From the Guidelines
The recommended management for allergic rhinitis involves a stepwise approach starting with allergen avoidance and progressing to medications based on symptom severity, with intranasal corticosteroids being the most effective single therapy for moderate to severe symptoms, as recommended by the 2017 joint task force on practice parameters 1.
Key Considerations
- Patients should identify and minimize exposure to triggers such as pollen, dust mites, pet dander, or mold.
- For mild symptoms, second-generation oral antihistamines like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily) are first-line treatments as they effectively block histamine receptors with minimal sedation.
- Intranasal corticosteroids such as fluticasone propionate (1-2 sprays per nostril daily) or mometasone furoate (2 sprays per nostril daily) are the most effective single therapy for moderate to severe symptoms, reducing inflammation and multiple allergic mediators.
- These can be used alone or combined with antihistamines for better symptom control.
- For nasal congestion, decongestants like pseudoephedrine (120mg twice daily) can provide short-term relief but should be limited to 3-5 days to avoid rebound congestion.
- Saline nasal irrigation is a helpful adjunct therapy that physically removes allergens and thins mucus.
- For patients with persistent symptoms despite optimal medical therapy, allergen immunotherapy (allergy shots or sublingual tablets) may be considered for long-term modification of the allergic response, as supported by the clinical practice guideline: allergic rhinitis executive summary 1.
Treatment Approach
- The approach to treatment should be individualized, considering factors such as the patient’s age, symptoms, tolerability of route of administration, overall clinical condition, comorbidities, and concomitant medication, as outlined in the diagnosis and management of rhinitis: an updated practice parameter 1.
- A step-up approach (when therapy is inadequate) or step-down approach (after symptoms relief is achieved or maximized) should be used to manage rhinitis.
- Selection of the pharmacologic agent for treatment must be based on the patient’s symptoms, age, and overall clinical condition.
From the FDA Drug Label
The efficacy of SINGULAIR tablets for the treatment of seasonal allergic rhinitis was investigated in 5 similarly designed, randomized, double-blind, parallel-group, placebo- and active-controlled (loratadine) trials conducted in North America. The primary outcome variable was mean change from baseline in daytime nasal symptoms score (the average of individual scores of nasal congestion, rhinorrhea, nasal itching, sneezing) as assessed by patients on a 0-3 categorical scale Four of the five trials showed a significant reduction in daytime nasal symptoms scores with SINGULAIR 10-mg tablets compared with placebo. The efficacy of SINGULAIR tablets for the treatment of perennial allergic rhinitis was investigated in 2 randomized, double-blind, placebo-controlled studies conducted in North America and Europe. In the study in which efficacy was demonstrated, SINGULAIR 10-mg tablets once daily was shown to significantly reduce symptoms of perennial allergic rhinitis over a 6-week treatment period
The recommended management for allergic rhinitis includes the use of montelukast (SINGULAIR) 10-mg tablets once daily, which has been shown to significantly reduce symptoms of seasonal allergic rhinitis and perennial allergic rhinitis in clinical trials 2.
- Key benefits of montelukast include:
- Reduction in daytime nasal symptoms score
- Improvement in symptoms of nasal congestion, rhinorrhea, nasal itching, and sneezing However, it is essential to consult the FDA drug label and other relevant clinical guidelines for the most up-to-date and comprehensive information on the management of allergic rhinitis 2.
From the Research
Recommended Management for Allergic Rhinitis
The management of allergic rhinitis includes:
Pharmacotherapy Options
Pharmacotherapy options for allergic rhinitis include:
- Second-generation H1 antihistamines (e.g., cetirizine, fexofenadine, desloratadine, loratadine) 3, 6, 7
- Intranasal antihistamines (e.g., azelastine, olopatadine) 3, 6, 4
- Intranasal corticosteroids (e.g., fluticasone, triamcinolone, budesonide, mometasone) 3, 6, 4, 7
- Leukotriene receptor antagonists 6
- Oral and intranasal decongestants 6
- Oral and intranasal anticholinergics 6
Treatment Recommendations
Treatment recommendations for allergic rhinitis are categorized by disease severity and duration of symptoms:
- Mild intermittent or mild persistent allergic rhinitis: second-generation H1 antihistamine or intranasal antihistamine 3
- Persistent moderate to severe allergic rhinitis: intranasal corticosteroid alone or in combination with an intranasal antihistamine 3, 6, 7
- Nonallergic rhinitis: intranasal antihistamine as monotherapy or in combination with an intranasal corticosteroid 3
Nonpharmacological Measures
Nonpharmacological measures for allergic rhinitis include: