I am experiencing persistent nasal congestion and irritative conjunctivitis despite daily treatment with Claritin (Loratadine) and Triamcinolone Acetate 55mcg (Triamcinolone), what could be the cause?

From the Guidelines

You should consult your healthcare provider about adjusting your allergy treatment plan to include intranasal corticosteroids, as they are typically the most effective medication class for controlling sneezing, itching, rhinorrhea, and nasal congestion, the 4 major symptoms of allergic rhinitis. While Claritin (loratadine) and Triamcinolone Acet 55mcg once daily are effective for many people, your persistent severe nasal congestion and eye irritation suggest they may not be sufficient for your symptoms 1. Your doctor might consider adding or switching to a different treatment approach, as intranasal corticosteroids have been shown to be more effective than antihistamines and oral decongestants in controlling allergic rhinitis symptoms 1.

Some key points to consider when adjusting your treatment plan include:

• Intranasal corticosteroids are generally well-tolerated and have minimal systemic side effects when used at recommended doses 1
• Oral decongestants, such as pseudoephedrine or phenylephrine, can help reduce symptoms of nasal congestion, but may cause insomnia, loss of appetite, irritability, and palpitations 1
• Topical decongestants should be used on a short-term basis only, as regular daily use can lead to rhinitis medicamentosa 1
• Environmental modifications, such as using air purifiers, washing bedding weekly in hot water, keeping windows closed during high pollen seasons, and showering before bed to remove allergens, can also help alleviate symptoms

It's essential to work with your healthcare provider to determine the best course of treatment for your specific symptoms and needs, as untreated chronic congestion can lead to sinus infections or affect your sleep quality. Intranasal corticosteroids, such as Triamcinolone, are a good option to consider, as they can help control nasal congestion, sneezing, itching, and rhinorrhea, and are generally well-tolerated 1.

From the Research

Medication Efficacy

• The studies 2, 3, 4, 5 suggest that intranasal triamcinolone acetonide is effective in relieving symptoms of allergic rhinitis, including nasal congestion, nasal itch, sneezing, and ocular symptoms.
• Triamcinolone acetonide has been shown to be more effective than oral loratadine in reducing total nasal symptoms and individual symptoms of nasal congestion, nasal itch, and sneezing 3, 4, 5.
• The medication has been found to be well-tolerated, with headache and epistaxis being the most commonly reported adverse events 2, 3, 4, 5.

Dosage and Administration

• The recommended dosage of triamcinolone acetonide is 110 to 220 micrograms per day, administered intranasally once daily 2.
• The studies suggest that once-daily administration of triamcinolone acetonide can provide significant relief from symptoms of allergic rhinitis within the first day of administration 2, 3, 4, 5.

Combination Therapy

• The use of intranasal triamcinolone acetonide and oral loratadine in combination did not confer any additional advantage over triamcinolone acetonide alone 2.
• However, the studies do not provide information on the efficacy of combination therapy with other medications, such as Claritin.

Patient Adherence

• Medication adherence is an important factor in the success of treatment, and non-adherence can be costly for the health service 6.
• Patients should be encouraged to take their medications as prescribed and to consult with their healthcare provider if they experience any difficulties or concerns with their treatment regimen.