By vgreene, 14 April, 2017 Combo tx. Benefits of oral antihistamine-decongestant combo are controversial. If mod-severe26 or if sx warrant27 faster response, may combine w/ intranasal antihistamine. If pt refuses intranasal steroids, consider combo use (AAO28); or instead use oral/
By vgreene, 14 April, 2017 Antihistamines: Intranasal (azelastine, olopatadine) may be more effective than oral, especially for nasal congestion; rapid onset advantageous for seasonal/episodic/intermittent sx.8-11 Use oral antihistamines daily, not prn; 2nd-gen preferred vs 1st-gen
By vgreene, 14 April, 2017 If severe allergic rhinitis/conjunctivitis: Oral steroids (not parenteral) may be used x5-10 days8-10
By vgreene, 14 April, 2017 Intranasal steroids: Various steroids have similar efficacy; most effective w/ continuous use5-7
By vgreene, 14 April, 2017 Consider comorbid conditions that may respond to surgical tx: severe septal deviation, inferior turbinate hypertrophy, adenoid hypertrophy39-41
By vgreene, 14 April, 2017 Consider DDx: nonallergic rhinitis (eg, vasomotor, infectious, pregnancy/hormonal, drug-induced), mimics (eg, nasal polyps, septal deformity, adenoid hypertrophy)37,38
By vgreene, 14 April, 2017 Consider referral to allergist/immunologist for allergen immunotherapy to identify/manage allergens, in complex cases (eg, poor control, med side effects, comorbid dz)36
By vgreene, 14 April, 2017 Offer immune-tx to pts w/ confirmed IgE to relevant allergen, not responding to med tx + environmental control/avoidance (or avoidance unfeasible), or undesirable burden of meds (side effects, cost)32-35
By vgreene, 14 April, 2017 Avoid irritant triggers (eg, smoke, chemical fumes, temp change, perfumes),28,29 occupational triggers (allergic or irritant)30,31
