OIA2004 MANAGEMENT OF ALLERGIC RHINITIS

Allergic Rhinitis Symptoms

Sneezing, itchy nose/mouth, rhinorrhea, nasal congestion, itchy/watery eyes, postnasal drip, dry cough.

Seasonal Allergic Rhinitis (Hay Fever)

Triggered by airborne allergens (e.g. pollen) during specific times of year.

Perennial Allergic Rhinitis

Persistent symptoms year-round due to indoor allergens (dust mites, pets, mold).

Dennie-Morgan lines

Skin folds under the eyes seen in chronic allergy sufferers.

Allergic shiners

Darkened lower eyelids due to venous congestion from chronic nasal obstruction.

Common allergens

Pollen, dust mites, mold, pet dander, cockroach droppings.

Non-allergic rhinitis causes

Temperature extremes, humidity, strong odors, chemical irritants.

Predisposing factors

Family history of allergy, environmental exposure, occupational hazards.

Impact on quality of life

Sleep disruption, fatigue, impaired school/work performance, social discomfort.

Potential complications

Otitis media, sinusitis, asthma exacerbation, impaired smell and taste.

Main treatment goals

Minimize symptoms, reduce drug side effects/costs, and maintain normal lifestyle.

Dust mite control

Use allergen-proof bedding, wash linens in hot water, sun-dry fabrics.

Mold control

Keep environments dry, use antifungal cleaners.

Pet allergy tips

Keep pets out of bedrooms, bathe regularly, use air purifiers.

Pollen avoidance

Stay indoors during peak pollen, keep windows closed, use face masks outdoors.

Occupational exposure

Avoid known workplace allergens or irritants when possible.

Saline spray benefits

Flushes allergens, clears mucus, reduces inflammation, and moisturizes nasal passages.

H1-antihistamines role

Block histamine receptors → reduce sneezing, itching, rhinorrhea.

Sedating (1st gen) antihistamines

Chlorpheniramine, diphenhydramine — effective but cause drowsiness.

Non-sedating (2nd gen) antihistamines

Loratadine, cetirizine, fexofenadine — preferred for daily use, less CNS effects.

Common side effects of antihistamines

Drowsiness, dry mouth, nausea, constipation, urinary retention.

Eye drop antihistamines

Olopatadine, ketotifen, azelastine — relieve allergic conjunctivitis.

Intranasal antihistamines

Azelastine (often combined with fluticasone) — effective for nasal itching and runny nose.

Elderly caution

Avoid 1st gen antihistamines due to anticholinergic and sedative burden.

Mast cell stabilizer examples

Lodoxamide, sodium cromoglicate — prevent histamine release from mast cells.

Mast cell stabilizer use

Mainly as eye drops for allergic conjunctivitis; less effective than steroids or antihistamines.

Mechanism of nasal decongestants

Alpha-agonists → vasoconstriction → reduces nasal swelling and congestion.

Examples Nasal Decongestant

Oxymetazoline, xylometazoline (topical); pseudoephedrine (oral, often combined with antihistamines).

Important caution

Do not use nasal decongestants >3–5 days → risk of rebound congestion (rhinitis medicamentosa).

Age restrictions

Avoid in children <6 years.

Mechanism of action (Intranasal Corticosteroids)

Reduce nasal inflammation by suppressing immune cells and cytokines.

(Intranasal Corticosteroids) First-line treatment of

Moderate-to-severe and perennial allergic rhinitis.

Examples Intranasal Corticosteroids

Mometasone, fluticasone (low systemic absorption); betamethasone (higher systemic effect — short-term use only).

Side effects (Intranasal Corticosteroids)

Local irritation, nosebleeds, throat dryness; monitor growth in children with long-term use.

Example: Montelukast

Blocks leukotriene D4 → reduces nasal congestion, especially helpful with concurrent asthma.

Use in allergic rhinitis (LTRAs)

Alternative to antihistamines; sometimes used in combination therapy.

Unilateral nasal discharge

Especially thick/foul — may indicate foreign body or infection.

Facial pain/swelling

Consider sinusitis, cellulitis.

Visual or auditory symptoms

Eye pain, visual changes, ear infections → serious complications.

Systemic signs

High fever, severe headache, weight loss, night sweats → evaluate for systemic disease.