1. Avoid exposure to allergen
2. In excessive nasal secretions (Rinorrhea,sneezing,itching):

• Azelastine 0.1% (1mg/ml ) nasal spray one spray into each nostril q12h

3. In nasal obstruction:

• Free breath 7.1mg/1ml nasal spray 1puffs 4-6 times daily

4. In more sever :

• Nasonex 0.05% nasal spray one spray into each nostril once daily
• Singulair 5mg once daily at bed time(>2y)

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. 
• Dimetindene maleate should not be used in pregnant women unless the benefit of treating the mother outweighs the risk for the foetus

Breast-feeding :

• There is a well-founded presumption that dimetindene can be excreted in human milk. So its not recommended.

Side effect :

• Fatigue
• Somnolence, nervousness

Free breath 7.1mg/1ml  nasal spray

• Metered dose nasal spray
• sea water natural nasal decongestant spray
• Physiological solution for rinsing the nose
• Makes the breathing easier
• Free Breath Metered Dose Nasal Spray moisturizes the nose and improves comfort during flight. Using this product daily can help restore and optimize this self-cleaning system.
• Helps to stimulate the body’s natural shield
• Natural way to relieve congestion
• Does not contain any medication, just salt and water

Dose:

• 1puffs 4-6 times daily

Pregnancy and lactation:

• Save

Corticosteroids nasal spray (Mometasone)

• help to relieve inflammation(swelling and irritation of the nose), sneezing, itching and a blocked up or runny nose.

Available forms:

• Nasonex, Tabunex, Sinocort: 05% nasal spray

 Indications:

• to treat the symptoms of seasonal allergic rhinitis (also called hayfever) and perennial (long lasting) rhinitis in adults and children aged 3 and older;
•  to treat nasal polyps in adults aged 18 and over

Dose:

Adult:

• recommended dose is two sprays in each nostril once a day. 
• Once symptoms are controlled, dose reduction to one spray in each nostril may be effective for maintenance.
• may  increase to  the dose; the maximum daily dose is four sprays into each nostril once a day. 

Children aged 3 to 11 years :

• the usual dose is one spray into each nostril once daily. 
• May used some days before the start of the allergy season, as this will help to prevent  allergic rhinitis symptoms from occurring. 
• Prophylaxis must be initiated up to 2-4 weeks prior to the anticipated start of the allergy season.
•  Benefit of treatment may be achieved in the first two days.
•  Maximum benefit is achieved within 1-2 weeks following initiation of treatment. Therefore, patients should continue regular use to achieve full therapeutic benefit. 

For patients who use MOMEX® at regular intervals for treatment of allergic rhinitis,:

• recommended dose is a spray into each nostril once a day. For children between the ages of 2 and 11 years the usual recommended dose is one spray in each nostril once a 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 therapy 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