From the Guidelines
For allergic rhinitis treatment, I recommend starting with a second-generation antihistamine like cetirizine 10mg once daily or loratadine 10mg once daily, as they have been shown to be effective in reducing symptoms with minimal sedation 1. These medications block histamine receptors to reduce sneezing, itching, and runny nose. For nasal congestion, adding an intranasal corticosteroid such as fluticasone propionate (2 sprays in each nostril once daily) or mometasone furoate (2 sprays in each nostril once daily) is recommended, as they reduce inflammation in the nasal passages and are most effective when used regularly 1. Some key points to consider when treating allergic rhinitis include:
- The use of second-generation antihistamines, such as cetirizine and loratadine, which have less sedative properties compared to first-generation antihistamines 1.
- The addition of an intranasal corticosteroid for patients with nasal congestion, as it has been shown to be effective in reducing symptoms 1.
- The consideration of combination therapy with an intranasal antihistamine and an intranasal corticosteroid for patients with moderate to severe symptoms 1.
- The importance of environmental control measures, including avoiding known allergens, using air purifiers, and washing bedding regularly in hot water to reduce allergen exposure. It's also important to note that for patients with severe symptoms, combining both treatments is more effective than either alone 1. If eye symptoms are present, adding olopatadine 0.1% eye drops (1 drop in each affected eye twice daily) may be beneficial 1. For immediate relief of congestion, oxymetazoline nasal spray can be used (1-2 sprays in each nostril twice daily), but limit use to 3 days to prevent rebound congestion 1. Overall, the treatment of allergic rhinitis should be individualized based on the severity of symptoms and the presence of comorbidities, such as asthma 1.
From the FDA Drug Label
For allergic rhinitis -Take once daily at about the same time each day: One 10-mg tablet for adults and adolescents 15 years of age and older, 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 medication that would be used for the treatment of allergic rhinitis is montelukast (PO). The recommended dosage is:
- 10-mg tablet once daily for adults and adolescents 15 years of age and older 2
- 5-mg chewable tablet once daily for children 6 to 14 years of age 2
- 4-mg chewable tablet or one packet of 4-mg oral granules once daily for children 2 to 5 years of age 2
From the Research
Treatment Options for Allergic Rhinitis
The treatment for allergic rhinitis includes pharmacotherapy, allergen avoidance, and immunotherapy. The mainstays of treatment are second-generation oral antihistamines and intranasal corticosteroids 3.
Medications Used
- Oral and intranasal antihistamines:
- Intranasal corticosteroids:
- Combination therapy:
- Combination of fluticasone propionate and an oral antihistamine such as loratadine may be used for moderate to severe allergic rhinitis 3.
Dosage Information
The dosage of medications for allergic rhinitis may vary depending on the severity of symptoms, age of the patient, and other factors. It is essential to consult a healthcare professional for specific dosage recommendations.
Pharmacotherapy
Pharmacotherapy is patient-specific, based on type, duration, and severity of symptoms, comorbidities, prior treatment, and patient preference 3. The community pharmacist plays an important role in managing allergic rhinitis, and many medications are available over the counter in pharmacies 3.