1. Avoid exposure to allergen
2. Flixonase 50mcg/dose 2 sprays per nostril once daily (200 mcg per day).

If there are excessive secretions and sneezing   add:

• Fencil drop 1mg/1ml 20 –40 drops 3× a day

 If there is nasal obstruction add :

• Apisal 9mg/ml drop 1puffs /drop 4-6 times daily

In more sever cases add:

• unicast10mg once daily at bed time

Dimetindene

Available forms:

• Fenistil: drop 1mg/1ml, 4mgcaps, 1mgtab
• Pedia fast: drop 0.1g/100ml, 0.01g/100ml syrup
• Alergin: drop 1mg/1ml (1 ml = 20 drops).
• Fencil: drop 1mg/1ml
• 1 ml contains dimetindene maleate 1 mg (1 ml = 20 drops).

 Therapeutic indications

• Symptomatic treatment of allergic diseases:
• Skin: Urticaria, pruritus of various etiology, endogenous eczema with previous medical diagnosis.
• Respiratory system: Seasonal (hay fever) and perennial rhinitis with previous medical diagnosis.
• Relieve of itching associated with infectious diseases (e.g. chickenpox) with previous medical diagnosis or after an insect bite or stings.

Dose:

1mg/1ml oral drops, 0.1g/100ml drop:

• Adults :The recommended daily dose is 3 – 6 mg of dimetindene maleate divided into 3 doses, 
• 20 –40 drops 3× a day.
• Paediatric The recommended daily dose for children 1 – 11 years is 0.1 mg dimetindene maleate/kg body
• 2 drops/kg/day divided into 3 doses.

1mg tablet:

• 1 to 2 milligrams three times daily 

0.01g/100ml syrup:

• the recommended dose is 1 teaspoonful (5 ml) of a 0.01g/100ml syrup 3-4 times daily

4mg capsule :

• 1capsule once      daily 

Contraindications :

• Hypersensitivity to the active substance or to any of the excipientsInfants and children under 1 year of age.

pregnancy and lactation :

• Pregnancy There are no data about the use of dimetindene maleate during pregnancy.
• Category B 

Corticosteroids nasal spray (Fluticasone)

Available forms:

• Flixonase, Rhinase, Dalman, Avamys, Aierxem: 50mcg/dose

Indications:

• corticosteroid indicated for the management of thenasal symptoms of perennial nonallergic rhinitis in adult and pediatric patients
• aged 4 years and older. 

Dose:

For intranasal use only. Recommended starting dosages:

• Adults:  2 sprays per nostril once daily (200 mcg per day). 
• Adolescents and children aged 4 years and older: 1 spray per nostril oncedaily (100 mcg per day). 

 Montelukast

Available forms :

• Singulair
• Lukast
• Unicast
• Sincast
• Motrinex
• 4mg 5mg, 10mg Chewable tab

Action:

• Montelukast is in the leukotriene receptor antagonist family of medications. It works by blocking the action of leukotriene D4 in the lungs resulting in decreased inflammation and relaxation of smooth muscle
• Leukotrienes cause tightening of airway muscles and the production of excess mucus and fluid. These chemicals play a key role in allergies, allergic rhinitis, and asthma, also causing a tightening of your airways, making it difficult to breathe. 

Indications

• Indicated in the treatment of asthma as add-on therap in adults and adolescents from 15 years of age and older with mild to moderate persistent asthma who are inadequately controlled on inhaled corticosteroids and in whom “as-needed” short acting β-agonists provide inadequate clinical control of asthma. 
• Montelukast Film-coated tablet can also provide symptomatic relief of seasonal allergic rhinitis. 
• Indicated in the prophylaxis of asthma in which the predominant component is exercise-induced bronchoconstriction. 

Pregnancy

• Montelukast may be used during pregnancy only if it is considered to be clearly essential. 

Lactation

• Studies in rats have shown that montelukast is excreted in milk. It is not known if montelukast is excreted in human milk. 
• May be used in breast-feeding only if it is considered to be clearly essential. 
• Side effects:
• Headache
• Abdominal pain
• Upper respiratory infection
• Diarrhea, nausea, vomiting
• Elevated levels of serum transaminases (ALT, AST)
• Rash
• Pyrexia

Dose:

• Adult: 10mg once daily at bed time
• Children 6-14y: 5mg once daily at bed time

2-5 y: 4mg once daily at bed time