Alopecia areata (AA) is an organ specific autoimmune disease with an unpredictable clinical course. While there is currently no consensus guideline on the management of AA, current therapies predominantly revolve around corticosteroids and immune-modulating drugs. These treatments are fraught with various challenges and limitations such as long-term adverse effects associated with corticosteroid and immunosuppressive therapies and the limited availability and cost constraints of biologics especially in resource limited settings. 

Recent findings have implicated mast cells in the pathogenesis of AA, however the benefits antihistamines or mast cell stabilizers in the treatment of the disease are yet to be substantially explored. 

This case series describes 5 patients with patch-type alopecia areata and concomitant atopic disorders, all of whom experienced rapid and sustained hair regrowth following the administration of levocetirizine-montelukast combination therapy prescribed for their allergies. 

The observed positive outcomes in these patients suggest that antihistamines combined with montelukast may have a synergistic pleiotropic effect on AA and may be particularly useful for patients with co-existing atopic disorders. However, more research is needed to confirm this finding, and determine the long-term benefits of antihistamines/montelukast on other types of AA.

Keywords: Alopecia Areata, Autoimmune, Hair loss, Antihistamines, Montelukast,