What is the best otc sinus allergy medicine

Allergens can be inhaled, ingested, or enter through the skin. Common allergic reactions, such as hay fever, certain types of asthma, and hives are linked to an antibody produced by the body called immunoglobulin E (IgE). Each IgE antibody can be extremely specific, reacting against certain pollens and other allergens. In other words, a person can be allergic to one type of pollen, but not another. When a susceptible person is exposed to an allergen, the body starts producing a large quantity of similar IgE antibodies. The next exposure to the same allergen may result in an allergic reaction.

Symptoms of an allergic reaction will vary depending on the type and quantity of allergen encountered and the manner in which the body’s immune system reacts to that allergen.

Allergies can affect anyone, regardless of age, gender, race, or socioeconomic status. Generally, allergies are more common in children. However, a first-time occurrence can happen at any age, or recur after numerous years of remission. Hormones, stress, smoke, perfume, or environmental irritants may also frolic a role in the development or severity of allergies.


What is anaphylactic shock?

Anaphylactic shock, also called anaphylaxis, is a severe, life-threatening reaction to certain allergens.

Body tissues may swell, including tissues in the throat. Anaphylactic shock is also characterized by a sudden drop in blood pressure. The following are the most common symptoms of anaphylactic shock. However, each person may experience symptoms differently. Other symptoms may include:

  1. Pain or cramps

  2. Shock

  3. Swelling of the throat and tongue or tightness in throat

  4. Feeling warm

  5. Nausea, vomiting, or diarrhea

  6. Headache

  7. Difficulty breathing or shortness of breath

  8. Feeling light-headed

  9. Itching and hives over most of the body

  10. Loss of consciousness

  11. Dizziness

  12. Anxiety

  13. Abnormal heart rate (too quick or too slow)

Anaphylactic shock can be caused by an allergic reaction to a drug, food, serum, insect venom, allergen extract, or chemical.

Some people who are aware of their allergic reactions or allergens carry an emergency anaphylaxis kit that contains injectable epinephrine (a drug that stimulates the adrenal glands and increases the rate and force of the heartbeat).


For information about food allergies please visit the following pages:

Allergic rhinitis is an immunoglobulin E&#x;mediated disease that occurs after exposure to indoor or outdoor allergens, such as dust mites, insects, animal dander, molds, and pollen.

Symptoms include rhinorrhea, sneezing, and nasal congestion, obstruction, and pruritus.1

Optimal treatment includes allergen avoidance and pharmacotherapy. Targeted symptom control with immunotherapy and asthma evaluation should be considered when appropriate.2,3

Symptoms of allergic rhinitis are classified based on the temporal pattern (seasonal, perennial, or episodic), frequency, and severity. Frequency can be divided into intermittent or persistent (more than four days per week and more than four weeks per year, respectively). 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).3


What is the immune system?

The purpose of the immune system is to defend itself and hold microorganisms, such as certain bacteria, viruses, and fungi, out of the body, and to destroy any infectious microorganisms that do invade the body.

The immune system is made up of a complicated and vital network of cells and organs that protect the body from infection.

The organs involved with the immune system are called the lymphoid organs. They affect growth, development, and the release of lymphocytes (a type of white blood cell). The blood vessels and lymphatic vessels are significant parts of the lymphoid organs. They carry the lymphocytes to and from diverse areas in the body.

Each lymphoid organ plays a role in the production and activation of lymphocytes.

Lymphoid organs include:

  1. Lymph nodes (small organs shaped love beans, which are located throughout the body and join via the lymphatic vessels)

  2. Peyer’s patches (lymphoid tissue in the little intestine)

  3. Appendix (a little tube that is connected to the large intestine)

  4. Blood vessels (the arteries, veins, and capillaries through which blood flows)

  5. Lymphatic vessels (a network of channels throughout the body that carries lymphocytes to the lymphoid organs and bloodstream)

  6. Spleen (a fist-sized organ located in the abdominal cavity)

  7. Adenoids (two glands located at the back of the nasal passages)

  8. Thymus (two lobes that join in front of the trachea behind the breast bone)

  9. Bone marrow (the soft, fatty tissue found in bone cavities)

  10. Tonsils (two oval masses in the back of the throat)


Pharmacotherapy

Pharmacologic options for the treatment of allergic rhinitis include intranasal corticosteroids, oral and intranasal antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics, and leukotriene receptor antagonists,13 Decongestants and intranasal cromolyn are not recommended for children

The 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.3,12,13,15,16 Patients with more severe disease not responding to intranasal corticosteroids with or without second-line therapies should be referred for consideration of immunotherapy.2,3,14,17Table 1 lists treatments based on symptom type.4Table 2 summarizes the treatment options.4

ORAL ANTIHISTAMINES

Histamine is the most studied mediator in early allergic response.

