Treatment
If rhinitis is caused by non-allergic conditions, particularly if there are accompanying symptoms indicating a serious problem, the physician should treat any underlying disorders. If rhinitis is caused by medications, the patient should consider any possible alternatives, if appropriate.
Preventing the Onset of Allergy Attacks
Patients with chronic allergic rhinitis may require daily medications. Patients with severe seasonal allergies may be advised to start medications a few weeks before the pollen season, and to continue it until the season is over. Effective medications include the following:
- Agents that reduce the inflammatory response are proving to be important for preventing severe allergic rhinitis. Nasal corticosteroids (commonly called steroids) are now considered to be the most effective measure for preventing allergy attacks. Other anti-inflammatory agents include leukotriene-antagonists and nasal cromolyn also reduces inflammation and may be beneficial in specific cases.
- Antihistamine tablets relieve sneezing and itching and can prevent nasal congestion before an allergy attack. Many brands are available by prescription and over the counter.
- Immunotherapy, commonly referred to as "allergy shots, may be considered for patients with severe seasonal allergies that do not respond to treatment. It also may prevent asthma and the development of new allergies in children. Many experts are now immediately recommending immunotherapy in people with both asthma and allergies. Newer immunotherapeutic approaches using specially designed antibodies and vaccines are also showing promise.
All drug treatments have side effects, some very unpleasant and, in rare cases, serious. Patients may need to try different drugs until they find one that relieves symptoms without producing excessively distressing side effects.
Treating Nasal Symptoms of Allergic Rhinitis
Because seasonal allergies generally last only a few weeks, most physicians do not recommend the more potent prescription treatments for children. It is important for parents to determine if the child is actually under severe distress and that the parent is not simply responding to their own anxiety when they hear the child snorting or snoring. Prescription drugs are required only in some severe cases. Of note, however, in children with both asthma and allergies, intense treatments for allergic rhinitis may also improve asthmatic symptoms.
Treating Mild Allergy Attacks. Mild allergy attacks usually require little more than reducing exposure to allergens and using a nasal wash. Dozens of drugs are available for treating allergic rhinitis. Many are available over the counter but some require a prescription. They include the following:
- Nasal Washes.
- Decongestants relieve nasal congestion and itchy eyes.
- Decongestant/Antihistamine combinations.
Treating Severe Allergic Rhinitis. Patients with chronic allergic rhinitis, particularly if they also have asthma may require daily medications. Patients with severe seasonal allergies may be advised to start medications a few weeks before the pollen season, and to continue it until the season is over. Effective medications include the following:
- Antihistamines. The newer non-sedating antihistamines, such as cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra), or desloratadine (Clarinex) are now recommended as first-line therapy over the older ones (e.g., Benadryl), which cause more drowsiness. (It should be noted, however, that a major analysis concluded that there are no clear or consistent differences in sedation between the newer or older antihistamines.)Some of the newer agents, such as Zyrtec and Clarinex, may also relieve nasal congestion. Zyrtec may possibly prevent asthma from developing in very young children with severe allergies.
- Anti-inflammatory agents. Nasal corticosteroids are now considered to be the most effective measure for preventing allergy attacks. They are recommended for patients with very severe allergies that do not respond to antihistamines.
- Leukotriene-antagonists and nasal cromolyn may be beneficial in specific cases of allergies
- Allergen immunotherapy ("allergy shots"). Immunotherapy, commonly called allergy shots, is highly effective for many patients with severe allergies. It is even proving to reduce asthma symptoms and the use of asthma medications in patients with known allergies.
Treating Itchy Eyes
Itching and redness in the eyes sometimes responds to oral antihistamines. Eye drops, however, provide faster relief and a combination of the two may be best. The following are eye drops for itchy eyes. Others are also available. Customers respond differently to these products, and report a wide range of effectiveness.
- Antihistamine Eye Drops: azelastine (Optivar), olopatadine (Patanol), ketotifen (Zaditor), levocabastine (Livostin) for relief of both nasal symptoms and itchy red eyes. (In one 2001 comparative study, olopatadine was more effective than azelastine. Other comparative studies are needed.)
- Decongestant Eye Drops: phenylephrine (Allergan Relief), naphazoline (Naphcon, Opcon-A, Vasoclear), tetrahydrozoline (Murine Plus, Visine, A number of brands).
- Combination Decongestant/Antihistamine: Visine A.
- Corticosteroids: loteprednol (Lotemax, Alrex), pemirolast (Alamast).
General Side Effects and Warning.
- All eye drops can cause stinging and some may cause headache and congestion.
- No one should continue taking eye drops if they experience pain, changes in vision, worsened redness or irritation, or if the condition lasts more than three days.
- Do not touch tip of the device or touch other surfaces with it. Replace the cap after using. Discard any solution that changes color or becomes cloudy.
People who have heart disease, high blood pressure, an enlarged prostate gland, and glaucoma should avoid eye drops.
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