1. Avoid exposure to allergen
2. If there are excessive secretions and sneezing add:

• Chlorohistol 4mg tab 4mg 1tab every 4-6 hours

3. If there is nasal obstruction add :

• Vibrocil nasal spray apply 1 to 2 sprays in each nostril, 3to 4 times a day

4. In more sever cases:

• Avamys 50mcg/dose nasal spray 2 sprays in each nostril once a day
• Montelukast 10mg once daily at bed time

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). 

 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

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

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