AAAAI & ACAAI GUIDELINES Bundle (free trial)

Pharmacologic Therapy ÎThe selection of pharmacotherapy for a patient depends on multiple factors, inc (eg, allergic, nonallergic, mixed, episodic), most prominent symptoms, severity, Table 3. Principal Medication Options for Rhinitis1 Allergic rhinitis (AR): Seasonal allergic rhinitis (SAR) and perennial allergic rhini Monotherapy Therapeutic considerations Antihistamines, oral (H1 receptor antagonists) > Continuous use most effective for SAR and PAR, but appropria > Less effective for nasal congestion than for other nasal symptom > Other options, in general, are better choices for more severe AR > Less effective for AR than INS, with similar effectiveness to IN > Because generally ineffective for nonallergic rhinitis, other choi > To avoid sedation (often subjectively unperceived), performanc agents generally preferred > Of second-generation agents, fexofenadine, loratadine, deslorat Corticosteroids, oral Decongestants, oral Leukotriene receptor antagonists (LTRA) Intranasal antihistamines > A short course (5-7 days) of oral corticosteroids may be approp > Preferred to single or recurrent administration of intramuscular > Pseudoephedrine reduces nasal congestion > Side effects include insomnia, irritability, palpitations, hyperten > Montelukast approved for SAR and PAR > No significant difference in efficacy between LTRA and oral an > Approved for both rhinitis and asthma; may be considered in p > Side effects minimal > Effective for SAR and PAR > Have clinically significant rapid onset of action, making them a > Effectiveness for AR equal or superior to oral second-generation > Less effective than INS for nasal symptoms > Appropriate choice for mixed rhinitis, because also approved fo > Side effects with intranasal azelastine: bitter taste, somnolence Intranasal anticholinergic (ipratropium) Intranasal corticosteroids (INS) > Reduces rhinorrhea but not other symptoms of SAR and PAR > Appropriate for episodic rhinitis because of rapid onset of actio > Side effects minimal, but dryness of nasal membranes may occu > Most effective monotherapy for SAR and PAR > Effective for all symptoms of SAR and PAR, including nasal co > PRN use (eg, > 50% days use) effective for SAR > May consider for episodic AR > Usual onset of action is less rapid than oral or intranasal antihis > More effective than combination of oral antihistamine and LTR > Similar effectiveness to oral antihistamines for associated ocular > Appropriate choice for mixed rhinitis, because agents in class al > Without significant systemic side effects in adults > Growth suppression in children with PAR has not been demon > Local side effects minimal, but nasal irritation and bleeding occ Intranasal cromolyn Intranasal decongestants > For maintenance treatment of AR, onset of action within 4 to 7 > For episodic rhinitis, administration just before allergen exposu > Less effective than nasal corticosteroids, inadequate data for com > Minimal side effects > For short-term and possibly for episodic therapy of nasal conge > May assist in intranasal delivery of other agents when significan Intranasal agents Oral agents FOR INTERNAL USE ONLY

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