Rhinitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]

Overview

Rhinitis is a heterogegeous disorder that is often undertreated or overlooked( PMID 11449200)

The treatment of allergic rhinitis includes the following key components:^[1]^[2]^[3]

Patient education on allergen avoidance and non-pharmacologic treatments such as saline douching of the nose
Pharmacotherapy
Allergen-specific immunotherapy in patients uncontrolled with pharmacotherapy
Surgery in selected cases

Medical Treatment of Allergic Rhinitis
Severity of Rhinitis	Medication (Use in conjunction with allergen avoidance and saline douching)	Treatment Failure (Ensure patient adherence to treatment before making changes to the treatment plan)	Evaluation and treatment of associated conditions
Mild	Nonsedating oral/intranasal antihistamine	Consider intranasal steroids	Asthma Eczema Rhinosinusitis Conjunctivitis Otitis media Obstructive sleep apnea Laryngopharyngeal reflux
Moderate	Intranasal corticosteroid (+/- nonsedating oral or intranasal antihistamine)	Persistent/uncontrolled symptoms after 2-4weeks of treatment: Increase dose of intranasal steroid Consider targeted medications such as Ipratoprium for rhinorrhea, short-term(not >5 days) intranasal decongestant for nasal obstruction +/- short course of oral corticosteroids in patients who continue to have persistent, severe symptoms (especially when the nasal mucosa is very edematous) Persistent symptoms despite medical therapy Consider allergen immunotherapy Surgery for structural problems like inferior turbinate hypertrophy
Severe	Intranasal corticosteroid (+/- nonsedating oral or intranasal antihistamine)

Other Medications

Leukotriene receptor antagonists- These can be prescribed especially when lower airway symptoms are also present. They are not recommended for use in adults with persistent allergic rhinitis, and they should not be offered as primary therapy for the treatment of allergic rhinitis.^[4]^[1]

↑ ^1.0 ^1.1 Lee S (2014). "Practical clinical approaches to the allergic rhinitis patient". Int Forum Allergy Rhinol. 4 Suppl 2: S66–9. doi:10.1002/alr.21389. PMID 25182359.
↑ Rotiroti, Giuseppina; Scadding, Glenis (July 2016). "Allergic Rhinitis-an overview of a common disease". Paediatrics and Child Health. Volume 26 (Issue 7): 298–303. Retrieved January 20, 2017.
↑ Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A; et al. (2008). "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)". Allergy. 63 Suppl 86: 8–160. doi:10.1111/j.1398-9995.2007.01620.x. PMID 18331513.
↑ Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR; et al. (2015). "Clinical practice guideline: Allergic rhinitis". Otolaryngol Head Neck Surg. 152 (1 Suppl): S1–43. doi:10.1177/0194599814561600. PMID 25644617.