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.

Treatment:

Class

Drug

Indication

When to give

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

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

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

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

Mast-cell stabilizer

Nasalcrom NS 1 spray TID-QID

Sneezing, itching

Start before allergen exposure

Montelukast

Singulair 10 MG QD

Sneezing, itching, rhinorrhea, congestion

 

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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