Most allergic rhinitis patients complain of nasal congestion and rhinorrhea, and topical nasal steroids are the most effective means of treating this problem. Typically, these medicines take up to a week to reach full efficacy, so encourage your patients to give them a good trial. Your patients may also exhibit some “steroid phobia,” so you will need to explain to them that these medicines are extremely safe.

Antihistamines will help most of the allergic symptoms other than nasal congestion. They generally have a rapid onset of action, so they are effective as PRN medications. Be careful with the first generation antihistamines. They are inexpensive and effective, but they are also “sedating.” Actually, “impairing” would be a better description, since many patients do not recognize the sedating qualities of the medications. This decreased cognition could lead to decreased productivity and increased accidents. The second generation antihistamines are significantly safer.

Singulair has been approved for the treatment of allergic rhinitis. Relief may be similar to that provided by some antihistamines. Singulair has a slower onset of action than that of the antihistamines, so it would need to be taken prophylactically rather than as needed.

Decongestants are effective at treating nasal congestion, but the topical nasal steroids are more effective and better tolerated. Insomnia is the most common side effect of this class of medications, which may be why many patients become fatigued on these “non-sedating” medications. Tremors, palpitations, and increased blood pressure are also potential side effects.

Allergy Immunotherapy is also a safe and effective option that you should consider for your patients with Allergic Rhinitis, especially if they do not experience significant relief from the other treatment options. Some patients may prefer immunotherapy because of the high cost of medications, or they may prefer not to rely on medications for their relief. Even if you find an effective medication, there is a chance that it may fail in the future. You may also want to consider immunotherapy for patients who have other related diseases, such as asthma or sinus disease.

Children with Allergic Rhinitis are at a higher risk of developing allergic asthma, and Allergy Immunotherapy has been demonstrated to significantly reduce the development of asthma in these patients. While the other treatments for Allergic Rhinitis focus on symptom control, allergy immunotherapy targets the cause. It can make the patient less allergic and often effects a cure. The biggest downside to allergy immunotherapy is that it is often inconvenient for patients to come in for routine injections, but most patients are able to go 3-4 weeks between injections after the first year, and even less frequently after that. Also, most patients are able to discontinue allergy injections after 3-5 years and still maintain the benefit for many years later.

About The Author
Dr. Gary B. Moss received a BA in Biology from the University of Chicago and an MS in Human Physiology from Georgetown University. He graduated from the Medical College of Virginia, where he also completed his Internship and Residency in Internal Medicine. He served as a Fellow of Allergy and Immunology at Barnes-Jewish Hospital and Washington University at the St. Louis School of Medicine.

He is Board Certified in Internal Medicine and in Allergy and Immunology. Dr. Moss is on staff at Sentara Norfolk General Hospital, Sentara Leigh Memorial Hospital, Bon Secours De Paul Hospital, and Chesapeake General Hospital.