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ALLERGIC RHINITIS Definition: sneezing, rhinorrhea, itchy watery eyes or nose, postnasal drip, cough, wheezing, nasal congestion caused by seasonal or perennial reaction to aeroallergens or environmental allergens. Most common cause of cough in older people. |
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Treatment: |
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Class |
Drug |
Indication |
When to give |
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non-sedating antihistamines |
Clarinex or Zyrtec @ 5 MG QD, Allegra 60 MG QD – BID or Claritin 10 MG QD |
sneezing, rhinorrhea, tearing, pruritus |
before or at start of allergy season- may need year round |
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decongestants |
Sudafed 60 mg Q 8-12 hours |
nasal congestion |
short course to provide relief while topical steroids become therapeutic - avoid topicals to prevent rebound rhinitis |
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intranasal corticosteroids |
Beconase 1 spray BID-QID, Nasacort 1 spray QD, Flonase 2 sprays QD |
sneezing, itching, rhinorrhea, including vasomotor rhinitis, pruritus, congestion |
minimum side effects therefore better than oral antihistamines |
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intranasal anticholinergics |
Atrovent NS 2 sprays BID-TID |
non-allergic rhinorrhea i.e. gustatory or viral rhinitis |
No effect on sneezing, itching, congestion- effective for rhinorrhea |
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Mast-cell stabilizer |
Nasalcrom NS 1 spray TID-QID |
Sneezing, itching |
Start before allergen exposure |
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Montelukast |
Singulair 10 MG QD |
Sneezing, itching, rhinorrhea, congestion |
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References: The Clinical Advisor, Stat Consult Allergic rhinitis, August 2004, p. 107-109. Geriatrics At Your Fingertips, 2004 Edition, p. 145-147. The Medical Letter Treatment Guidelines: Drugs for Allergic Disorders, Vol. 1, #15, November 2003. Patient Care Supplement: Allergic Rhinitis: Goals of therapy 2000, Fall 2000, p.21-28. Revised
8/04 |
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