It causes smooth muscle constriction, mucus secretion, vascular permeability, and sensory nerve stimulation, resulting in the symptoms of allergic rhinitis.

First-generation antihistamines, including brompheniramine, chlorpheniramine, clemastine, and diphenhydramine (Benadryl), may cause sedation, fatigue, and impaired mental status. These adverse effects happen because the older antihistamines are more lipid soluble and more readily cross the blood-brain barrier than second-generation antihistamines. The use of first-generation sedating antihistamines has been associated with poor school performance, impaired driving, and increased automobile collisions and work injuries&#x;30

Compared with first-generation antihistamines, second-generation drugs own a better adverse effect profile and cause less sedation, with the exception of cetirizine (Zyrtec) Second-generation nonsedating oral antihistamines include loratadine (Claritin), desloratadine (Clarinex), levocetirizine (Xyzal), and fexofenadine (Allegra).

Second-generation antihistamines own more complicated chemical structures that decrease their movement across the blood-brain barrier, reducing central nervous system adverse effects such as sedation. Although cetirizine is generally classified as a second-generation antihistamine and a more potent histamine antagonist, it does not own the benefit of decreased sedation.

In general, oral antihistamines own been shown to effectively relieve the histamine-mediated symptoms associated with allergic rhinitis (e.g., sneezing, pruritus, rhinorrhea), but they are less effective than intranasal corticosteroids at treating nasal congestion and ocular symptoms.

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 numerous patients with mild symptoms requiring as-needed treatment.2,3,14

INTRANASAL CORTICOSTEROIDS

Intranasal 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 generally noted after two to four weeks of use Numerous studies own demonstrated that intranasal corticosteroids are more effective than oral and intranasal antihistamines in the treatment of persistent or more severe allergic rhinitis.2,3,12,13,19&#x;21

There is no evidence that one intranasal corticosteroid is superior.

However, numerous of the products own diverse age indications from the U.S. Food and Drug istration (FDA), only budesonide (Rhinocort Aqua) has an FDA pregnancy category B safety rating, and only fluticasone furoate (Flonase) and triamcinolone acetonide are available over the counter.

The most common adverse effects of intranasal corticosteroids are throat irritation, epistaxis, stinging, burning, and nasal dryness.2,22 Although there has been concern about potential systemic adverse effects, including the suppression of the hypothalamic-pituitary axis, these effects own not been shown with currently available intranasal corticosteroids,24 The studies that specifically looked at the effects of the drugs on skeletal growth and adrenal activity did not protest a decrease in growth of children over the course of one to three years,26 Despite these data, every intranasal corticosteroids carry a warning that long-term use may restrict growth in children.

INTRANASAL ANTIHISTAMINES

Compared with oral antihistamines, intranasal antihistamines own 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 own been shown to be similar or superior to oral antihistamines in treating symptoms of conjunctivitis and rhinitis, and may improve congestion Adverse effects include a bitter aftertaste, headache, nasal irritation, epistaxis, and sedation. Although intranasal antihistamines are an option if symptoms do not improve with nonsedating oral antihistamines, their use as first- or second-line therapy is limited by adverse effects, twice daily dosing, cost, and decreased effectiveness compared with intranasal corticosteroids&#x;33

LEUKOTRIENE RECEPTOR ANTAGONISTS

The leukotriene D4 receptor antagonist montelukast (Singulair) is comparable to oral antihistamines but is less effective than intranasal corticosteroids.2,16,36 It may be particularly useful in patients with coexistent asthma because it reduces bronchospasm and attenuates the inflammatory response.2

INTRANASAL CROMOLYN

Intranasal cromolyn is available over the counter and is thought to inhibit the degranulation of mast cells.1 Although safe for general use, it is not considered first-line therapy for allergic rhinitis because it is less effective than antihistamines and intranasal corticosteroids and is given three or four times daily.1,2,34

INTRANASAL ANTICHOLINERGICS

Although evidence supports the use of intranasal ipratropium (Atrovent) for severe rhinorrhea, one study showed that it may also improve congestion and sneezing in children, but to a lesser extent than intranasal corticosteroids Adverse effects include dryness of the nasal mucosa, epistaxis, and headache, and the recommended istration is two to three times daily.1

DECONGESTANTS

Oral and intranasal decongestants improve nasal congestion associated with allergic rhinitis by acting on adrenergic receptors, which causes vasoconstriction in the nasal mucosa, decreasing inflammation.2,12,13 The most common decongestants are phenylephrine, oxymetazoline (Afrin), and pseudoephedrine.

