{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:46:00Z","timestamp":1792043160890,"version":"4.4.0"},"reference-count":36,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T00:00:00Z","timestamp":1690502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Drug-induced neuropsychiatric effects are important for disease management. We aim to evaluate the neuropsychiatric effects of montelukast\u2013levocetirizine combination therapy in children. This descriptive study was conducted with children aged 2\u20135 years, diagnosed with asthma and allergic rhinitis, who began to receive montelukast and levocetirizine combination therapy. The respiratory and asthma control test for children (TRACK), Rhino Conjunctivitis Scoring System (RCSS), and common neuropsychiatric effects (irritable behavior, hallucinations, headaches, nightmares, sleep disorders, behavioral and mood disorder, restlessness, depression) were ascertained by the questionnaire applied before and 4 weeks after the treatment. Parents answered on behalf of their children. The most common finding before and after treatment was irritable behavior. While irritable behavior was observed in 82.4% (n = 56) of children before the treatment, this percentage was 63.2% (n = 43) after the treatment (p = 0.004). The percentage of children who developed at least one neuropsychiatric symptom after treatment was 22.1% (n = 15). There was no significant effect of age, gender, RCSS, TRACK, or allergy test positivity on the development of neuropsychiatric symptoms (p &gt; 0.05). According to the results, at least one neuropsychiatric finding developed in approximately one in five children. Identifying risk factors will enable more careful treatment or consideration of alternative treatments for children at higher risk in the clinical follow-up period.<\/jats:p>","DOI":"10.3390\/children10081301","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T07:35:24Z","timestamp":1690529724000},"page":"1301","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Evaluation of Neuropsychiatric Effects of Montelukast\u2013Levocetirizine Combination Therapy in Children with Asthma and Allergic Rhinitis"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5871-2033","authenticated-orcid":false,"given":"U\u011fur","family":"Alta\u015f","sequence":"first","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, University of Health Sciences, \u00dcmraniye Training and Research Hospital, \u00dcmraniye, 34764 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0475-8946","authenticated-orcid":false,"given":"Zeynep Meva","family":"Alta\u015f","sequence":"additional","affiliation":[{"name":"\u00dcmraniye District Health Directorate, \u00dcmraniye, 34764 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2098-0435","authenticated-orcid":false,"given":"F\u0131rat","family":"\u00d6z","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Siirt Training and Research Hospital, 56000 Siirt, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1290-8318","authenticated-orcid":false,"given":"Mehmet Ya\u015far","family":"\u00d6zkars","sequence":"additional","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, University of Health Sciences, \u00dcmraniye Training and Research Hospital, \u00dcmraniye, 34764 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/ACI.0b013e32834ec13b","article-title":"Allergic diseases and asthma: A major global health concern","volume":"12","author":"Pawankar","year":"2012","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1939-4551-7-12","article-title":"Allergic diseases and asthma: A global public health concern and a call to action","volume":"7","author":"Pawankar","year":"2014","journal-title":"World Allergy Organ. J."},{"key":"ref_3","unstructured":"World Health Organization (2023, June 03). Asthma. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/asthma."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"393","DOI":"10.2500\/aap.2019.40.4255","article-title":"The infant and toddler with wheezing","volume":"40","author":"Padem","year":"2019","journal-title":"Allergy Asthma Proc."},{"key":"ref_5","unstructured":"Centers for Disease Control and Prevention (2023, June 06). Data from Yearly National Health Interview Survey, Available online: https:\/\/www.cdc.gov\/asthma\/most_recent_national_asthma_data.htm."},{"key":"ref_6","first-page":"33","article-title":"Be\u015f ya\u015f ve alt\u0131 \u00e7ocuklarda ast\u0131m tedavisine g\u00fcncel yakla\u015f\u0131m","volume":"10","author":"Sipahi","year":"2018","journal-title":"Klin. T\u0131p Pediatri Derg."},{"key":"ref_7","unstructured":"Global Initiative for Asthma (2023, June 08). 2022 GINA Main Report. Available online: https:\/\/ginasthma.org\/gina-reports\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/00000441-200403000-00004","article-title":"Clinical implications of the allergic rhinitis-asthma link","volume":"327","author":"Casale","year":"2004","journal-title":"Am. J. Med. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s12070-015-0828-5","article-title":"Allergic rhinitis: An overview","volume":"67","author":"Varshney","year":"2015","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1016\/j.intimp.2011.07.005","article-title":"Allergic rhinitis: An update on disease, present treatments and future prospects","volume":"11","author":"Mandhane","year":"2011","journal-title":"Int. Immunopharmacol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1398-9995.2007.01549.x","article-title":"A survey of the burden of allergic rhinitis in Europe","volume":"62","author":"Canonica","year":"2007","journal-title":"Allergy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.12669\/pjms.36.7.2657","article-title":"Role of Montelukast in asthma and allergic rhinitis patients","volume":"36","author":"Zuberi","year":"2020","journal-title":"Pak. J. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1007\/s40265-020-01406-9","article-title":"Efficacy of montelukast in allergic rhinitis treatment: A systematic review and meta-analysis","volume":"80","author":"Krishnamoorthy","year":"2020","journal-title":"Drugs"},{"key":"ref_14","unstructured":"U.S. Food and Drug Administeration (2023, June 20). Drug Approval Package, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/nda\/98\/020829s000_SingulairTOC.cfm."