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Fitzgerald Health Education Associates, Inc., August 2015 fhea.com
intranasal corticosteroid is needed because it is the most
effective therapy for nasal congestion. It is also superior
in relieving overall symptoms of allergic rhinitis.
Incorporating evidence-based guidelines into the
decision-making process is important when developing
the treatment plan for allergic rhinitis. The guidelines on
diagnosis and management of rhinitis from the Joint
Task Force on Practice Parameters for Allergy and Im-
munology, developed by experts from the American
Academy of Allergy, Asthma & Immunology, the Ameri-
can College of Allergy, Asthma and Immunology, and
the Joint Council of Allergy, Asthma and Immunology, is
Allergy & Asthma Consult
Continued on page 13
Table 1: Pharmacologic Therapies for the Management of Allergic Rhinitis
Pharmacologic Class Medications Mechanism of Action
Reliever (Rescue) Therapy: Helpful in Symptom Relief
First-generation Brompheniramine (Bromfed®, Blocks histamine-1 receptor sites. Significant potential to
antihistamines Dimetapp®), chlorpheniramine cause sedation, impair performance, and exert anticholinergic
(Chlor-Trimeton®), effects. Not first-line reliever therapy because of adverse effects.
diphenhydramine (Benadryl®), Found in OTC medications labeled to "dry runny nose."
hydroxyzine (Atarax®, Vistaril®)
Second-generation Cetirizine (Zyrtec®), Blocks histamine-1 receptor sites. Little or no sedative effect.
antihistamines desloratadine (Clarinex®), Preferred over first-generation antihistamines because of
fexofenadine (Allegra®), more favorable adverse effect profile.
loratadine (Claritin®),
levocetirizine (Xyzal®)
Nasal Azelastine (Astelin®, Blocks histamine-1 receptor sites. Particularly beneficial with
antihistamines Astepro®), olopatadine nasal congestion, though generally less effective than
(Patanase®) intranasal corticosteroids.
Decongestant Phenylephrine (Sudafed PE®), Alpha-adrenergic agonist; relieves upper respiratory tract congestion
(oral) pseudoephedrine (Sudafed®) via vasoconstriction. Found in OTC medications labeled to "relieve
nasal congestion."
Controller Therapy: Helps Prevent Formation of Inflammatory Mediators
Intranasal Beclomethasone nasal aerosol Broad anti-inflammatory effects. Reduces mucosal edema and
corticosteroids (QNASL®), budesonide nasal hyperreactivity and inhibits mediator release. Relieves all
(Rhinocort Aqua®), ciclesonide nasal symptoms and may relieve ocular symptoms. The most
(Omnaris®), ciclesonide nasal effective controller therapy for moderate-to-severe symptoms
aerosol (Zetonna®), fluticasone and/or nasal congestion.
furoate (Veramyst®), fluticasone
propionate (Flonase®),
triamcinolone (Nasacort AQ®)
Leukotriene Montelukast (Singulair®) Blocks the activity of leukotrienes, a potent mediator of allergy
modifier symptoms and inflammation.
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