There is no significant difference between an over-the-counter decongestant and a prescription medication that costs almost four times as much in relieving hay fever symptoms, report researchers from the University of Chicago in the February issue of Archives of Otolaryngology - Head & Neck Surgery.
The study, conducted during the 2003 ragweed allergy season in Chicago, found that daily doses of 240 mg of pseudoephedrine hydrochloride (Sudafed. 24 Hour) were just as effective as 10 mg daily of montelukast sodium (Singulair.) at relieving symptoms such as nasal congestion, runny nose, sneezing and itching, and at improving quality of life for those with hay fever -- without any additional side effects.
"This came as a genuine surprise," said Fuad Baroody, M.D., associate professor of surgery at the University of Chicago and director of the study. "Our hypothesis was that montelukast would have additional benefits and pseudoephedrine would interfere with sleep, but when we compared them head-to-head we found that for treatment of allergic rhinitis, these drugs at these doses were virtually identical."
In fact, pseudoephedrine had small advantages in specific categories. It was slightly more effective, for example, in reducing congestion, which it was specifically designed to do.
Despite similar results, the drugs work in completely different ways. Pseudoephedrine, designed to treat nasal congestion, constricts vessels within the nasal mucosa, thus leading to a more patent airway and less nasal congestion. It does not have known anti-inflammatory effects.
On the other hand, Montelukast, originally designed to treat asthma, antagonizes leukotrienes, substances released during the allergic response. These substances have potent inflammatory effects and are known to cause nasal congestion and contribute to chronic inflammation, which is one of the hallmarks of allergic rhinitis.
Because of these properties, montelukast was approved by the FDA to treat allergic rhinitis, and "indeed," notes Baroody, "this study is one of few that shows that montelukast causes a significant improvement in nasal airflow, an objective measure of nasal congestion, an effect shared by pseudoephedrine in this study."
Another difference between the agents is the cost. At www.drugstore.com, timed-release 240 mg capsules of pseudoephedrine cost about 80 cents a day, compared to $3.20 a day for montelukast. Since allergic rhinitis - the nasal congestion, runny nose, sneezing and itching associated with seasonal allergies such as hay fever -- affects about 40 million people in the United States, the difference can add up.