June 24, 2024

Allergic rhinitis is often confused with the common colds. Allergic rhinitis is inflammation of the mucosa, the delicate lining of the nose due to hypersensitivity or allergic reaction to an allergen like dust or molds.
There is sneezing, runny nose (rhinorrhea), stuffy nose, postnasal drip, cough, and irritability. There may also be associated allergic conjunctivitis seen as redness of the eyes or allergy in the airways manifesting as asthma.
Inflammation causes congestion of the nose and nasal stuffiness. The symptoms may occur episodically when a person is exposed to his allergens, it can be seasonal, or may be present during the whole year. The common colds may present with similar symptoms but is caused by a virus.
Avoidance of allergens and allergen immunotherapy (in cases where it is indicated and applicable) are cornerstones in the treatment of allergic rhinitis but there are also drugs that are used in treating and controlling the symptoms.
Treatment depends on the age of the patient, severity of symptoms, presence of comorbid conditions, and concurrent use of other drugs.
When the diagnosis is established in children less than two years old second generation (less sedating) antihistamines cetirizine, loratadine, and fexofenadine available in liquid forms can be given. Diphenhydramine, chlorpheniramine, and other sedating drugs are not recommended because these can cause agitation and may not be safe in this age group especially in infants. Cromolyn or sodium cromoglycate (mast cell stabilizers) nasal spray is also allowed and has been shown to be effective.
For children two years old and above and adults, the drugs used are similar. For mild symptoms, these medications are used:
Cetirizine, fexofenadine, loratadine;
Antihistamine nasal spray – azelastine or clopatadine;
Intranasal antihistamine – azelastine or clopatadine
Glucocorticoid nasal spray – mometasone furoate, fluticasone furoate, triamcinolone acetonide; and
Cromolyn sodium nasal spray is safe because it is not absorbed where it is sprayed hence it does not cause systemic effects.
For persistent or moderate to severe symptoms, glucocorticoid nasal sprays are considered as the best single treatment for persistent or moderate to severe symptoms. The type of nasal spray is age-specific:
Age two years and above: United States Food and Drug Administration-approved mometasone and fluticasone furoate; and
Age four years old and above: fluticasone propionate.
Add-on drugs for patients who do not respond to high dose nasal spray include antihistamine spray. There are nasal spray preparations that contain a combination of glucocorticoid and antihistamine.
Combining oral antihistamine plus glucocorticoid nasal spray did not show more advantage over glucocorticoid nasal spray alone. For severe cases of allergic rhinitis with asthma, stronger drugs used are omalizumab and dupilumab.
The use of minimally sedating antihistamines with decongestant may offer better relief than antihistamines alone but decongestants can have these adverse effects: irritability and nervousness, inability to sleep, headache, urinary hesitancy, increase in heart rate, increase in blood pressure, palpitations, and nausea or discomfort in the stomach.
Common decongestants (alpha adrenergic agonists) are phenylpropanolamine, phenylephrine, oxymetazoline, pseudoephedrine, and chlophanolamine maleate.
These are components of some decongestants that are sold over the counter. They cause constriction or narrowing of blood vessels in the nose, thereby reducing swelling and relief of nasal stuffiness. These are not recommended for persons with liver, kidney, heart disease or history of stroke, in patients with diabetes mellitus, and hypertension because of the side effects.
For older patients, sedating drugs are avoided and considering slower metabolism the dose of medications is reduced. Glucocorticoid nasal spray, minimally sedating antihistamines, is used.
Other treatments for allergic rhinitis include nasal saline irrigation or spray.
Ask your doctor to confirm the diagnosis of allergic rhinitis as the cause of symptoms and to prescribe the medications.
Avoiding medical consult is not safe, neither is self-medication. It should be noted that prescriptions are made based on patient’s individual characteristics, and there are drugs effects that can occur with improper use.
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