What is the management of allergic rhinitis with cough?

From the Guidelines

To manage allergic rhinitis with cough, start with a combination of antihistamines and intranasal corticosteroids, as this approach has been shown to be effective in reducing symptoms and improving quality of life 1. The most recent and highest quality study, published in 2015, recommends offering immunotherapy for patients with allergic rhinitis who have an inadequate response to pharmacologic therapy with or without environmental controls 1. However, for initial management, taking a second-generation antihistamine like cetirizine (10mg), loratadine (10mg), or fexofenadine (180mg) once daily can help reduce sneezing, itching, and runny nose, while an intranasal corticosteroid spray such as fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) can consistently provide best results for nasal congestion and other symptoms 1. For the cough specifically, consider adding montelukast (10mg daily for adults), which helps with both allergic symptoms and cough by blocking leukotrienes, as suggested by the 2006 study on chronic upper airway cough syndrome secondary to rhinosinus diseases 1. Additional measures such as nasal saline rinses using a neti pot or saline spray can help clear allergens and mucus, and for immediate cough relief, try honey (1-2 teaspoons) or an over-the-counter cough suppressant containing dextromethorphan. Environmental management is equally important, including identifying and avoiding triggers, using air purifiers with HEPA filters, keeping windows closed during high pollen seasons, and washing bedding weekly in hot water. If symptoms persist after 2-4 weeks of consistent treatment, consult a healthcare provider for possible prescription options or allergy testing.

Some key points to consider when managing allergic rhinitis with cough include:

• The importance of consistent use of intranasal corticosteroids for best results
• The potential benefits of adding montelukast for cough relief
• The need for environmental management to reduce exposure to allergens
• The consideration of immunotherapy for patients with inadequate response to initial treatment, as recommended by the 2015 clinical practice guideline on allergic rhinitis 1.

Overall, a comprehensive approach that includes medication, environmental management, and consideration of immunotherapy can help improve symptoms and quality of life for patients with allergic rhinitis and cough.

From the FDA Drug Label

Fluticasone Propionate Nasal Spray, USP, is indicated for the management of the nasal symptoms of seasonal and perennial allergic and nonallergic rhinitis in adults and pediatric patients 4 years of age and older. The management of allergic rhinitis with cough is not directly addressed in the provided drug labels. However, fluticasone propionate nasal spray can be used for the management of nasal symptoms of allergic rhinitis.

• For adults, the recommended dosage is 200 mcg once daily (two 50-mcg sprays in each nostril once daily) or 100 mcg twice daily (one 50-mcg spray in each nostril twice daily).
• For pediatric patients (4 years of age and older), the recommended dosage is 100 mcg once daily (one spray in each nostril once daily), which can be increased to 200 mcg once daily if necessary. It is essential to note that cough is not explicitly mentioned in the provided drug labels as a symptom that can be managed with fluticasone propionate nasal spray. Therefore, the use of this medication for cough associated with allergic rhinitis should be approached with caution and under the guidance of a healthcare professional 2, 2.

From the Research

Managing Allergic Rhinitis with Cough

To manage allergic rhinitis with cough, consider the following options:

• Avoid inciting allergens, as recommended by 3, 4, 5, 6
• Use second-generation H1 antihistamines (e.g., cetirizine, fexofenadine, desloratadine, loratadine) or intranasal antihistamines (e.g., azelastine, olopatadine) for mild intermittent or mild persistent allergic rhinitis, as suggested by 3, 4, 5
• Utilize intranasal corticosteroids (e.g., fluticasone, triamcinolone, budesonide, mometasone) for moderate to severe allergic rhinitis, as recommended by 3, 4, 5, 6
• Consider combination therapy, such as azelastine with fluticasone, for complex rhinitis phenotypes, as discussed in 7
• Nasal corticosteroids can be used in combination with oral antihistamines, as studied in 4

Treatment Options

Treatment options for allergic rhinitis with cough include:

• Pharmacotherapy, such as oral and intranasal antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists, as described in 4, 5, 6
• Allergen avoidance and immunotherapy, as mentioned in 3, 4, 5, 6
• Alternative therapies, such as homeopathy, acupuncture, and intranasal carbon dioxide, although these are not recommended by Allergic Rhinitis and its Impact on Asthma (ARIA), as noted in 6

Symptom Management

Symptoms of allergic rhinitis with cough can be managed by:

• Reducing nasal congestion, sneezing, and itching of the eyes, nose, and throat, as discussed in 3, 4, 5
• Relieving cough and postnasal drainage, as mentioned in 3, 4
• Improving quality of life, as emphasized in 4, 7