Prophylactic montelukast?

A seven-month-old girl with a history of respiratory syncytial virus infection at age 6 weeks, atopic dermatitis, and a family history of asthma is currently taking montelukast (Singulair) every night. She is asymptomatic. Should the nightly dosing continue only through “cold season” and cease once the season ends? Or is this a worthwhile prophylactic?
—AMBER GRECO, ARNP-C, Bonita Springs, Fla.

Singulair, a leukotriene receptor antagonist, has been shown to be effective in treating allergic rhinitis in infants aged 6-23 months and in treating asthma in children aged 12 months and older. It has not been studied in clinical trials for atopic dermatitis. Your mention of “cold season” leads me to believe you are concerned about the possibility of a viral trigger for reactive airway disease (asthma) in this child. Generally, the fewer medications children younger than age 1 year take, the better. If reactive airway disease is the diagnosis, such first-line therapies as inhaled steroids may be more effective.
—Julee B. Waldrop, MS, PNP
(127-9)
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