Positives

• A patient with 24 years of poorly controlled asthma reported Accolate was the only treatment that worked, with diminished appetite as the sole minor side effect Drugs.com.
  
  
• A long-term reviewer of 22 years on Accolate said they could not rate the medicine high enough for asthma quality-of-life improvement Drugs.com.
  
  

Negatives

• A reviewer who had relied on Accolate for years gave it up after the price kept climbing even with insurance until it became unaffordable Drugs.com.
  
  
• Patients are flagged by clinicians for routine liver enzyme monitoring because zafirlukast carries an estimated 2% risk of liver injury PubMed.
  
  

Hurdles & Side Effects

• Patients have to take zafirlukast on an empty stomach because food cuts bioavailability by 40%, complicating MCAS gastroparesis routines PubMed.
  
  
• Mast cell specialists position leukotriene blockers like zafirlukast as add-ons rather than standalone therapy, so patients usually still need H1 and H2 antihistamines alongside it TMS Society.