The abuse potential for pseudoephedrine should be weighed against its benefits.

Common adverse effects of intranasal decongestants are sneezing and nasal dryness. Use for more than three to five days is generally not recommended because patients may develop rhinitis medicamentosa, or may own rebound or recurring congestion.2,3 Oral decongestants may cause headache, elevated blood pressure and intraocular pressure, tremor, urinary retention, dizziness, tachycardia, and insomnia; therefore, these medications should be used with caution in patients with underlying cardiovascular conditions, glaucoma, or hyperthyroidism.2,12,13 Decongestants may be considered for short-term use in patients without improvement in congestion with intranasal corticosteroids.2,3

COMBINATION THERAPY

Although most patients should be treated with just one medication at a time, combination therapy is an option for patients with severe or persistent symptoms.

Numerous studies own looked at the combination of an intranasal corticosteroid and an oral antihistamine or leukotriene receptor antagonist, but most own concluded that combination therapy is no more effective than an intranasal corticosteroid alone.3,20,37&#x;39 However, recent studies own found the combination of azelastine/fluticasone (Dymista) to be superior (better effectiveness and faster symptom relief) to either treatment alone in patients with more severe allergic rhinitis&#x;42

IMMUNOTHERAPY

Immunotherapy should be considered for moderate or severe persistent allergic rhinitis that is not responsive to usual treatments, in patients who cannot tolerate standard therapies or who desire to avoid long-term medication use, and in patients with allergic asthma.2,3,13,16,17,31,43&#x;46 Targeted immunotherapy, the only treatment that changes the natural course of allergic rhinitis, consists of istering a little quantity of allergen extract subcutaneously or sublingually

Subcutaneous injections are istered in the physician’s office at regular intervals, typically three times per week during a buildup phase, then every two to four weeks during a maintenance phase.

The first dose of sublingual immunotherapy is istered in the physician’s office so that the patient can be observed for adverse effects, and then it is istered at home daily. The optimal length of therapy has not been sure, but three to five years is thought to be the best duration.3 The effects of immunotherapy can final up to seven to 12 years after the treatment is discontinued.3,45

Subcutaneous immunotherapy has been proven effective in the treatment of adults and children with allergic rhinitis from exposure to dust mites, birch, Parietaria

Enlarge Print

Table 1.

Pharmacotherapy

Pharmacologic options for the treatment of allergic rhinitis include intranasal corticosteroids, oral and intranasal antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics, and leukotriene receptor antagonists,13 Decongestants and intranasal cromolyn are not recommended for children

The 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.3,12,13,15,16 Patients with more severe disease not responding to intranasal corticosteroids with or without second-line therapies should be referred for consideration of immunotherapy.2,3,14,17Table 1 lists treatments based on symptom type.4Table 2 summarizes the treatment options.4

ORAL ANTIHISTAMINES

Histamine is the most studied mediator in early allergic response.

It causes smooth muscle constriction, mucus secretion, vascular permeability, and sensory nerve stimulation, resulting in the symptoms of allergic rhinitis.

First-generation antihistamines, including brompheniramine, chlorpheniramine, clemastine, and diphenhydramine (Benadryl), may cause sedation, fatigue, and impaired mental status. These adverse effects happen because the older antihistamines are more lipid soluble and more readily cross the blood-brain barrier than second-generation antihistamines. The use of first-generation sedating antihistamines has been associated with poor school performance, impaired driving, and increased automobile collisions and work injuries&#x;30

Compared with first-generation antihistamines, second-generation drugs own a better adverse effect profile and cause less sedation, with the exception of cetirizine (Zyrtec) Second-generation nonsedating oral antihistamines include loratadine (Claritin), desloratadine (Clarinex), levocetirizine (Xyzal), and fexofenadine (Allegra).

Second-generation antihistamines own more complicated chemical structures that decrease their movement across the blood-brain barrier, reducing central nervous system adverse effects such as sedation. Although cetirizine is generally classified as a second-generation antihistamine and a more potent histamine antagonist, it does not own the benefit of decreased sedation.

