Allergic Rhinitis Treatment Guidelines

Study Notes

Step 1: Avoidance and environmental control
Step 2: Antihistamines, decongestants, and mast cell stabilizers. Recommended for mild, intermittent symptoms. Includes intranasal antihistamines, cromoglycate, or short-acting antihistamines. Short-term nasal decongestants like pseudoephedrine may be effective. Nasal Ipratropium bromide might be used if rhinorrhea is the main symptom.

Useful for chronic symptoms. Intranasal glucocorticosteroids are effective for all symptoms and more effective than antihistamines or cromoglycate.

Examples: Azelastine, levocabastine (intranasal)
Side Effects: Sedation, drowsiness, and potential for anticholinergic effects (increased intraocular pressure, hyperthyroidism, or cardiovascular disease). Advise patients not to skip doses or take double doses. Taking with meals or with a full glass of water can minimize gastrointestinal problems.

Examples include: Epinephrine (long-acting), oxymetazoline (long-acting), phenylephrine (short-acting), and pseudoephedrine (oral)
Note: Available as nasal sprays or oral medications.

Topical: Examples include beclomethasone, budesonide, fluticasone, mometasone, and triamcinolone.
Advantages: Minimal systemic absorption, primarily localized side effects.
Considerations: Improvement often takes 1-2 weeks. Nasal passages should be cleared before treatment with decongestants or saline. Patients should refrain from sneezing or blowing their nose for at least 10 minutes after treatment.
Contraindications: Avoid in patients with nasal ulcers or recent nasal surgery/trauma.

Leukotriene Modifiers (e.g., montelukast): Less effective than other treatments.
Anticholinergics (e.g., ipratropium bromide): Used for rhinorrhea but may not control sneezing or nasal congestion.
Cromolyn and nedocromil: Helpful for seasonal rhinitis. Often used intranasally. Nonprescription forms are available.