Allergic Rhinitis

Allergic Rhinitis – Treatment Overview

Introduction
Allergic rhinitis (AR) is an IgE-mediated inflammatory condition of the nasal mucosa triggered by allergens such as pollen, dust mites, mold, or animal dander. It is characterized by sneezing, nasal congestion, rhinorrhea (runny nose), and itching, often accompanied by conjunctival symptoms (allergic conjunctivitis). Though not life-threatening, allergic rhinitis significantly affects quality of life, sleep, and productivity. Treatment aims to relieve symptoms, control inflammation, and prevent complications such as sinusitis or asthma exacerbations.

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Treatment Options and Doses

1. Allergen Avoidance and Environmental Control

• Minimize exposure to known triggers (e.g., pollen, dust, animal dander).

• Use HEPA filters, wash bedding frequently, and avoid smoking exposure.

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2. Antihistamines (first-line for sneezing, itching, rhinorrhea)

• Cetirizine: 10 mg orally once daily.

• Loratadine: 10 mg orally once daily.

• Fexofenadine: 120–180 mg orally once daily.

• For children: Doses adjusted by age/weight (e.g., cetirizine 5 mg once daily for 2–6 years).

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3. Intranasal Corticosteroids (most effective for nasal congestion and overall control)

• Fluticasone propionate nasal spray: 1–2 sprays per nostril once daily (maximum 200 mcg/day).

• Mometasone furoate nasal spray: 2 sprays per nostril once daily (200 mcg/day).

• Budesonide nasal spray: 1 spray per nostril twice daily (128 mcg/day).

• Require daily, consistent use for optimal benefit.

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4. Decongestants (short-term relief of nasal blockage)

• Pseudoephedrine: 60 mg orally every 6 hours (max 240 mg/day).

• Oxymetazoline nasal spray: 1–2 sprays per nostril every 12 hours (limit to ≤3 days to avoid rebound congestion/rhinitis medicamentosa).

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5. Leukotriene Receptor Antagonists (alternative/adjunct therapy)

• Montelukast: 10 mg orally once daily (adults).

• Children 6–14 years: 5 mg chewable tablet once daily.

• Useful when AR coexists with asthma.

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6. Adjunctive Therapies

• Saline nasal irrigation: Improves mucociliary clearance, reduces congestion.

• Antihistamine eye drops (e.g., olopatadine) if conjunctivitis is present.

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7. Immunotherapy (for severe, persistent cases unresponsive to pharmacologic therapy)

• Subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT).

• Administered under specialist supervision for long-term desensitization.