In general, oral antihistamines own been shown to effectively relieve the histamine-mediated symptoms associated with allergic rhinitis (e.g., sneezing, pruritus, rhinorrhea), but they are less effective than intranasal corticosteroids at treating nasal congestion and ocular symptoms. 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 numerous patients with mild symptoms requiring as-needed treatment.2,3,14

INTRANASAL CORTICOSTEROIDS

Intranasal 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 generally noted after two to four weeks of use Numerous studies own demonstrated that intranasal corticosteroids are more effective than oral and intranasal antihistamines in the treatment of persistent or more severe allergic rhinitis.2,3,12,13,19&#x;21

There is no evidence that one intranasal corticosteroid is superior. However, numerous of the products own diverse age indications from the U.S.

Food and Drug istration (FDA), only budesonide (Rhinocort Aqua) has an FDA pregnancy category B safety rating, and only fluticasone furoate (Flonase) and triamcinolone acetonide are available over the counter.

The most common adverse effects of intranasal corticosteroids are throat irritation, epistaxis, stinging, burning, and nasal dryness.2,22 Although there has been concern about potential systemic adverse effects, including the suppression of the hypothalamic-pituitary axis, these effects own not been shown with currently available intranasal corticosteroids,24 The studies that specifically looked at the effects of the drugs on skeletal growth and adrenal activity did not protest a decrease in growth of children over the course of one to three years,26 Despite these data, every intranasal corticosteroids carry a warning that long-term use may restrict growth in children.

INTRANASAL ANTIHISTAMINES

Compared with oral antihistamines, intranasal antihistamines own 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 own been shown to be similar or superior to oral antihistamines in treating symptoms of conjunctivitis and rhinitis, and may improve congestion Adverse effects include a bitter aftertaste, headache, nasal irritation, epistaxis, and sedation. Although intranasal antihistamines are an option if symptoms do not improve with nonsedating oral antihistamines, their use as first- or second-line therapy is limited by adverse effects, twice daily dosing, cost, and decreased effectiveness compared with intranasal corticosteroids&#x;33

LEUKOTRIENE RECEPTOR ANTAGONISTS

The leukotriene D4 receptor antagonist montelukast (Singulair) is comparable to oral antihistamines but is less effective than intranasal corticosteroids.2,16,36 It may be particularly useful in patients with coexistent asthma because it reduces bronchospasm and attenuates the inflammatory response.2

INTRANASAL CROMOLYN

Intranasal cromolyn is available over the counter and is thought to inhibit the degranulation of mast cells.1 Although safe for general use, it is not considered first-line therapy for allergic rhinitis because it is less effective than antihistamines and intranasal corticosteroids and is given three or four times daily.1,2,34

INTRANASAL ANTICHOLINERGICS

Although evidence supports the use of intranasal ipratropium (Atrovent) for severe rhinorrhea, one study showed that it may also improve congestion and sneezing in children, but to a lesser extent than intranasal corticosteroids Adverse effects include dryness of the nasal mucosa, epistaxis, and headache, and the recommended istration is two to three times daily.1

DECONGESTANTS

Oral and intranasal decongestants improve nasal congestion associated with allergic rhinitis by acting on adrenergic receptors, which causes vasoconstriction in the nasal mucosa, decreasing inflammation.2,12,13 The most common decongestants are phenylephrine, oxymetazoline (Afrin), and pseudoephedrine.

The abuse potential for pseudoephedrine should be weighed against its benefits.

Common adverse effects of intranasal decongestants are sneezing and nasal dryness. Use for more than three to five days is generally not recommended because patients may develop rhinitis medicamentosa, or may own rebound or recurring congestion.2,3 Oral decongestants may cause headache, elevated blood pressure and intraocular pressure, tremor, urinary retention, dizziness, tachycardia, and insomnia; therefore, these medications should be used with caution in patients with underlying cardiovascular conditions, glaucoma, or hyperthyroidism.2,12,13 Decongestants may be considered for short-term use in patients without improvement in congestion with intranasal corticosteroids.2,3

COMBINATION THERAPY

Although most patients should be treated with just one medication at a time, combination therapy is an option for patients with severe or persistent symptoms.

