Managing allergic rhinitis: The role of pharmacotherapy

While avoidance measures are a key component of the treatment of allergic rhinitis, pharmacologic therapies are often needed to adequately control symptoms. Intranasal corticosteroids are highly effective and are particularly useful in patients with moderate to severe disease. After use for 1 to 2 weeks, the patient should be reevaluated and the dose adjusted based on the response to therapy, with the goal being symptom relief at the lowest effective dose. Antihistamines, which may be given alone or with intranasal corticosteroids, control the patient's sneezing, nasal itching, rhinorrhea, and conjunctival itching. For most patients, the second- and third-generation antihistamines are better options than the first-generation antihistamines because of their superior side-effect profiles. When using cromolyn to manage seasonal symptoms, it is advisable to begin therapy 2 weeks before the expected allergen exposure. Ipratropium is helpful in patients whose main symptom is rhinorrhea.