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

• Hydroxyzine 25mg 1 tab every 8-6 hours

3. If there is nasal obstruction add :

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

4. In more sever cases add:

• Sincast 10mg once daily at bed time
• Rhinocort 32mcg/dose nasal spray one spray in each nostril once a day

Corticosteroids nasal spray (Budesonide)

Available forms:

• Rhinocort :32mcg/dose,64mcg/dose

 Indications:

• corticosteroid indicated for the management of thenasal symptoms of perennial nonallergic rhinitis in adult and pediatric patients aged  6years and older. 

Dose:

• Rhinocort :32mcg/dose For intranasal use only.

Starting dosage:

Adult and children >6 years:

• 64 mcg (one spray per nostril ) once daily. 

Maximum dosages:

• Adults: 256 mcg (four sprays per nostril of Rhinocort :32mcg/dose) once daily. 
• Pediatric patients (6 to <12 years of age): 128 mcg (two sprays per nostril Rhinocort :32mcg/dose) once daily.

Hydroxyzine

Available forms:

• Atarax :25mg tab, 10mg/5ml syrup
• Newrax  :10mg/5ml syrup

Therapeutic indications:

• Anxiety in adults 
• Itching (pruritus) caused by allergic reactions in adults and children.

Dose :

• In adults the maximum daily dose is 100 mg (4 tablets) per day 

Adults

For anxiety:

• The usual dose is ½ tablet at breakfast, ½ tablet at lunch and 1 tablet in the evening
• doctor may increase this to a maximum of 4 tablets taken three times a day.

For pruritis (itchiness of the skin):

• The usual dose is 1 tablet before going to bed
• doctor may increase this to 1 tablet three or four times a day

Children

• In children up to 40 kg, the maximum daily dose is 2 mg/kg/day.

For pruritis :

• The usual dose is 0.5 mg per kg of body weight twice a day
• doctor may increase this to a maximum of 1 mg per kg of body weight twice a day

The elderly

• In the elderly, the maximum daily dose is 50 mg (2 tablets) per day.
• The usual starting dose is 25 mg (1 tablet) a day

Contraindication :

• allergy to hydroxyzine hydrochloride or any of the other ingredients 
• allergy to cetirizine, other piperazine derivatives, aminophylline or ethylenediamine
• pregnancy or breastfeeding
• porphyria.(A blood disease that can cause stomach pain, vomitingand mental disturbances such as depression
• ECG (electrocardiogram) shows a heart rhythm problem called “QT interval prolongation”

Pregnancy and breastfeeding :

• Not recommended in  pregnancy or breastfeeding

Side effect:

• feeling sleepy
• dry mouth, feeling tired, headache

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

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