From the Guidelines
Allergic rhinitis should be diagnosed based on a clinical diagnosis when patients present with a history and physical exam consistent with an allergic cause and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing, as recommended by the 2015 clinical practice guideline 1.
Diagnosis
The diagnosis of allergic rhinitis is made based on a combination of patient history and physical examination, with specific findings including clear rhinorrhea, nasal congestion, pale discoloration of the nasal mucosa, and red and watery eyes. Allergy testing, such as specific IgE (skin or blood) testing, may be performed or referred to a clinician who can perform and interpret the test for patients who do not respond to empiric treatment, or when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy 1.
Treatment
Treatment for allergic rhinitis typically begins with identifying and avoiding triggers such as pollen, dust mites, pet dander, or mold.
- Intranasal corticosteroids, such as fluticasone (Flonase) or mometasone (Nasonex), are the most effective medication class for controlling symptoms, used as 1-2 sprays in each nostril daily, as recommended by the 2017 joint task force on practice parameters 1.
- Oral antihistamines, such as second-generation options like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily), can provide additional relief, as they cause less drowsiness than first-generation alternatives 1.
- For persistent congestion, adding a nasal decongestant like oxymetazoline may help, but should not be used for more than 3 consecutive days to avoid rebound congestion, as cautioned in the 2008 practice parameter 1.
- Saline nasal irrigation can safely remove allergens and thin mucus.
- For severe or persistent cases, allergen immunotherapy (allergy shots or sublingual tablets) may be recommended to gradually desensitize the immune system, as suggested by the 2017 joint task force on practice parameters 1. These treatments work by blocking histamine receptors or reducing inflammation, addressing the underlying immune response where mast cells release inflammatory mediators when allergens bind to IgE antibodies on their surface.
Additional Considerations
- Clinicians should assess patients with a clinical diagnosis of allergic rhinitis for associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media, as recommended by the 2015 clinical practice guideline 1.
- Environmental controls, such as removal of pets, use of air filtration systems, bed covers, and acaricides, may be advised for patients with identified allergens that correlate with clinical symptoms, as suggested by the 2015 clinical practice guideline 1.
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. USE(S) Temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: • runny nose • itchy, watery eyes • sneezing • itching of the nose or throat
The diagnosis of allergic rhinitis (hay fever) is based on symptoms such as:
- Nasal congestion
- Rhinorrhea
- Nasal itching
- Sneezing
- Itchy, watery eyes
- Itching of the nose or throat
The treatment for allergic rhinitis (hay fever) includes:
- Montelukast (SINGULAIR) 10-mg tablets, which have been shown to significantly reduce symptoms of seasonal and perennial allergic rhinitis 2
- Loratadine, which temporarily relieves symptoms of hay fever or other upper respiratory allergies, including runny nose, itchy, watery eyes, sneezing, and itching of the nose or throat 3
From the Research
Diagnosis of Allergic Rhinitis
- Allergic rhinitis is typically diagnosed based on symptoms such as nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat 4
- Physical examination findings may include edematous and pale turbinates in seasonal allergic rhinitis, and erythematous and inflamed turbinates with serous secretions in perennial allergic rhinitis 4
- Diagnosis may also involve identifying the type of allergic rhinitis, such as intermittent or persistent, and assessing its severity, such as mild or moderate to severe 5
Treatment Options for Allergic Rhinitis
- Allergen avoidance is the initial step in the management of allergic rhinitis 6, 4, 5
- Pharmacotherapy options include:
- Oral antihistamines, such as cetirizine, fexofenadine, desloratadine, and loratadine, which are recommended for mild to moderate intermittent and mild persistent rhinitis 6, 4, 5, 7
- Intranasal antihistamines, such as azelastine and olopatadine, which may be used as monotherapy or in combination with intranasal corticosteroids 4
- Intranasal corticosteroids, such as fluticasone, triamcinolone, budesonide, and mometasone, which are recommended as first-line treatment for moderate to severe allergic rhinitis 6, 4, 5, 7
- Leukotriene receptor antagonists, such as montelukast, which may be used in combination with other medications 6, 5
- Immunotherapy, such as subcutaneous and sublingual immunotherapy, may be considered for patients with severe allergic rhinitis uncontrolled by pharmacotherapy 5, 8
Treatment Guidelines
- Treatment guidelines recommend intranasal corticosteroids as first-line treatment for moderate to severe allergic rhinitis 6, 4, 5, 7
- Second-generation oral antihistamines and intranasal antihistamines may be recommended for mild to moderate intermittent and mild persistent rhinitis 6, 4, 5, 7
- Combination therapy with intranasal antihistamines and corticosteroids may be considered for patients with severe allergic rhinitis 8