immunology allergic disorders
Allergic Rhinitis
Treatment of Allergic Rhinitis
Antihistamines Decongestants Nasal corticosteroids For seasonal or severe refractory rhinitis, sometimes desensitization Treatment of seasonal and perennial allergic rhinitis is generally the same, although attempts at Prevention (eg, eliminating dust mites and cockroaches) are recommended for perennial rhinitis. For seasonal or severe refractory rhinitis, The most effective first-line drug treatments are with or without oral or intranasal antihistamines Oral antihistamines plus oral decongestants (eg, a sympathomimetic such aspseudoephedrine) Intranasal decongestant sprays (eg,oxymetazoline,phenylephrine) are used for short-term relief of nasal congestion. Usually, they are not recommended for use for more than 3 consecutive days because rebound nasal congestion may occur. Less effective alternatives include nasal mast cell stabilizers (eg, cromolyn) given 3 or 4 times a day, the intranasal H1 blockerazelastine1 to 2 puffs twice a day, and nasalipratropium0.03% 2 puffs every 4 to 6 hours, which relieves rhinorrhea. A combination ofazelastine/fluticasone(137 mcg/50 mcg) is available. Initial dose is 1 spray each nostril twice a day. Intranasal drugs are often preferred to oral drugs because less of the drug is absorbed systemically. Intranasal saline,often forgotten, helps mobilize thick nasal secretions and hydrate nasal mucous membranes; various saline solution kits and irrigation devices (eg, squeeze bottles, bulb syringes) and kits are available over the counter, or patients can make their own solutions. Montelukast, a leukotriene inhibitor, relieves allergic rhinitis symptoms but, due to a risk of mental health adverse effects (eg, hallucination, obsessive-compulsive disorder, suicidal thoughts and behavior),montelukastshould be used only when other treatments are not effective or not tolerated. Omalizumab, an anti-IgE antibody has been used to treat allergic rhinitis but probably has a limited role because less expensive, effective alternatives are available. 