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Allergic Rhinitis

Do your have the following symptoms frequently? 
  Icon Runny nose       Icon Itchy eyes, mouth or skin       Icon Sneezing  

Runny nose


Itchy eyes, mouth or skin



  Icon Stuffy nose due to blockage or congestion       Icon Fatigue       Icon Eye itching, burning, tearing, and redness  

Stuffy nose due to blockage or congestion



Often reported due to poor quality sleep as a result of nasal obstruction

Eye itching, burning, tearing, and redness

Ocular symptoms
If yes, you may have allergic rhinitis. Allergic rhinitis develops when the body’s immune system becomes sensitized and overreacts to something in the environment that typically causes no problem in most people.
Allergic rhinitis takes two different forms:

Management and Treatment

Identifying and avoidance of Trigger


Outdoor exposure


Indoor exposure


Exposure to pets


Pharmacological Treatment

Many allergens that trigger allergic rhinitis are airborne, so you can’t always avoid them. If your symptoms can’t be well-controlled by simply avoiding triggers, your doctor/pharmacist may recommend medications that reduce nasal congestion, runny nose, sneezing and itching. They are available in many forms — oral tablets, liquid medication, nasal sprays and eyedrops.

1) Intranasal corticosteroids (eg. Avamys, Nasonex, Omnaris, Rhinocort etc)


2) Antihistamines

Antihistamines help to relieve nasal allergy symptoms such as:
Sneezing and an itchy, runny nose   Eye itching, burning, tearing and redness   Itchy skin, hives and eczema

Classified into 2 classes:

  First Generation Antihistamine   Second Generation Antihistamine  
  • Shorter duration of action (4-6 hours), requires few dosing per day
  • Causes drowsiness, take care not to drive or work with dangerous machinery.
  • Slightly faster onset of action (15 - 30 minutes)
  • Eg. Chlorpheniramine, Dexchlorpheniramine, Promethazine, Triprolidine, diphenhydramine
  • Longer duration of action (12-24hours), can be taken once daily
  • Less likely to cause drowsiness
  • Eg. loratadine, desloratadine, cetirizine, levocetirizine, fexofenadine, bilastine
  • Follow your doctor/pharmacist's instructions.
  • Alcohol and tranquilizers increase the sedation side effects of antihistamines.
  • Do not use more than one antihistamine at a time, unless prescribed.
  • Keep these medications out of the reach of children.
  • Know how the medication affects you before working with heavy machinery, driving or doing other performance-intensive tasks; some products can slow your reaction time.
  • Some antihistamines appear to be safe to take during pregnancy, but there have not been enough studies to determine the absolute safety of antihistamines in pregnancy. Again, consult your doctor/pharmacist if you must take antihistamines.
  • CNS: restlessness, nervousness, overexcitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances.
  • GI: decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea.
  • Increased or decreased urination, urinary retention. Men with prostate enlargement may encounter urinary problems while on antihistamines. Consult your doctor/pharmacist if these reactions occur.

3) Decongestants

  • Side effects include insomnia if patient take the medication in the afternoon or evening. If this occurs, a dose reduction may be needed.
  • Often found in combination with oral antihistamines.
  • Help relieve the stuffiness and pressure caused by swollen nasal tissue
  • May elevate blood pressure, hence need to be avoided in patients with high blood pressure.
  eg. pseudoephedrine, phenylephrine  
  • Should not use them for more than 5 days. Prolonged use can cause rhinitis medicamentosa, or rebound congestion.
  • Work within minutes and last for hours.
  eg. Afrin spray, Iliadin Spray, Oxynase spray  

4) Nonprescription saline nasal spray

  • Help counteract symptoms such as dry nasal passages or thick nasal mucus. Unlike decongestant nasal sprays, a saline nasal spray can be used as often as it is needed.

5) Leukotriene Receptor Antagonist

  • Block the action of leukotriene, a substance in the body that can cause symptoms of allergic rhinitis.
  • Beneficial for patients with existing asthma since it also helps in asthma control.
  eg. Montelukast  

Treatments that are not recommended for allergic rhinitis

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