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

If there are excessive secretions and sneezing   add:

• Claritine 10mg orally once a day in the evening

 If there is nasal obstruction add :

• Sterimar Isotonic sea water spray 1puff 4-6 times daily

In more sever cases add:

• Montelukst 10mg once daily at bed time

Loratadine

Available forms:

• Loratan, clara, histal, Klarihist, Loreen, Lorine Lohist, Ramitin:10mg tab, 5mg/5ml syrup
• Tidilor, Claritine, Lorax :10mg tab, 1mg/1ml syrup
• Loratin, Restamine:10mg tab
• Lostamin: 5mg/5ml syrup

Indications:

• Relief of symptoms associated with allergic rhinitis, such as sneezing, nasal discharge (rhinorrhea) as well as ocular itching and burning.
• indicated for the relief of symptoms and signs of chronic urticaria and other allergic dermatologic disorders.

Dose:

• Adults and children 6 years and older who weigh more than 30kg : 1 x tablet once daily
• Adults and children over 12 years of age: 2 teaspoons (10 ml), once a day, with or without food.
• The dosage for children aged 2-12 is by weight:
• Body weight over 30 kg: 2 teaspoons (10 ml), once a day, with or without food.
• Body weight of 30 kg or less: one teaspoon (5 ml), once a day, with or without food.

Pregnancy and breast-feeding :

As a precautionary measure, it is preferable to avoid the use of Loratadine Tablets during pregnancy. Loratadine is excreted in breast milk so preferable to avoid the use in lactation

side effect:

• drowsiness  
• headache
• increased appetite 
• difficulty sleeping.

Pregnancy : 

• Category b

Sterimar Isotonic sea water spray 

• Is a natural nasal decongestant spray
• Is an isotonic filtered sea water solution, 100% natural and free from preservatives
• Restores natural moisture of the nose (air conditioning, heating, travel). To assist when ENT disorders (sinusitis, colds, hayfever, allergies, dry & stuffy noses).

Dose:

• 1puffs 2 to 6 times a day in each nostril as required or as needed.

Pregnancy and lactation:

• Save

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 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