By vgreene, 14 April, 2017 Avoid irritant triggers (eg, smoke, chemical fumes, temp change, perfumes),48,49 occupational triggers (allergic or irritant)50,51
By vgreene, 14 April, 2017 Avoidance of animals effective for animal allergy;39-42 highly pollen-allergic pts should stay indoors during high pollen counts;43 benefit of other environmental measures uncertain44-47
By vgreene, 14 April, 2017 Start w/ intranasal steroid mono-tx;1 if mod-severe2 or if sx warrant3 faster response, may combine w/ intranasal antihistamine; individualize med mgmt4 in light of pt preference; avoid triggers
By vgreene, 14 April, 2017 Complementary: WHO-ARIA advises against acupuncture,37 while AAO says it may be offered.38 Don’t use homeopathy, butterbur/other herbs, phototherapy, or other complementary tx37,38
By vgreene, 14 April, 2017 If severe allergic rhinitis/conjunctivitis: Oral steroids (not parenteral) may be used x5-10 days34-36
By vgreene, 14 April, 2017 If ocular sx/allergic conjunctivitis: may require ophthalmic med; dual-action antihistamine/mast-cell stabilizers (azelastine, epinastine, ketotifen, olopatadine) most effective32,33
By vgreene, 14 April, 2017 If pregnant:30,31 intranasal steroids, select oral antihistamines, montelukast, or cromolyn; oral decongestant recommendations vary
