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

• Cerin 10mg tab once daily

3. If there is nasal obstruction add :

• Rhinaction Hypertonic sea water spray1puff 4-6 times daily

4. In more sever cases add:

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

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). 

 Cetirizin

Available forms:

• Zyrtic: 10mg tab, 1mg/1ml syrup, 10mg/ml oral drop
• Cerin :10mg tab, 1mg/1ml syrup
• Zertazin : 10mg tab, 5mg/5ml syrup
• Zeran :10mg tab
• Zain :10mg tab
• Siraz : 5mg tab, 5mg/5ml syrup
• Finallerg :10mg tab, 1mg/1ml syrup, 10mg/ml oral drop
• Sezonal :10mg tab
• Omcet : 5mg tab, 5mg/5ml syrup, 10mg/ml syrup

Therapeutic  indication:

• for the relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis
• for the relief of chronic nettle rash (chronic idiopathic urticaria).

Pregnancy and breast-feeding :

• Cetirizin should be avoided in pregnant women. Accidental use of the medicine by a pregnant
• woman should not produce any harmful effects on the foetus. Nevertheless, the medicine should be only administered if necessary and after medical advice.
• Cetirizine passes into breast milk. Therefore, should not taken during breast feeding 

 How to take Cetirizin Sandoz :

Adults :

• The recommended dose is 10 mg once daily as 1 tablet

Use in children between 6 and 12 years old:

• The recommended dose is 5 mg twice daily as a half tablet twice daily

side effects :

• fatigue
• dry mouth, nausea, diarrhoea
• dizziness, headache
• somnolence (sleepiness)
• pharyngitis (sore throat), rhinitis (swelling and irritation inside the nose)

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

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