By vgreene, 23 April, 2021 Intranasal cromolyn is a 1st line consideration per AAAAI but onset is slow 1 2wk qid dosing may limit adherence2
By vgreene, 23 April, 2021 Add decongestants initially if edema impairs delivery of intranasal tx oral2 3 not rec d by BSACI or intranasal 2 4 combo PSE 2nd gen OAH preferred over intranasal cromolyn by AAAAI don t use 5 days exercise caution in certain pts5
By vgreene, 23 April, 2021 Antihistamines INAH may be more effective than OAH rapid onset advantageous for seasonal episodic intermittent sx use OAH daily not prn per BSACI AAAAI recommends against 1st gen OAH2
By vgreene, 23 April, 2021 Intranasal corticosteroid is a 1st line option per AAAAI ARIA AAO HNS combo w INAH more effective than INCS alone is also 1st line per ARIA reserved for mod severe dz or tx failure by other societies
By vgreene, 23 April, 2021 Start w intranasal steroid INCS intranasal antihistamine INAH 2nd gen oral antihistamine OAH or intranasal cromolyn as mono tx individualize med mgmt in light of pt preference 1 avoid triggers step down stop tx if sx controlled trigger gone
By vgreene, 23 April, 2021 Consider immuno tx in pts w mod severe AR who prefer to avoid pharmaco tx or desire additional benefit in setting of comorbid conditions eg asthma 2
By vgreene, 23 April, 2021 Avoidance of animals effective for animal allergy 4 highly pollen allergic pts should stay indoors during high pollen counts benefit of other environmental measures uncertain4 8
