Sedating antihistamines examples
Patients should be educated about their condition and advised to avoid known allergens.
Intranasal corticosteroids are the most effective treatment and should be first-line therapy for persistent symptoms affecting quality of life.
Because their onset of action is typically within 15 to 30 minutes and they are considered safe for children older than two years, second-generation antihistamines are useful for many patients with mild symptoms requiring as-needed treatment.214Compared with oral antihistamines, intranasal antihistamines have the advantage of delivering a higher concentration of medication to a targeted area, resulting in fewer adverse effects and an onset of action within 15 minutes.2 Intranasal antihistamines FDA-approved for the treatment of allergic rhinitis are azelastine (Astelin; for patients five years and older) and olopatadine (Patanol; for patients six years and older).
They have been shown to be similar or superior to oral antihistamines in treating symptoms of conjunctivitis and rhinitis, and may improve congestion.31 Adverse effects include a bitter aftertaste, headache, nasal irritation, epistaxis, and sedation.
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Severity can be divided into mild (symptoms do not interfere with quality of life) or severe (symptoms impact asthma control, sleep, sports participation, or school or work performance).3Patients with allergic rhinitis should avoid exposure to cigarette smoke, pets, and allergens that are known to trigger their symptoms.3 Nasal saline irrigation alone or combined with traditional treatments for allergic rhinitis has been shown to improve symptoms and quality of life while decreasing overall allergy medication use.
Second-generation antihistamines have more complex chemical structures that decrease their movement across the blood-brain barrier, reducing central nervous system adverse effects such as sedation.Although evidence does not support measures to avoid dust mites, such as mite-proof impermeable mattresses and pillow covers, many guidelines continue to recommend them.2Pharmacologic options for the treatment of allergic rhinitis include intranasal corticosteroids, oral and intranasal antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics, and leukotriene receptor antagonists.1213 Decongestants and intranasal cromolyn are not recommended for children.14The International Primary Care Respiratory Group; British Society for Allergy and Clinical Immunology; and American Academy of Allergy, Asthma, and Immunology recommend intranasal corticosteroids alone for the initial treatment of persistent symptoms affecting quality of life and second-generation nonsedating antihistamines for mild intermittent disease.3Intranasal corticosteroids are the mainstay of treatment for allergic rhinitis.They act by decreasing the influx of inflammatory cells and inhibiting the release of cytokines, thereby reducing inflammation of the nasal mucosa.2 Their onset of action can be less than 30 minutes, although peak effect may take several hours to days, with maximum effectiveness usually noted after two to four weeks of use.18 Many studies have demonstrated that intranasal corticosteroids are more effective than oral and intranasal antihistamines in the treatment of persistent or more severe allergic rhinitis.221There is no evidence that one intranasal corticosteroid is superior.Allergic rhinitis is a common and chronic immunoglobulin E–mediated respiratory illness that can affect quality of life and productivity, as well as exacerbate other conditions such as asthma.Treatment should be based on the patient's age and severity of symptoms.