Treatment:

If rhinitis symptoms are caused by non-allergic conditions, particularly if there are accompanying symptoms indicating a serious problem, the doctor should treat any underlying disorders. If rhinitis is caused by medications, such as decongestants, the patient may need to stop taking them or find alternatives.

Overall Approaches to Treating Allergic Rhinitis

A variety of items must be considered in selecting a treatment approach. These include:

• Severity of the symptoms
• Frequency (seasonal versus all year, how often during the week)
• Age of patient
• Presence of other related illnesses, such as asthma, atopic eczema, sinusitis, and polyps
• Patient preference regarding types of treatment
• Association with allergens
• Potential and known side effects of medications
• In children, it is important for parents to determine if the child is actually under severe distress and that the parent is not simply responding to their own anxiety when they hear their child snorting or snoring.

Patients with allergic rhinitis have a variety of treatment options available to them:

• Environmental control measures
• Nasal washes may provide good symptomatic relief for some patients.
• Drugs that reduce the inflammatory response are important for preventing moderate or severe allergic rhinitis. Nasal corticosteroids (commonly called steroids) are now considered to be the most effective measure for preventing allergy attacks. Other anti-inflammatory drugs, including leukotriene antagonists and nasal cromolyn, may be tried as second-line medications.
• Antihistamine tablets relieve sneezing and itching and can prevent nasal congestion before an allergy attack, or may be used to treat symptoms. Many brands are available by prescription and over-the-counter.
• Decongestant pills may be used by patients to relieve symptoms. Antihistamine pills may be combined with decongestants. DO NOT USE OVER THE COUNTER DECONGESTANT SPRAYS FOR MORE THAN THREE DAYS AT A TIME.
• Ipratopium bromide nasal spray (Atrovent) does not help with congestion, but may help relieve runny nose.
• Immunotherapy ("allergy shots") may be considered for patients with more severe seasonal allergies that do not respond to treatment. It may also prevent or help manage asthma and the development of new allergies in children.

All drug treatments have side effects, some very unpleasant and, in rare cases, serious. Patients may need to try different drugs until they find one that relieves symptoms without producing excessively distressing side effects.

Treating Seasonal Allergies

Because seasonal allergies generally last only a few weeks, most doctors do not recommend the stronger prescription treatments for children.

• Prescription drugs are required only in severe cases. However, in children with both asthma and allergies, treatments for allergic rhinitis may also improve asthmatic symptoms.
• Patients with severe seasonal allergies should start medications a few weeks before the pollen season and continue taking them until the season is over.
• Immunotherapy ("allergy shots") may be considered for patients with severe seasonal allergies that do not respond to treatment.

Treating Mild Allergy Attacks. Treating mild allergy attacks usually involves little more than reducing exposure to allergens and using a nasal wash. Dozens of treatments are available for allergic rhinitis. Many are available over-the-counter, but some require a prescription. They include:

• Nasal washes
• Intermittent usage of second-generation, nonsedating antihistamines
• Decongestants that relieve nasal congestion and itchy eyes for children over the age of 2 and adults
• Decongestant/antihistamine combinations

Treating Moderate-to-Severe Allergic Rhinitis. Patients with chronic allergic rhinitis or those who have bothersome symptoms that active during most of the year (particularly if they also have asthma) may require daily medications. These drugs include:

• Anti-inflammatory drugs. Nasal corticosteroids are recommended for patients with moderate-to-severe allergies, either alone or in combination with second-generation antihistamines.
• Antihistamines. The second-generation, non-sedating antihistamines -- such as cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra), or desloratadine (Clarinex) -- cause less drowsiness than older antihistamines, such as Benadryl. They are recommended alone or in combination with nasal corticosteroids for treatment of moderate-to-severe allergic rhinitis.
• Leukotriene-antagonists and nasal cromolyn may be beneficial in specific cases of allergies.
• Immunotherapy ("allergy shots") works well for many patients with severe allergies. It is also proving to reduce asthma symptoms and the use of asthma medications in patients with known allergies.

Nasal Washes

For mild allergic rhinitis, a nasal wash can be helpful for removing mucus from the nose. You can purchase a saline solution at a drug store or make one at home (2 cups of warm water, a teaspoon salt, pinch of baking soda). Over-the-counter saline nasal sprays that contain benzalkonium chloride as a preservative may actually worsen symptoms and infection.

Simple method for administering a nasal wash:

• Lean over the sink head down.
• Pour some solution into the palm of the hand and inhale it through the nose, one nostril at a time.
• Spit the remaining solution out.
• Gently blow the nose.

Neti pots have also become popular in recent years for prevention and treatment of allergic rhinitis. Nasal irrigation with a saline solution through a neti pot involves:

• Lean over the sink with your head tilted to one side.
• Insert the spout of the neti pot in the upper nostril.
• Slowly pour the salt water into your nose while continuing to breathe through your mouth.
• The water will flow through the upper nostril and out through the lower nostril.
• When the water finishes dripping out, blow your nose.
• Reverse the tilt of your head and repeat the process with the other nostril.

Treating Itchy Eyes

Itching and redness in the eyes sometimes respond to oral antihistamines. Eye drops, however, provide faster relief, and a combination of the two may be best. The following are eye drops for itchy eyes. Others are also available. Individual responses vary, and patients need to find which specific treatment works best for them.

• Antihistamine eye drops: azelastine (Optivar), olopatadine (Patanol), ketotifen (Zaditor), levocabastine (Livostin) for relief of both nasal symptoms and itchy red eyes
• Decongestant eye drops: phenylephrine (Allergan Relief), naphazoline (Naphcon, Opcon-A, VasoClear), tetrahydrozoline (Murine Plus, Visine)
• Combination decongestant/antihistamine: Visine A
• Corticosteroids: loteprednol (Lotemax, Alrex), pemirolast (Alamast)
• Non-steroidal antiinflammatory eye drops: ketorolac (Acular)

General Side Effects and Warnings.

• All eye drops can cause stinging, and some may result in headache and congestion.
• No one should continue taking eye drops if they experience pain, changes in vision, worsened redness, or irritation, or if the condition lasts more than 3 days.
• Do not touch the tip of the device to the eye or touch other surfaces with it. Replace the cap after using. Discard any solution that changes color or becomes cloudy.
• People who have heart disease, high blood pressure, an enlarged prostate gland, or glaucoma should talk to their doctor before taking these types of eye drops.