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Allergy & Asthma Consult
Fitzgerald Health Education Associates, Inc., August 2015 fhea.com
A
lthough many patients have given up hope of
finding help for their allergic rhinitis, relief and
control of symptoms are possible with the im-
plementation of a tailored pharmacologic treatment
plan. In this issue, we discuss pharmacologic manage-
ment options to relieve and control the symptoms of
allergic rhinitis. In the
July FHEA Newsletter , we dis-
cussed history and diagnosis of allergic rhinitis in light
of this year's particularly severe allergy season.
Lori, a 34-year-old woman with allergic rhinitis,
presents to your practice, stating that she is feeling
miserable and that "nothing is working" to relieve
her allergies. Lori's history reveals lifelong allergic
rhinitis symptoms. Until three years ago, symptoms
had been mild, limited to the spring and fall, and
well controlled with an occasional antihistamine.
Since then, symptoms have progressively
worsened. Lori complains of a runny nose, nasal
congestion, sinus pressure, headaches, and
postnasal drainage occurring frequently and year-
round. This year, symptoms have been much more
severe even though she is taking cetirizine daily.
Nasal congestion is the most bothersome symptom
and is affecting her sleep.
There are several classes of medications and several
choices of medications within these classes that are
options for the treatment of allergic rhinitis (
Table 1 ).
Prior to choosing one of these medications, the health-
care provider needs to take the following steps:
1. Ascertain what the chief complaint is, obtain a his-
tory of the present illness, and perform a review of
pertinent systems
2. Identify the most bothersome symptom(s)
3. Determine details regarding the patient's prior
use of allergic rhinitis medications
4. Assess the severity and chronicity of the patient's
allergic rhinitis symptoms
5. Compare the effectiveness of the various allergic
rhinitis medications' ability to relieve the specific
symptoms
6. Incorporate information from evidence-based
guidelines.
For example, if itching were Lori's most bothersome
symptom, an oral antihistamine should be used. Oral an-
tihistamines are more effective in relieving itching than
other pharmacologic therapies for allergic rhinitis (
Table
2
).
1
If Lori needs relief from chronic nasal congestion, an
Pharmacologic Management of Allergic
Rhinitis When Nothing Seems to Help!
Christy Yates, MSN, FNP-BC, NP-C, AE-C
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