Efficacy of Montelukast-Antihistamine Combination Therapy Compared with Antihistamine Monotherapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis

Abstract

Objective: Allergic rhinitis (AR) impairs quality of life, and combination therapy is often required for comprehensive symptom control. This study aimed to evaluate the efficacy of montelukast-antihistamine combination therapy compared with antihistamine monotherapy in improving AR symptoms and quality of life.

Methods: PubMed, Embase, MEDLINE, Scopus, the Cochrane Library, and Google Scholar were searched up to April 2025. Eligible studies compared combination therapy with montelukast plus an antihistamine against antihistamine monotherapy and reported nasal symptoms or rhinoconjunctivitis quality of life questionnaire (RQLQ) scores. Standardized mean differences (SMDs) were calculated, and subgroup analyses were conducted according to antihistamine type.

Results: Fifteen studies including 2,882 subjects were analyzed. Combination therapy significantly improved daytime nasal symptoms (SMD [95% CI] = 0.44 [0.21-0.67]), nighttime nasal symptoms (SMD [95% CI] = 0.12 [0.01-0.23]), and RQLQ scores (SMD [95% CI] = 0.14 [0.00-0.27]) compared with monotherapy. Sneezing, nasal obstruction, and rhinorrhea improved significantly, while nasal itching and ocular symptoms did not. Combinations with desloratadine and levocetirizine showed greater benefits than those with loratadine or fexofenadine.

Conclusion: Montelukast-antihistamine combination therapy improves overall symptoms and quality of life compared with antihistamine monotherapy. The magnitude of benefit appears to vary depending on the specific antihistamine used, highlighting the potential value of individualized treatment strategies in the management of AR.

Keywords: Meta-Analysis; allergic rhinitis; antihistamine; drug combinations; montelukast.