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:

• Rhinaction nasal spray 1 spray per nostril, 6 times a day

4. In more sever :

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

Chlorpheniramine

Available forms:

• Allerfin: 4mg tab, 10mg/ml ampule, 2.5mg/5ml syrup
• Anallerge: 4mg tab 2mg/5ml syrup
• Chlorohistol: 4mg tab

 Therapeutic indications:

• symptomatic control of all allergic conditions responsive to antihistamines, including hay fever, vasomotor rhinitis, urticaria, angioneurotic oedema, food allergy, drug and serum reactions, insect bites.
• Also indicated for the symptomatic relief of itch associated with chickenpox.

Method of administration:

• Adults:  4 mg (1 tablet or 10 ml) every 4-6 hours. Not more than six doses (24 mg) a day if under 65 years of age, or more than a total of three doses (12 mg) a day if over 65 years.
• Children aged 6-11 years: 2 mg (5 ml) every 4-6 hours. Not more than a total of six doses (12 mg) a day.
• Children aged 2-5 years: 1 mg (2.5 ml liquid medicine) every 4-6 hours. Not  more than a total of six doses (6 mg) a day.
• Children 1 year-23 months: 1 mg (2.5 ml liquid medicine) twice daily, preferably morning and evening

Contraindications

• contra-indicated in patients who are hypersensitive to antihistamines or to any of the tablet ingredients.

Pregnancy

• There are no adequate data from the use of chlorphenamine maleate in pregnant women. The potential risk for humans is unknown. Use during the third trimester may result in reactions in the newborn or premature neonates. Not to be used during pregnancy unless considered essentially by a physician.

Lactation

• Chlorphenamine maleate and other antihistamine may inhibit lactation and may be secreted in breast milk. Not to be used during lactation unless considered essential by a physician

Side effects :

• Sedation
• drowsiness, dizziness, blurred vision and psychomotor impairment
• Nausea, dry mouth
• Disturbance in attention

Rhinaction Hypertonic sea water spray

• Sea water
• is a natural nasal decongestant spray
• Clearing and purifying solution, combining hypertonic seawater with a complex of 3 essential oils: Ravintsara, Thyme Linalool and Field Mint. 
• Enables a reduction in symptoms of congestion, rhinorrhoea (runny nose) and sneezing by eliminating viruses and bacteria from nasal passages through draining effect
•  Quickly relieves blocked nose and for up to 8 hours with a regular application of 1 spray per nostril, 6 times a day.

Dose:

• 1 spray per nostril, 6 times a day.

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