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

• Atarax 25mg tab 1tab every 8-6 hours

3. If there is nasal obstruction add :

• Rhinaction Hypertonic sea water spray1puff 4-6 times daily

4. In more sever cases add:

• Montelukast 10mg once daily at bed time
• Flixonase 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). 

 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

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