Montelukast and Bilastine Combination Therapy in Allergic Rhinitis: A Narrative Review of Evidence

Allergic rhinitis (AR) is a chronic inflammatory disorder of the nasal mucosa triggered by immunoglobulin E (IgE)-mediated responses to allergens. The release of histamines and leukotrienes results in nasal irritation, excessive secretions, and frequent sneezing, affecting both children and adults. This review aims to provide an updated understanding of AR by evaluating the prevalence, treatment approaches, and clinical effects of bilastine and montelukast in AR management. A comprehensive literature search was conducted to identify research papers published between January 2003 and September 2023. Studies assessing the clinical efficacy of montelukast and bilastine, alone or in combination, in AR treatment were reviewed. Several clinical studies suggest that montelukast and bilastine combination therapy significantly improves daytime and composite nasal symptoms, including itching, sneezing, and rhinorrhea. Evidence indicates that combination therapy is superior to monotherapy with either drug for managing moderate-to-severe persistent AR. Bilastine, a second-generation antihistamine, offers rapid symptom relief with minimal sedation, while montelukast, a leukotriene receptor antagonist, reduces inflammation. Their complementary mechanisms enhance overall efficacy in symptom control. Although combined bilastine and montelukast therapy is supported by growing clinical evidence, data on their comparative effectiveness against other commercially available AR treatments remain limited. Further research is needed to establish optimal treatment strategies and long-term safety.