High-dose montelukast exposures in a 3-year-old and a 5-year-old child

The leukotriene receptor antagonists (LTRAs) is a relatively new class of asthma medication with a lack of toxicity for unintentional poisoning situations. This makes it difficult to determine which exposures require aggressive decontamination or simple monitoring in the home setting; prompting the question, "What LTRA dose is likely to produce significant toxicity?" We report a case of an unintentional poisoning with 80 mg montelukast in a 3-y-o asthmatic child that was managed in the home with observation alone and a second case of untentional 135 mg montelukast poisoning in a 5-y-o asthmatic child managed in an emergency department. In both cases, symptoms were not observed. These cases and available literature suggest that doses < 4.5 mg/kg in children result in minimal toxicity.