P1: SBT
0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6
94 Allergic Rhinitismanagement
What to Do First
■Assess exposures & assess for any complicating conditions (asthma
or acute sinusitis)
General Measures
■Avoidance of known allergens
➣Stay indoors when pollen counts are highest (usually early AM &
windy conditions)
➣Encase mattress & pillow for dust mite allergy
➣Remove or limit contact w/ pet
➣Identify & remove sources of mold exposure
➣Occupation? Some jobs are high risk.
specific therapy
Treatment Options
■Nonsedating antihistamines
➣Cetirizine
➣Fexofenadine
➣Loratidine
■Pseudoephedrine as needed for nasal congestion
■Intranasal corticosteroids
➣Budesonide
➣Fluticasone
➣Mometasone
Topical Nasal Antihistamines
■Azelastine
■Topical antihistamine/vasoconstrictor for ocular symptoms: cro-
molyn sodium
➣Nedocromil
➣Levocobastine
➣Olopatadine
Immunotherapy
■Should be reserved for pts w/ severe symptoms unresponsive to
pharmacotherapy
Side Effects & Contraindications
■Cetirizine may cause sedation & fatigue in a minority of pts
■Epistaxis may result from intranasal corticosteroids
■Pseudoephedrine may cause nervousness, insomnia, blood
■pressure elevations