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Tuesday, March 7, 2006

Singulair for Hayfever?

Singulair has become a popular choice for those who would otherwise suffer from asthma most of the time, probably because it is a convenient, once-a-day pill instead of another inhaler. It is also perceived by patients and parents as safer than corticosteroid and bronchodilator asthma inhalers.

During the past couple of years, Singulair has also been marketed for hay fever (allergic rhinitis). However, a study published last month, authored by ENT specialists from Chicago, demonstrated that Singulair, a which costs 3 dollars a day by prescription, was no more effective than sustained-release 240mg Sudafed, an over-the-counter decongestant capsule which costs less than one dollar.

Sudafed was slightly more effective at reducing nasal congestion during the September allergy season in Chicago, and was no more likely to cause side-effects than Singulair.

Homeopathic treatments (equivalent to a placebo) also work rather well for hayfever (allergic rhinitis, sinusitis, and conjunctivitis). A Merck-funded study published in December 2005 [Patel P] showed that 6 weeks of a placebo pill substantially reduced hayfever symptoms in 53% of 1000 adult patients while Singulair did the same for 58% of the other 1000 patients, randomized at 122 medical centers in the United States and Europe. While the difference between 53% and 58% was “statistically significant,” the much higher cost of Singulair doesn’t seem to me to justify the slightly improved chance of effectiveness. Placebos are also much less likely to cause worrisome dreams than is Singulair.

Patients in the U.S. spend more than 6 billion dollars each year on prescription medicines for hayfever [Yawn, Medscape 2006]. Most of this money is probably spent on non-sedating antihistamines, such as Zyrtec, Clarinex, or Allegra; and for nasal corticosteroid sprays, such as Beconase, Rhinocort, Nasalide, Flonase, Nasonex, or Nasacort. These all cost somebody (patient or insurance) about 75 dollars per month.

However, non-prescription generic Claritin is usually just as effective as the prescription antihistamines and only costs about 3 dollars a month. Rinsing the nose with salt water, such as Sinus Rinse, is even less expensive, often effective at relieving nasal congestion, and has no side-effects. Long-acting nasal decongestant sprays, such as Afrin and generics, can also be used safely for up to ten days, and cost less than 6 dollars for a bottle without a prescription.

In my opinion, people like me with allergic rhinitis should first try the low cost, non-prescription treatments, starting with allergen avoidance, then saline rinses, then generic Claritin, before asking their doctor for an expensive medication.

Related Topics: Plagued by Pollen, Allergy Proof Home Guide

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Posted by: Paul Enright MD at 5:58 am

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