Clinician’s perspectives on the use of levocetirizine alone or in combination therapy in allergic rhinitis

Objective: To gather expert perspectives on the use of levocetirizine-montelukast combination in managing allergic rhinitis (AR) within the Indian context. Methods: A cross-sectional study was conducted among clinical experts using a 24-item questionnaire to collect their opinion on the use of levocetirizine, both as monotherapy and in combination with montelukast, in the routine management of AR. The survey explored various aspects such as clinical observations, clinician preferences, and experiences with levocetirizine alone and in combination with montelukast. Data were analyzed using descriptive statistics. Results: The survey included 551 experts. A substantial proportion (72%) indicated that patient visits for AR symptoms are most frequent during the winter season. Asthma emerged as the most commonly associated comorbidity, as reported by 86% of physicians. The majority (90%) identified levocetirizine as their preferred antihistamine in clinical practice. Around 78% of respondents consistently favored combining montelukast with antihistamines for treating AR, and 93% specifically preferred the levocetirizine-montelukast combination. Sedation was reported as the most frequent adverse effect associated with levocetirizine by 84% of respondents. Furthermore, 84% of practitioners indicated that their first-line approach for managing AR involves a combination of an antihistamine and montelukast. Additionally, 58% believed that incorporating montelukast with an antihistamine enhances treatment efficacy. Conclusion: The survey highlights physicians' preference for levocetirizine, particularly when combined with montelukast, for managing AR due to its efficacy and tolerability. Asthma was the most commonly associated comorbidity, while sedation was the primary adverse effect reported. Combination therapy is widely favored as a first-line treatment strategy, especially during the winter season.