Managing Seasonal Allergic Rhinitis with Medications

December 30, 2017

Information sourced from NEJM Journal Watch:

 

Managing Seasonal Allergic Rhinitis with Medications

 

Updated guidelines from the 2017 Joint Task Force on Practice Parameters recommend initial treatment with an intranasal corticosteroid alone.

 

Sponsoring Organizations: American Academy of Allergy, Asthma, and Immunology (AAAAI); American College of Allergy, Asthma, and Immunology (ACAAI)

 

Target Audience: Primary care providers, otolaryngologists, allergists, and pulmonologists

 

Background

 

Seasonal allergic rhinitis affects as many as 14% of adults in the U.S. Most patients either self-treat or see primary care clinicians; only a minority of patients see allergists. Patients and physicians alike often express confusion about the best medication or combination of medications to use. This update of a 2008 guideline from the AAAAI and ACAAI provides specific guidance on pharmacologic treatment for seasonal allergic rhinitis, including for initial therapy.

 

Key Recommendations

 

  • For initial treatment in adolescents and adults (age, ≥12), monotherapy with an intranasal corticosteroid is preferred; combining it with an oral antihistamine confers no additional benefit.

  • For initial treatment in patients older than 14, an intranasal corticosteroid should be chosen over a leukotriene-receptor antagonist such as montelukast.

  • For moderate-to-severe allergic rhinitis, adding an intranasal antihistamine to an intranasal corticosteroid can be beneficial.

COMMENT

 

Patients tend to prefer oral medications over nasal sprays, but if an intranasal corticosteroid is used regularly, it is the most effective medication for addressing all allergic rhinitis symptoms, with no need to add an oral antihistamine. However, because many patients seem to feel better while taking oral antihistamines, I suggest using them only as needed and stressing daily use of their nasal steroid. For patients with mild nasal symptoms (especially mild itching, rhinorrhea, or sneezing) or systemic itching or urticaria, an oral antihistamine is appropriate first-line therapy. For patients whose allergic rhinitis is not controlled adequately with intranasal corticosteroids alone or who have severe symptoms and want quicker onset of action, intranasal antihistamines such as azelastine can be added to their nasal steroid, albeit at the expense of dysgeusia.

 

David J. Amrol, MD reviewing Wallace DV et al. Ann Intern Med 2017 Nov 28.

 

CITATION(S):

 

Wallace DV et al. Pharmacologic treatment of seasonal allergic rhinitis: Synopsis of guidance from the 2017 Joint Task Force on Practice Parameters. Ann Intern Med 2017 Nov 28; [e-pub].

 

NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society. Copyright ©2017 Massachusetts Medical Society. All rights reserved.

 

The above message comes from NEJM Journal Watch, who is solely responsible for its content.

 

Please reload

Featured Monthly Article
Recent News
Please reload

Please reload

Curt Wood, R.Ph., FASCP

Board Certified Geriatric Pharmacist

Elder Care Pharmacy Consultants take pride in being truly independent. Elder Care Pharmacy Consultants, LLC. has a comprehensive approach to antipsychotic use in order to help ensure nursing homes reach their goals, enhance star quality measures, and maintain federal and state compliance. Our success depends on your satisfaction with the services we provide..

The Consultant Pharmacist's Creed
 
I hold my patients' interest above all others.
 
I take responsibility for my patients' medication-related needs.
 
I ensure my patients' medications are the most appropriate, the most effective available, the safest possible, and are used correctly.
 
I identify, resolve and prevent medication-related problems that may interfere with the goals of therapy.

Address: 17566 Doe Run Rd.

               New London, MO 63459

 

Telephone : (573) 795 - 6351

Fax: (573) 985 - 3076
Email : curt@eldercarepharmacyconsultants.com

Copyright © Elder Care Pharmacy Consultants 2015

  • LinkedIn App Icon
  • Wix Twitter page
"Elder Care Pharmacy Consultants LLC., provides experienced clinical and regulatory pharmacy and consulting services relating to safe and effective medication use to skilled, assisted living, residential care nursing facilities." "Our mission is to provide pharmacy consulting services intended to optimize safe and effective medication use with the goal of helping skilled, assisted living and residential care nursing facilities provide the highest quality of care to achieve the best outcomes and maintain regulatory compliance."