Allergic Rhinitis Treatment Guidelines PDF

# Pharmacology-2 Dietitian Program 2024-2025 ## Allergic Rhinitis (AR) Prof Dr Manar A Nader - (seasonal allergic rhinitis) or "hay fever" - "perennial allergic rhinitis" ### Guidelines for treatment of allergic rhinitis (hay fever) - **Step 1** avoidance & environmental control - **Step 2** antihi...

# Pharmacology-2 Dietitian Program 2024-2025 ## Allergic Rhinitis (AR) Prof Dr Manar A Nader - (seasonal allergic rhinitis) or "hay fever" - "perennial allergic rhinitis" ### Guidelines for treatment of allergic rhinitis (hay fever) - **Step 1** avoidance & environmental control - **Step 2** antihistamine, decongestant and mast cell stabilizer. - For patients with mild intermittent symptoms: - intranasal antihistamine, cromoglycate or a shorter -antihistamine - Short term nasal decongestant such as pseudoephedrine is effective, - Intranasal Ipratropium bromide if rhinorrhea predominant - **Step 3:** corticosteroids (symptoms are more chronic) - intranasal glucocorticosteroids - effective against all symptoms & more effective than antihistamines or cromoglycate. - **Step 4:** Immunotherapy ## Pharmacotherapy option for AR ### I. Antihistamines (H₁-receptor blockers) **ex** - azelastine, intranasal - levocabastine ophthalmic **S/E** - Sedatives and drowsiness. - Anticholinergics (Increased intraocular pressure, hyperthyroidism, and cardiovascular disease.) - 1. Patients should be told not to take a double dose when a dose is missed - Taking the antihistamine with meals or at least a full glass of water prevent gastrointestinal adverse effects ### II. a-Adrenergic agonists "nasal decongestants" #### Nasal aerosols - Epinephrine & oxymetazoline (Long acting) - Phenylephrine (Short acting) #### Oral - Pseudoephednne ## III. Corticosteroids "anti inflammatory (nasal) **Examples** - Topical (Intranasal) corticosteroids, such as: - Beclomethasone, budesonide, fluticasone, mometasorie, and Triamcinolone **S/E** - Nasal irritation, nosebleed, sore throat, and candidiasis **Consideration** 1. For patients with chronic rhinitis improvement may not be seen until 1 to 2 weeks after starting therapy. 2. Blocked nasal passages should be cleared with a decongestant or saline irrigation before administration to ensure adequate penetration of the spray 3. NO sneezing or blowing their noses for at least 10 minutes after administration. **Advantages over Systemic** - Systemic absorption is minimal & S/E of intranasal are localized. **Contraindicated** - Topical steroids should not be used in patients with nasal septum ulcers or recent nasal surgery or trauma. ### Other agents - **Cromolyn and nedocromil** - Intranasal cromolyn - Beneficial in seasonal rhinitis - A nonprescription (OTC) nasal formulation of cromolyn is available. - **LT modifiers (Montelukast)** - inferior to other treatments, - Monotherapy or in combination with other agents. - option in patients who also have asthma with allergic rhinitis - **Anticholinergics** - intranasal Ipratropium bromide - Treat rhinorrhea - not relieve sneezing or nasal congestion. - might be more effective in rhinitis ## IMMUNOTHERAPY - Omalizumab