ur mom

First-generation vs second-generation oral antihistamines in allergic rhinitis

Avoid first-generation; prefer second-generation due to better safety and fewer side effects.

Is montelukast recommended as first-line treatment for allergic rhinitis?

No — less effective than other agents and risk of serious neuropsychiatric events. Use only if other therapies fail or aren’t tolerated.

Oral corticosteroids in allergic rhinitis

May use a short 5–7 day course for very severe or intractable allergic rhinitis.

Depot parenteral corticosteroids in allergic rhinitis

Avoid due to systemic and local steroid side effects.

Initial treatment for seasonal or intermittent allergic rhinitis

Intranasal antihistamines.

Preferred monotherapy for persistent allergic rhinitis

Intranasal corticosteroids.

First-line for moderate or severe seasonal allergic rhinitis in patients 15 years and older

Intranasal corticosteroids preferred over montelukast.

Intranasal decongestant use

Short-term or episodic only; up to 5 days for severe mucosal edema.

Oral decongestants cautions

Use carefully in elderly, children under 4, and patients with cardiac disease, hypertension, glaucoma, hyperthyroidism, or Tourette’s syndrome.

Oral decongestants in pregnancy

Avoid in the first trimester.

Best option for perennial allergic rhinitis with rhinorrhea as main symptom

Intranasal ipratropium.

Intranasal cromolyn use in allergic rhinitis

Taken just before allergen exposure for episodic relief.

When to combine intranasal corticosteroids and intranasal antihistamines

Moderate or severe seasonal allergic rhinitis (age 12 and older) or perennial allergic rhinitis not controlled with monotherapy.

What to add if rhinorrhea persists on intranasal corticosteroids

Add intranasal ipratropium.

What to add if congestion persists on intranasal corticosteroids with or without intranasal antihistamines

Add intranasal decongestant for up to 4 weeks.

What to add if allergic rhinitis with congestion is uncontrolled on oral antihistamine

Consider pseudoephedrine if tolerated.

Combine montelukast with oral antihistamines for seasonal allergic rhinitis?

Not recommended (little benefit and safety concerns).

Combine oral antihistamines with intranasal corticosteroids for seasonal or perennial allergic rhinitis?

Not recommended; intranasal corticosteroids alone are preferred.

Add montelukast to intranasal corticosteroids for allergic rhinitis?

Not recommended due to limited evidence and neuropsychiatric risks.

When to consider allergen immunotherapy

Moderate or severe allergic rhinitis not controlled with avoidance or medications, or if patient prefers to avoid long-term medications; may help prevent asthma.

Can allergen immunotherapy be used in patients with asthma and allergic rhinitis?

Yes — consider in controlled mild or moderate asthma with allergic rhinitis.