Allergic Rhinitis and Sinusitis: Treatment

Allergic Rhinitis

Avoidance of inciting factors is the most helpful treatment. The following measures are also helpful:

• Nasal irrigation with hypertonic saline solution may improve symptoms.
• Among pharmaceutical treatments, intranasal steroids are first–line agents and may also improve asthma symptoms. They will not help allergic conjunctivitis, for which ophthalmic antihistaminic drops should be used.
• Skin testing focused immunotherapy injections may significantly improve symptoms and quality of life. Beta–blocker therapy is an absolute contraindication to immunotherapy. Immunotherapy injections may help prevent asthma onset in children.
• Cromolyn is generally less effective than nasal steroids, but it can improve symptoms by inhibiting mast cell mediator release.
• Leukotriene receptor antagonists may be used in combination with other medications and are similar in efficacy to loratadine, a second–generation antihistamine.³
• Antihistamines, either oral or intranasal, will improve allergic rhinitis symptoms and are most effective when taken prior to allergen exposure, Adequate treatment with intranasal steroids should preclude the need for antihistamines and decongestants. Second–generation antihistamines have fewer unpleasant side effects.
• NSAIDs improve systemic sequelae, such as cough.
• Nasal decongestant sprays should not be used due to tachyphylaxis, unless on a temporary basis for a few days, or prior to elevation gain (eg, mountains, airplanes).
• Oral decongestants such as pseudoephedrine do not cause tachyphylaxis, which nasal decongestant sprays often do.
• Ipratroprium bromide may be helpful when profuse rhinorrhea occurs.

Sinusitis

• Nasal irrigation with hypertonic saline solution may improve symptoms.
• In presumed cases of acute bacterial sinusitis, antibiotics are not always necessary for initial therapy.
• Amoxicillin, amoxicillin–clavulanate, telithromycin, and cephalosporins are reasonable initial options.
• Chronic bacterial sinusitis may require a prolonged course of antibiotics (3–6 weeks).
• Recurrent/chronic disease may necessitate intranasal steroids and a repeat antibiotic course, radiologic imaging, and specialty referral.
• Nasal steroids are the most effective and safest method to control sinonasal inflammation in patients with chronic rhinosinusitis.
• Symptomatic treatment with antihistamines, decongestants, and nonsteroidal anti–inflammatory drugs (NSAIDs) for systemic sequelae, such as cough, congestion, and fatigue, may be helpful.