From the Guidelines
For persistent severe seasonal allergic rhinitis, a combination of an intranasal corticosteroid and an intranasal antihistamine is recommended as initial treatment, as it provides additional benefit compared to monotherapy with either agent alone, as supported by the 2017 Joint Task Force on Practice Parameters 1.
Treatment Approach
The treatment approach for persistent severe seasonal allergic rhinitis involves a multi-faceted strategy, including:
- Second-generation antihistamines, such as cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily), which cause less drowsiness than first-generation options
- Nasal corticosteroid sprays, such as fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily), which reduce inflammation and can be used long-term
- Intranasal antihistamines, which provide additional benefit when combined with intranasal corticosteroids
- Eye symptoms can be managed with ketotifen eye drops (1 drop per eye twice daily) or olopatadine (1 drop per eye twice daily)
- Montelukast (10mg daily) can be added if symptoms persist, as it blocks leukotrienes that contribute to allergic reactions
- Immunotherapy (allergy shots or sublingual tablets) may provide long-term desensitization over 3-5 years for severe cases
Environmental Controls
Environmental controls are equally important and include:
- Keeping windows closed during high pollen seasons
- Using HEPA air purifiers
- Showering after outdoor exposure
- Regularly washing bedding in hot water
These measures work by blocking histamine receptors, reducing inflammatory responses, or preventing immune cell activation that occurs when allergens bind to IgE antibodies on mast cells, thereby stopping the cascade of symptoms including congestion, sneezing, itching, and excessive mucus production.
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. Four of the five trials showed a significant reduction in daytime nasal symptoms scores with SINGULAIR 10-mg tablets compared with placebo.
The remedy for persistent severe seasonal allergic rhinitis is SINGULAIR 10-mg tablets, which have been shown to significantly reduce symptoms of seasonal allergic rhinitis in clinical trials 2.
- The primary outcome variable was mean change from baseline in daytime nasal symptoms score.
- SINGULAIR 10-mg tablets were taken once daily.
- It is essential to follow the doctor's instructions and take the medication as prescribed.
From the Research
Remedies for Persistent Severe Seasonal Allergic Rhinitis
The following remedies are available for persistent severe seasonal allergic rhinitis:
- Allergen avoidance as the first step in management 3
- Symptomatic relief and improved quality of life through pharmacotherapy, including:
- Oral or intranasal second-generation antihistamines for mild to moderate cases 3
- Intranasal corticosteroids for more severe cases, which can be used alone or in combination with other agents 3, 4, 5, 6
- Combination therapy with oral histamine and leukotriene receptor antagonists 5
- Intranasal azelastine as an alternative to intranasal fluticasone propionate for symptom control 7
- Immunotherapy for patients who require medications for more than 6 months per year, have two or more seasons of unacceptable pollinosis, or experience intolerable side effects from pharmacotherapy, especially those with co-morbid conditions 3
Treatment Options
Treatment options for persistent severe seasonal allergic rhinitis include:
- Fluticasone propionate aqueous nasal spray, which has been shown to be effective in reducing nasal symptoms and improving quality of life 4, 6
- Mometasone furoate, which has been shown to be effective in reducing nasal symptoms and improving quality of life 5
- Azelastine, which has been shown to be comparable to fluticasone propionate in symptom control 7
- Montelukast and cetirizine, which have been shown to be effective in reducing nasal symptoms and improving quality of life when used in combination 5