Pharmacologic Therapy

There are three guideline documents, all published in 2008, that are the basis for the

summary that follows. Other sources provide additional information for the treat-

ment of AR. The recommended approaches begin with allergen avoid ance, emphasize patient/family education, and include immunotherapy as an option in selected patients.

The most reasonable plan may include considerations from several of these documents. Routine first-line agents are intranasal corticosteroids and antihistamines (oral and/or intranasal, depending on the patient). Adjunctive or secondary choice agents, each of which may have a first-line role in selected patients, include decongestants, the mast cell stabilizer/cromone (cromolyn), the leukotriene receptor antagonist (LTRA) (montelukast), the antimuscarinic/anticholinergic (ipratropium) and intranasal saline. In all cases, therapy must be individualized, in cooperation with the patient. Considerations include frequency and severity of specific symptoms, realistic avoidance measures, patient age, patient preferences for route of administration, tolerance of side effects, adherence issues, comorbid disorders, and concurrent therapy. See Table 62-4 of intranasal and oral medications for the treatment of AR.

Table 62-3 Allergen Avoidance Measures

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