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1042\/BJ20070289","article-title":"Biosynthesis and metabolism of leukotrienes","volume":"405","author":"Murphy","year":"2007","journal-title":"Biochem. J."},{"key":"ref_16","first-page":"238","article-title":"Leukotrienes in respiratory disease","volume":"2","author":"McMillan","year":"2001","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Jo-Watanabe, A., Okuno, T., and Yokomizo, T. (2019). The role of leukotrienes as potential therapeutic targets in allergic disorders. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20143580"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/j.1365-2222.1996.tb00621.x","article-title":"The role of leukotrienes in asthma and allergic rhinitis","volume":"6","author":"Busse","year":"1996","journal-title":"Clin. Exp. Allergy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.jpeds.2019.02.009","article-title":"Montelukast and neuropsychiatric events in children with asthma: A nested case\u2013control study","volume":"209","author":"Finkelstein","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1016\/j.jaip.2023.03.010","article-title":"Psychiatric adverse effects of montelukast\u2014A nationwide cohort study","volume":"11","author":"Jordan","year":"2023","journal-title":"J Allergy Clin. Immunol. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e067554","DOI":"10.1136\/bmj-2021-067554","article-title":"Neuropsychiatric reactions with the use of montelukast","volume":"376","author":"Ekhart","year":"2022","journal-title":"BMJ"},{"key":"ref_22","first-page":"59","article-title":"Scientific update of singulair-focused on neuropsychiatric disorder","volume":"9","author":"Park","year":"2021","journal-title":"Obstr. Lung Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1080\/02770903.2020.1861626","article-title":"Neuropsychiatric adverse drug reactions induced by montelukast impair the quality of life in children with asthma","volume":"59","author":"Turktas","year":"2022","journal-title":"J. Asthma"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1700148","DOI":"10.1183\/13993003.00148-2017","article-title":"Neuropsychiatric adverse drug reactions in children initiated on montelukast in real-life practice","volume":"50","author":"Benard","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s40264-015-0360-2","article-title":"Psychiatric disorders and montelukast in children: A disproportionality analysis of the VigiBase\u00ae","volume":"39","year":"2016","journal-title":"Drug Saf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.jpeds.2019.05.019","article-title":"Neuropsychiatric side effects of montelukast","volume":"212","author":"Kovesi","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_27","unstructured":"(2023, June 20). U.S. Food and Drug Administeration, Available online: https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-requires-boxed-warning-about-serious-mental-health-side-effects-asthma-and-allergy-drug."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Gayathri, E., Sowmya, P., Punnagai, K., and Mahalakshmi, V. (2023). Comparative study on the efficacy and safety of bepotastine besilate versus levocetirizine in chronic spontaneous urticaria: A randomised, open-label, parallel study. Indian J. Dermatol. Venereol Leprol., 1\u20138.","DOI":"10.25259\/IJDVL_333_2021"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100594","DOI":"10.1016\/j.waojou.2021.100594","article-title":"Neuropsychiatric side reactions of leukotriene receptor antagonist, antihistamine, and inhaled corticosteroid: A real-world analysis of the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS)","volume":"14","author":"Bian","year":"2021","journal-title":"World Allergy Organ. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/j.jaci.2009.01.058","article-title":"Test for respiratory and asthma control in kids (TRACK): A caregivercompleted questionnaire for preschool-aged children","volume":"123","author":"Murphy","year":"2009","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_31","unstructured":"B\u00fcy\u00fcktiryaki, A.B. (2013). Okul \u00d6ncesi \u00c7a\u011f\u0131 Ast\u0131ml\u0131 T\u00fcrk \u00c7ocuklar\u0131nda \u00c7ocuklar \u0130\u00e7in Solunum ve Ast\u0131m Kontrol Testi (\u00c7\u0130SAKT)\u2019nin Ge\u00e7erlilik, G\u00fcvenilirlik ve De\u011fi\u015fime Duyarl\u0131l\u0131\u011f\u0131. [Subspecialty Thesis, University of Hacettepe]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1111\/pai.12562","article-title":"Comparison of six disease severity scores for allergic rhinitis against pollen counts a prospective analysis at population and individual level","volume":"27","author":"Florack","year":"2016","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1111\/j.1365-2222.2006.02548.x","article-title":"Levocetirizine in persistent allergic rhinitis and asthma: Effects on symptoms, quality of life and inflammatory parameters","volume":"36","author":"Pasquali","year":"2006","journal-title":"Clin. Exp. Allergy"},{"key":"ref_34","first-page":"PA4610","article-title":"Montelukast: Neuropsychiatric adverse drug reactions in Tunisian asthmatic children","volume":"52","author":"Ammari","year":"2018","journal-title":"Eur. Respir. Soc."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Al-Shamrani, A., Alharbi, S., Kobeisy, S., AlKhater, S.A., Alalkami, H., Alahmadi, T., Almutairi, A., Alharbi, A.S., and Yousef, A.A. (2022). Adverse drug reactions (ADRs) of montelukast in children. Children, 9.","DOI":"10.21203\/rs.3.rs-1955880\/v1"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.anai.2013.05.020","article-title":"Sleep impairment and daytime sleepiness in patients with allergic rhinitis: The role of congestion and inflammation. Ann","volume":"111","author":"Thompson","year":"2013","journal-title":"Allergy Asthma Immunol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/8\/1301\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:21:34Z","timestamp":1760127694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/8\/1301"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,28]]},"references-count":36,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["children10081301"],"URL":"https:\/\/doi.org\/10.3390\/children10081301","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,28]]}}}