Allergic Rhinitis
Allergic rhinitis affects approximately 10%-20% of the U.S. population and 40% of children. Mean age of onset is 8-12 year.
Clinical presentation usually consists of sneezing, nasal congestion, cough, postnasal drip, loss of or alteration of smell, and sensation of plugged ears.
Etiology due to:
- Pollens in the springtime, ragweed in fall, grasses in the summer
- Dust, mites, animal allergens
- Smoke or any irritants
- Perfumes, detergents, soaps
- Changes in atmospheric temperature
Treatment:
Non pharmacologic Therapy
- Maintain allergen-free environment by covering mattresses and pillows with allergen-proof casings, eliminating animal products, and removing dust collecting fixtures.
- Air purifiers and dust filters
- Maintain humidity to below 50% to prevent dust mites or mold
- Use air conditioners, especially in the bedroom
- Remove pets from homes of patients with suspected sensitivity to animal allergens
- Use of acupuncture to treat is controversial
Pharmacological Therapy
- Topical nasal steroids are very effective and I prefer as first line treatment in adults. Ex. Fluticasone (Flonase).
- Oral Antihistamine, first generation antihistamine, ex. Benadryl, can cause considerable sedation and anticholinergic symptoms. Second generation antihistamine, ex. Loratadine (Claritin), Cetirizine (Zyrtec), are preferred since they cause less sedation and anticholinergic effects.
- Oral leukotriene receptor antagonist, ex. Montelukast (Singulair), commonly used for asthma is also effective for allergic rhinitis.
- Cromolyn sodium used for prophylaxis.
