Allergic Rhinitis

Question 0

First-generation oral antihistamines

Answer 0

1. Diphenhydramine(Benadryl): 25-50mg q4-6h prn
2. Chlorpheniramine (chlor – trimeton)
3. Promethazine (Phenergan): 12.5-25mg q4-6h prn

Warning: do not use an elderly due to strong anticholinergic effects, caution with CV disease, prostate enlargement, glaucoma, asthma, thyroid disease

Generally safe in pregnancy but chlorpheniramine is first line

Blackbox warning for promethazine: do not use in children less than two years due to risk of respiratory failure

Question 1

Intranasal corticosteroids

Answer 1

First-line for moderate to severe rhinitis

Drugs:

1. Beclomethasone (Qnasil)
2. Budesonide (Rhinocort Aqua): first choice in pregnancy
3. Ciclesonide (Omnaris)
4. Flunisolide
5. Fluticasone (Flonase, Veramyst)
6. Fluticasone plus Azelastine (dymista)
7. Mometasone (Nasonex)
8. Triamcinolone (Nasacort)

Side effects: headache, pharyngitis, epistaxis

Question 2

Second-generation oral antihistamines

Answer 2

1. Cetirizine (Zyrtec)
2. Desloratadine (Clarinex, Clarinex D, Clarinex RediTabs)
3. Fexofenadine (allegro, Allegra-D 12 hour, Allegra D 24 hour, children’s Allegra ODT)
4. Levocetirizine (xyzal)
5. Loratadine (Claritin, Claritin-D 24 hour, Claritin RediTabs, Alavert)

Question 3

Intranasal antihistamines

Answer 3

1. Azelastine (astelin, astepro): indicated for >5 yo
2. Azelastine plus fluticasone (Dymista)
3. Olopatadine (patanase): indicated for >= 6yo

Side effects: better taste, headache, somnolence, major irritation, minor nosebleed, sinus pain