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

• Histazin 25mg tab 1tab at night

3. If there is nasal obstruction add :

• Decozal 0.1% spray/drop 2-3 drops in each nostrils up to 3 times daily up to 7 days

4. In more sever cases add:

• Lukast 10mg once daily at bed time
• Avamys 50mcg/dose nasal spray 2 spray 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). 

Promethazine

Available forms:

• Histazin : 5mg/5ml syrup, 25mg tab
• Promet: 25mg tab
• Promethazine: 50mg/2ml for iv,im injection 

Therapeutic indications

• As symptomatic treatment for allergic conditions of the upper respiratory tract and skin including allergic rhinitis, urticaria and anaphylactic reactions to drugs and foreign proteins.
• As an antiemetic.
• For short term use in treatment of insomnia in adults.
• For short term use as a paediatric sedative.

The usual doses are:

25mg tablet:

• Adults  and Children>10 years : Start with 1 tablet (25 mg) taken at night. This maybe increased to a maximum of 1 tablet (25 mg) twice a dayif necessary.
• Children 5-10 years: A single tablet (25 mg) given at night. DO NOT give more than 25 mg per day.

50mg/2ml for iv,im injection 

• Adult : 25 mg; may be repeated in 2 hours when necessary; switch to PO as soon as possible
• Pediatrics≥2 years: 12.5-25 mg IM at bedtime

5mg/5ml syrup:

• 2-5 years: 5-15 mg(1-3ml) daily in 1 or 2 divided doses
• >5-10 years : 10-25(2-5ml) mg daily in 1 or 2 divided doses

Contraindications

• should not be used in patients in coma or suffering from CNS depression of any cause.
• should not be given to patients with a known hypersensitivity to any of the excipients.
• contraindicated for use in children less than two years of age because of the potential for fatal respiratory depression..

pregnancy and lactation

• should not be used in pregnancy unless the physician considers it essential.
• The use is not recommended in the 2 weeks prior to delivery in view of the risk of irritability and excitement in the neonate.
• Available evidence suggests that the amount excreted in milk is insignificant. However, there are risks of neonatal irritability and excitement.

Side effects 

• drowsiness, dizziness, restlessness, headaches, nightmares, tiredness, and disorientation. blurred vision, dry mouth and urinary retention 

Otrivine

Otrivine Nasal Spray contains the active ingredient xylometazoline hydrochloride which helps to open up and clear the nasal passages by reducing the excessive nasal secretions and returning the swollen blood vessels to their normal size.

 Used in :

• nasal congestion (blocked nose, including colds)
• allergic rhinitis
• sinusitis.
• Not used>5 days Cause rebound congestion

Pregnancy : not  recommended

Available forms:

• Otrivin 0.1% spray/drop , .05% spray /drop
• Decozal 0.1% spray/drop , .05% spray /drop
• Xylomet 0.1% spray

Dose:

Adult

• 0.1% Nasal drop 2-3 drops in each nostrils up to 3 times daily

Child>6y

• 0.05% Nasal drop 2-3 drops in each nostrils up to 3 times daily

Child 6months-6y

• 0.05% Nasal drop 1drops in each nostrils up to 3 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