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

• Lesonal 0.5 mg /ml syrup 5 mL (1 teaspoon) once a day taken in the evening

3. In nasal obstruction:

• Vibrocil nasal drops 3 to 4 drops 3 to 4 times a day in each nostril

4. In more sever :

• Tabunex 0.05% nasal spray one spray into each nostril once daily
• Lukast 5mg once daily at bed time

Levocetirizine

Available forms:

• Xyzal, Levosyn, levar, Levozal, Zolix, Cetazal      :5mg tab
• Layal  : 5mg tab, 2.5 mg /5ml syrup
• L-cet : 5mg tab, 0.5mg/ml syrup
• Hpi –levocetirizine : 5mg tab
• Lesonal :  5mg tab, 0.5 mg /ml syrup

Theraputic indications:

• allergic rhinitis (including persistent allergic rhinitis);
• nettle rash (urticaria).

Dose:

Adults :

• 5 milligrams (mg) or 10 mL) (2 teaspoons) once a day taken in the evening. Some patients may be given 2.5 mg or 5 mL (1 teaspoon) once a day taken in the evening.

Children 6 to 11 years of age : 

• 2.5 mg or 5 mL (1 teaspoon) once a day taken in the evening. Do not take more than 2.5 mg per day.

Children 6 months to 5 years of age :

•  1.25 mg or 2.5 mL (1/2 teaspoon) once a day taken in the evening. Do not take more than 1.25 mg per day.

For oral dosage form (tablets):

• Adults and children 12 years of age and older—5 mg (1 tablet) once a day taken in the evening. Some patients may be given 2.5 mg (1/2 tablet) once a day taken in the evening. Do not take more than 5 mg per day.
• Children 6 to 11 years of age—2.5 mg (1/2 tablet) once a day taken in the evening. Do not take more than 2.5 mg per day.

Side effect:

• dry mouth,
• headache,
• tiredness
• somnolence/drowsiness.

Vibrocil

Composition :Nasal drops, nasal spray: Dimetindeni maleas 0.25 mg, Phenylephrinum 2.5 mg

Indications Therapeutic use :

• Common colds, acute and chronic rhinitis, seasonal (hay fever) and non-seasonal allergic rhinitis, acute and
• chronic sinusitis, pre- and postoperative care, adjuvant in cases of acute otitis media.

Dosage:

Nasal drops

• Children from 1to 6 years: 1 to 2 drops 3 to 4 times a day in each nostril.
• Children over 6 years and adults: 3to 4 drops 3 to 4 times a day in each nostril.

Nasal spray

• Adult: apply 1 to 2 sprays in each nostril, 3to 4 times a day.

pregnancy and breast-feeding :

• Vibrocil should not be used as a precaution because too little experience is available

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