

The researchers recruited 58 adults, aged 18 to 45 years, with seasonal ragweed allergic rhinitis. Of the participants, 30 were randomly assigned to take 10 milligrams (mg) of montelukast and 28 were randomly assigned to take 240 mg of pseudoephedrine once every morning for two weeks. All of the participants recorded the presence and severity of their allergy symptoms, nasal peak inspiratory flow (which measures nasal congestion), and their daytime and nighttime quality of life at the beginning of the study and then over the course of the two week study period.

At the end of the two weeks, both treatments had significantly improved all allergy symptoms, nasal peak inspiratory flow, and daytime and nighttime quality of life compared to the beginning of the study. Neither medication worked significantly better than the other with one exception; pseudoephedrine was significantly more effective than montelukast for the treatment of nasal congestion. Neither medication caused any significant side effects.

This study was limited by the lack of a control, or untreated, group against which to compare the effects of the two medications. In addition, Montelukast, while widely used and of proven efficacy in comparison to placebo, has previously been found to be significantly less effective in controlling allergic symptoms than some other prescription drugs. Had pseudoephedrine been compared to a different prescription treatment for allergic rhinitis it might not have been found equally effective. The present study was primarily designed to detect differences in nasal airflow rate between the two drugs (not found). With only 58 participants, the study may not have been sufficiently powered (big enough) to find true differences favoring one or the other drug.

How Does This Affect You?

This study found that the nasal decongestant pseudoephedrine treated a variety of ragweed allergy symptoms as effectively as montelukast. Pseudoephedrine has been associated with anxiety and insomnia in previous studies. In this study, there were no significant reports of insomnia, perhaps because participants were instructed to take their medication in the morning.

Allergy symptoms can take a toll on allergy suffers. In addition to the bothersome symptoms of sneezing, congestion, and runny nose, allergies often cause drowsiness and decreased productivity. This study was particularly encouraging because the participants reported not only improvement of their symptoms, but significant improvements in their quality of life. The other major advantage of pseudoephedrine treatment is cost. Generic pseudoephedrine is likely much less expensive than other non-sedating anti-allergy medications (including montelukast). But this savings in cost doesn’t come without at least some cautions. While recent studies suggest that pseudoephedrine doesn’t raise blood pressure (long a concern among some doctors), serious and even fatal reactions and complications have been reported in association with use of this widely-available medication.

If your current allergy medication is not working or is causing unpleasant side effects, ask your doctor about trying a different medication, combining your current medication with another, or even taking your medication at a different time of day.