- Avoid exposure to allergen
- If there are excessive secretions and sneezing add:
- Fexofast 120mg orally once a day
- If there is nasal obstruction add :
- Rinomest 6.5mg/ml spray 1puff 4-6 times daily
- In more sever cases add:
- Singulair 10mg once daily at bed time
- Dalman 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).
Fexofenadine
Available forms:
- Telfast, Exofen, Fexofast, Fexodex, Fenadex, Feskine, Fexadine:
- 120mg, 180mg tab
Theraputic indication:
for symptoms that occur with hay fever (seasonal allerigic rhinitis) such as sneezing, itchy, running or blocked nose and itchy, red an watery eye ).
Dose:
For adults and children aged 12 years and over:
- 120 mg Tablets: The recommended dose is one tablet (120mg) daily. Taken with water before a meal.
- 180 mg Tablets: The recommended dose is one tablet (180mg) daily. Taken with water before a meal.
Pregnancy and breast-feeding
- Fexofenadine hydrochloride is not recommended duing pregnancy breast-feeding.
Common side effects
- headache
- Drowsiness
- feeling sick (nausea)
- dizziness
Rinomist 6.5mg/ml nasal spray
- Sodium chloridenatural nasal decongestant spray
- is an over the counter (OTC) moisturizing nasal spray that relieves the symptoms of dry, irritated nasal mucosa due to nasal congestion, dry weather, smoking, colds, nose bleeds, and other similar conditions.
Dose:
- 1puffs 4-6 times daily
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
In Emergency room:
- Give Antihistamine In sneezing and rhinorrhea :
- Allerfin 10mg/ml IM injection :
Dose:
- 1-5 year : 25-5mg (½ ml )
- 6-12 year: 5-10mg (1ml )
- Adult : 10-20 mg (1-2 ml )
- Give Dexamethasone 4mg/1ml
Dose:
Pediatrics:
- 0.3 mg/kg/day IV / IM divided q6hr or q12hr
Adult:
- 4-8 mg IM /IV
Allergic rhinitis
Presentation :
- Rhinorrhea
- Repetitive sneezing
- nasal congestion, obstruction
- postnasal drainage
- Pruritus
- Itching of the palate, nose, ears, eye
- Snoring
- Frequent sore throats
- Cough
- Headache
- Itching redness watery eyes
Lines of management :
- Avoid exposure to allergens
- In excessive secretions and sneezing: oral antihistamine
- If nasal obstruction: Nasal decongestant
- For ocular symptoms: intranasal antihistamine
- If Symptoms persist and affect quality of life: Intranasal Corticosteroid
- Sever and persistent symptoms: Intranasal Corticosteroid + oral or intranasal antihistamine+ Oral leukotriene receptors antagonist