Non sedating anti allergic
Non sedating anti allergic
They may cause substantial adverse effects, including sedation, fatigue, and impaired mental status.
Some antihistamines may also be helpful in reducing anxiety, inducing sleep, or at preventing or treating motion sickness.
Common adverse effects that occur with the use of intranasal decongestants are sneezing and nasal dryness. Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. Sublingual immunotherapy with once-daily grass allergen tablets: a randomized controlled trial in seasonal allergic rhinoconjunctivitis. Specific immunotherapy for respiratory allergy: state of the art according to current meta-analyses. Effect of omalizumab on symptoms of seasonal allergic rhinitis: a randomized controlled trial.
Duration of use for more than three to five days is usually not recommended, because patients may develop rhinitis medicamentosa or have rebound or recurring congestion.3 However, a study of 35 patients found no rebound when oxymetazoline was used for 10 days.30 Because oral decongestants may cause headache, elevated blood pressure, tremor, urinary retention, dizziness, tachycardia, and insomnia, patients with underlying cardiovascular conditions, glaucoma, or hyperthyroidism should only use these medications with close monitoring.35 A study of 25 patients with controlled hypertension provides some reassurance about the use of oral decongestants; compared with placebo, this randomized crossover study found minimal effect on blood pressure with pseudoephedrine use.31Intranasal cromolyn is available over the counter and is thought to act by inhibiting the degranulation of mast cells.1 Although safe for general use, it is not considered first-line therapy for allergic rhinitis because of its decreased effectiveness at relieving symptoms compared with antihistamines or intranasal corticosteroids, and its inconvenient dosing schedule of three or four times daily.13Ipratropium (Atrovent) has been shown to provide relief only for excessive rhinorrhea. Comparison of beclomethasone dipropionate aqueous nasal spray, astemizole, and the combination in the prophylactic treatment of ragweed pollen-induced rhinoconjunctivitis.
Adverse effects include a bitter aftertaste, headache, nasal irritation, epistaxis, and sedation. Probiotics prevent Ig E-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort.
Although intranasal antihistamines are an option in patients whose symptoms did not improve with second-generation oral antihistamines, their use as first- or second-line therapy is limited by their adverse effects and cost compared with second-generation oral antihistamines, and by their decreased effectiveness compared with intranasal corticosteroids.2829Oral and topical decongestants improve the nasal congestion associated with allergic rhinitis by acting on adrenergic receptors, which causes vasoconstriction in the nasal mucosa, resulting in decreased inflammation.35 Although the most commonly available decongestants are phenylephrine, oxymetazoline (Afrin), and pseudoephedrine, the abuse potential for pseudoephedrine should be weighed against its benefits. Randomized placebo-controlled trial comparing fluticasone aqueous nasal spray in monotherapy, fluticasone plus cetirizine, fluticasone plus montelukast and cetirizine plus montelukast for seasonal allergic rhinitis [published correction appears in Ratner PH, Hampel F, Van Bavel J, et al. Durham SR, Yang WH, Pedersen MR, Johansen N, Rak S. Compalati E, Penagos M, Tarantini F, Passalacqua G, Canonica GW. Casale TB, Condemi J, La Force C, et al.; Omalizumab Seasonal Allergic Rhinitis Trial Group.
Symptoms include rhinorrhea, nasal congestion, obstruction, and pruritus.1 Optimal treatment includes allergen avoidance, targeted symptom control, immunotherapy, and asthma evaluation, when appropriate.2 In 2001, Allergic Rhinitis and Its Impact on Asthma guidelines were published in cooperation with the World Health Organization, suggesting that the treatment of allergic rhinitis make use of a combination of patient education, allergen avoidance, pharmacotherapy, and immunotherapy.3 In contrast with previous guidelines, these recommendations are based on symptom severity and age, rather than the type or frequency of seasonal, perennial, or occupational exposures.
The adverse effects and higher cost of intranasal antihistamines, as well as their decreased effectiveness compared with intranasal corticosteroids, limit their use as first- or second-line therapy for allergic rhinitis.
Advantages include that it does not cross the blood-brain barrier and is not systemically absorbed.1 Adverse effects include dryness of the nasal mucosa, epistaxis, and headache.
Compliance is also an issue because it needs to be administered two or three times daily.1Although the leukotriene LTD receptor antagonist montelukast (Singulair) is FDA approved for the treatment of allergic rhinitis, a systematic review of 20 trials involving adults treated with montelukast for allergic rhinitis showed only minimal improvement (which was not clinically relevant) in the symptom of nasal congestion.32 Another RCT involving 58 adults comparing montelukast with pseudoephedrine for two weeks showed no difference between the two therapies.33 In addition, two large, independent meta-analyses concluded that although montelukast is better than placebo, it is not as effective as intranasal corticosteroids or antihistamines and should only be considered as second- or third-line therapy.3234Although many studies have looked at the combination of an intranasal corticosteroid with an antihistamine or leukotriene receptor antagonist, most have concluded that combination therapy is no more effective than monotherapy with intranasal corticosteroids.1137 However, one study looking at the combination of fluticasone and azelastine found this treatment combination to be superior to either treatment alone in patients with moderate to severe allergic rhinitis.38 Therefore, although patients should not have therapy initiated with more than one agent, combination therapy is an option for patients with severe or persistent symptoms. Ten days' use of oxymetazoline nasal spray with or without benzalkonium chloride in patients with vasomotor rhinitis.
Because their onset of action is typically within 15 to 30 minutes and they are considered safe for children older than six months, antihistamines are useful for many patients with mild symptoms requiring “as needed” treatment.27Compared with oral antihistamines, intranasal antihistamines offer the advantage of delivering a higher concentration of medication to a specific targeted area, resulting in fewer adverse effects.3 Currently, azelastine (Astelin; approved for ages five years and older) and olopatadine (Patanase; approved for ages six years and older) are the two FDA-approved intranasal antihistamine preparations for the treatment of allergic rhinitis. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Placebo-controlled trial of house dust mite-impermeable mattress covers: effect on symptoms in early childhood. Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
As a class, their onset of action occurs within 15 minutes and lasts up to four hours. Contact [email protected] copyright questions and/or permission requests.
They act by decreasing the influx of inflammatory cells and inhibiting the release of cytokines, thereby reducing inflammation of the nasal mucosa.3 Their onset of action is 30 minutes, although peak effect may take several hours to days, with maximum effectiveness usually noted after two to four weeks of use.9Many studies have demonstrated that nasal corticosteroids are more effective than oral and intranasal antihistamines in the treatment of allergic rhinitis.412 One randomized controlled trial (RCT) looking at quality-of-life measures compared the antihistamine loratadine (Claritin) with the nasal corticosteroid fluticasone (Flonase) in 88 adults over a four-week period.13 The study's results showed that symptom scores were comparable, but quality-of-life scores were superior in the nasal corticosteroid group. Only budesonide (Rhinocort) carries the FDA pregnancy category B safety rating, and only mometasone (Nasonex) has a delivery device that received recognition from the National Arthritis Foundation for ease of use.14The adverse effects most commonly experienced with the use of intranasal corticosteroids are headache, throat irritation, epistaxis, stinging, burning, and nasal dryness.315 Although the use of intranasal corticosteroids has raised concern for potential systemic adverse effects, including the suppression of the hypothalamic-pituitary axis, the products currently available have not been shown to have such effects.16 There are a few studies that looked specifically at the effects of intranasal corticosteroids on skeletal growth and adrenal activity.