Allergic Rhinitis, Cough and Cold

First line for moderate-severe symptoms

Intranasal steroids

Budesonide (Generic)

Rhinocort Allergy (Brand)

Fluticasone (Generic)

Flonase (Brand)

Triamcinolone (Generic)

Nasacort (Brand)

Beclomethasone (Generic)

Beconase, Qnasl (Brand)

Mometasone (Generic)

Nasonex (Brand)

Mometasone + olopatadine (Generic)

Ryaltris (Generic)

Budesonide dosing

Rhinocort

Adult: 1 spray/nostril/d (max 4 sprays/nostril/d)

> 6: 1 spray/nostril/d (max 2 spray/nostril/day)

Fluticasone dosing

Flonase

Adult/>12 yrs old: 1-2 sprays/nostril/d'

2-11 yrs: 1 spray per nostril daily

Triamcinolone dosing

Nasacort

Adult/ >6 yr: 1-2 sprays/nostril/d

2-5yrs: 1 spray per nostril per day

Instranasal steroid warnings (nose)

recent nasal septal ulcers, nasal sx, recent nasal trauma/delayed healing

Instranasal steroid warnings (prolonged periods)

adrenal suppression, decreased growth, immunosuppression

Instranasal steroid warnings (cataracts/glaucoma)

Increased IOP; open angled glaucoma and cataracts with prolonged use

Intranasal steroid side effects

Epistaxis, headache, dry nose, unpleasant taste, localized infection

Onset of relief: intranasal steroids

up to one week

Use in pregnancy; intranasal steroids

Budesonide or beclomethasone

First line for mild-moderate allergic rhinitis

oral antihistamines

What do antihistamines not have an effect on?

nasal congestion

First generation antihistamines

Diphenhydramine, chlorpheniramine, doxylamine

Diphenhydramine (Generic)

Benadryl (Brand)

Chlorpheniramine (Generic)

Aller-Chlor (Brand)

Doxylamine (Generic)

Unisom SleepTabs (Brand)

Diphenhydramine dosing

Benadryl

Adult: 25 mg po q4-6 hrs OR 50mg po q6-8 hrs (max 300mg/d)

6-11yrs: 12.5-25 mg PO q4-6h (max 150mg/d)

<6: not OTC

Chlorpheniramine dosing

Aller-Chlor

IR: 4MG po q4-6h

ER: 12 mg po q12

Max 24mg/d

Doxylamine dosing

Unisom

12.5-25 mg po q4-6h (max 75mg/d)

First generation antihistamines: CI

Neonates, premature infants, breastfeeding

First generation antihistamine: warnings

elderly, <2yrs, CV disease, prostate enlargement, gluacoma, astham, pyloduodenal obstruction, thyroid disease

First generation antihistamines; what medication can you not use concomitantly?

MOAi

First generation antihistamines; side effects

Somnolence, cognitive impairment, anticholinergic effects, seizures/arrhythmias at high dose

Anticholinergic effects

dry mouth, blurred vision, urinary retention, constipation

Many uses of diphenhydramine

acute allergic reactions, prevention for allergic reactions, allergic rhinitis, cough, sleep, dystonic reactions, motion sickness