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Wednesday, March 19, 2008

Singulair: Another asthma miracle drug

This is my weekly focus on patient education, where I will discuss everything you need to know about (fill in blank).

The theory here is that, as a patient, I think it's good to go to your doctor armed with as much knowledge as possible. I call these posts patient wisdom, and you can refer to them at your convenience by clicking on the patient wisdom link near the top of this blog.

Today's focus is on allergies, asthma and Singulair.

I talked to one of the doctors I respect very much a few months back while I was working, and somehow the topic of discussion changed to me, and how much I love spring, but hate how miserable my allergies are at that time of year.

He said, "I think that every asthmatic should be on Singulair. I prescribe it for all my asthma patients."

So, when I went to my doctor, I said, "So, what would you recommend for allergies?"

My doctor said, "Well, did you try over the counter stuff, like Drixorol, Claratin, benadryl and that type of stuff?"

"Yeah, I've tried it all over the past 25 years, I even had allergy shots as a kid. None of it seemed to work. I was just wondering if you knew of anything stronger I might try, not that I really want more medicine to take or anything."

"Well, there is Singulair."

"Ah, that's what I was leading at. I didn't want to say Singulair just in case you had a better idea."

"Yeah, I suppose we could try that."

There, I got what I wanted. "Since spring is right around the corner, I will know right away if it works."

So, how do you know if Singulair is right for you?

Pretty much, based on my research, Singulair has proven effective for anyone with Allergic Rhinitis (hay fever) and asthma/allergies. For the most part, these two tend to go hand in hand.

Thus, if doctors could somehow prevent allergies, they could control asthma.

Finally, in 1998, after spending millions of dollars and 63 years studying leukotrines and working on a way to block their release, Singulair was approved for use by the FDA.

Singulair has an active ingredient in it called Montelukast sodium, which blocks the action of leukotrien, thus preventing allergies, and preventing bronchospasm caused by allergies, and, in turn, preventing asthma.

So lets back up a bit. What the heck are Leukotrienes? Better yet, what causes allergies in the first place?

When our bodies sense a foreign substance that might cause harm has entered the body, such as a bacteria or virus, it releases chemicals to attack the foreign substance. This is the bodies normal immunologic response to prevent and fight diseases. This is a good response by our immune system.

However, in some people, those of us who are prone to allergies, our immune system responds to harmful things, but also things that are relatively harmless, and generally cause no reaction in people who do not have allergies. In essence, with allergies, our body is fighting itself, and this is bad.

These harmless things that cause allergies are called allergens. Some common allergens are pollens released from trees, mold, hay, grass, dander, and food.

For the most part, if something causes us to have an allergic response, or asthma, we try to identify our triggers, in this case allergens, and avoid them. If you only have one allergen it might be easy to avoid, but for us asthmatics who are allergic to a ton of things, the only way to avoid all of them is to live in a bubble.

Now we all know that's not possible, or at least extremely difficult.

To give you an idea of the allergy process, I'll provide here a pithy example.

Say you are prone to allergies and breathe in a molecule of pollen. Your body fails to recognize it as harmless, and releases a chemical called pollen IgE antibody that binds to mast cells.

Now, at this point, nothing really happens, but the next time you are exposed to pollen, the IgE primed mast cell releases chemical mediators which attach to specific cells in the body causing inflammation.

Leukotreins are one type of chemical mediator which is responsible for inflammation, and are the culprits responsible for causing bronchoconstriction (tightening of the muscles around the airways) and swelling of the airways.

Thus, if we could find a way to block the release of these leukotriens, we could stop, or greatly diminish, an allergy attack, and thus an asthma attack.

And that's where Singulair comes into play. It blocks the release of leukotreins.

It has been proven effective for the management of allergies in asthma, and allergic rhinitis. It usually takes 3-7 days to start working, so, unlike antihistamines, it does not have an immediate effect, and must be taken on a regular basis (every day) to be effective.

In other words, even if you have no symptoms, you should never stop taking this medicine, unless otherwise prescribed by your doctor.

Singulair has not been proven effective as treatment of itchy eyes, itchy nose, sneezing and runny nose. If these symptoms continue to be problems for you, you might want to try an antihistamine, which can be purchased over the counter.

There is one other use for Singulair, and that is for people who have excercise induced asthma.

According to Health Library at, "Because exercise-induced asthma has the same symptoms and results from the same airway reaction involved in regular asthma, standard asthma medications can control it."

Patients who experience excercise induced asthma but don't necessarily have a problem with allergins, and do not already take the medicine on a daily basis can take the medicine two hours prior to excersising, but not again for 24 hours thereafter.

Some patients have managed to control their asthma, excersise induced asthma and/or allergic rhinitis with the use of Singulair alone. However, some asthmatics may need other prophylactic therapies, such as Chromolyn or Advair and an occasional use of a rescue medicine such as an Albuterol inhaler.

So there, in a nutshell, is everything you need to know about asthma related allergies and singulair.

For more information, check out this link. Also check out this, the official website of singulair

That concludes today's class.


Anonymous said...

GREAT post. I was thinking about writing up something on leukotriene modifiers but I'll probably just link to this one instead.

I wish my daughter could take Singulair, but unfortunately she just doesn't tolerate it well--just our luck, huh?

It is totally a miracle drug for so many people--I've got a second cousin who can use it rather than steroids for mainetnance.

JeRRTep said...

with my allergies, I only have a 3% change in my FEV so I technically don't have "asthma" and since I technically don't have "asthma" my insurance company won't allow me to have the drug for allergies alone...
the only thing that ever worked for me was injectable long term steroids..and now, the doc's don't want me to have that because I'm older and the side effects increase with age...

so...I'm screwed!! but thanks for the info...great reading..

Anonymous said...

My brother had some really nasty side effects from singulair