Numerous studies own looked at the combination of an intranasal corticosteroid and an oral antihistamine or leukotriene receptor antagonist, but most own concluded that combination therapy is no more effective than an intranasal corticosteroid alone.3,20,37&#x;39 However, recent studies own found the combination of azelastine/fluticasone (Dymista) to be superior (better effectiveness and faster symptom relief) to either treatment alone in patients with more severe allergic rhinitis&#x;42

IMMUNOTHERAPY

Immunotherapy should be considered for moderate or severe persistent allergic rhinitis that is not responsive to usual treatments, in patients who cannot tolerate standard therapies or who desire to avoid long-term medication use, and in patients with allergic asthma.2,3,13,16,17,31,43&#x;46 Targeted immunotherapy, the only treatment that changes the natural course of allergic rhinitis, consists of istering a little quantity of allergen extract subcutaneously or sublingually

Subcutaneous injections are istered in the physician’s office at regular intervals, typically three times per week during a buildup phase, then every two to four weeks during a maintenance phase.

The first dose of sublingual immunotherapy is istered in the physician’s office so that the patient can be observed for adverse effects, and then it is istered at home daily. The optimal length of therapy has not been sure, but three to five years is thought to be the best duration.3 The effects of immunotherapy can final up to seven to 12 years after the treatment is discontinued.3,45

Subcutaneous immunotherapy has been proven effective in the treatment of adults and children with allergic rhinitis from exposure to dust mites, birch, Parietaria

Enlarge Print

Table 1.

Symptom-Based Treatments for Allergic Rhinitis

Treatment Symptoms


Ocular Nasopharyngeal itching Sneezing Rhinorrhea

Intranasal corticosteroids

&#x;

&#x;

&#x;

&#x;

Oral and intranasal antihistamines

&#x;

&#x;

&#x;

Combination intranasal corticosteroid and antihistamine

&#x;

&#x;

&#x;

&#x;

Oral and intranasal decongestants

&#x;

Intranasal cromolyn

&#x;

&#x;

&#x;

Intranasal anticholinergics

&#x;

Leukotriene receptor antagonists

&#x;

&#x;

&#x;

Immunotherapy

&#x;

&#x;

&#x;

&#x;

Table 1.

Symptom-Based Treatments for Allergic Rhinitis

Treatment Symptoms


Ocular Nasopharyngeal itching Sneezing Rhinorrhea

Intranasal corticosteroids

&#x;

&#x;

&#x;

&#x;

Oral and intranasal antihistamines

&#x;

&#x;

&#x;

Combination intranasal corticosteroid and antihistamine

&#x;

&#x;

&#x;

&#x;

Oral and intranasal decongestants

&#x;

Intranasal cromolyn

&#x;

&#x;

&#x;

Intranasal anticholinergics

&#x;

Leukotriene receptor antagonists

&#x;

&#x;

&#x;

Immunotherapy

&#x;

&#x;

&#x;

&#x;

Enlarge Print

Table 2.

Summary of Treatments for Allergic Rhinitis

Type of therapy FDA pregnancy category Minimum age for use Mechanism/onset of action Adverse effects Cost*

Intranasal corticosteroids

Decrease the influx of inflammatory cells and inhibit the release of cytokines; onset of action is less than 30 minutes

Bitter aftertaste, burning, epistaxis, headache, nasal dryness; possible systemic absorption, rhinitis medicamentosa, stinging, throat irritation

Beclomethasone

C

4 years

NA ($) for 1 inhaler

Budesonide (Rhinocort Aqua)

B

6 years

$ ($) for 1 nasal spray

Ciclesonide (Omnaris)

C

6 years

NA ($) for 1 nasal spray

Flunisolide

C

6 years

$55 (NA) for 1 nasal spray

Fluticasone furoate (Veramyst)

C

2 years

NA ($) for 1 nasal spray

Fluticasone propionate (Flonase)

C

4 years

$15 ($15) for 1 nasal spray

Mometasone (Nasonex)

C

2 years

NA ($) for 1 nasal spray

Triamcinolone acetonide

C

2 years

$70 ($) for 1 nasal spray

Oral antihistamines

Block histamine H1 receptors; onset of action is 15 to 30 minutes

Dry mouth, sedation at higher than recommended doses

Cetirizine (Zyrtec)

B

6 months

$10 ($20) for 30 tablets

Desloratadine (Clarinex)

C

6 months

$40 ($) for 30 tablets

Fexofenadine (Allegra)

C

2 years (allergic rhinitis)

$15 ($20) for 30 tablets

Loratadine (Claritin)

B

2 years

$13 ($25) for 30 tablets

Combination intranasal corticosteroid and antihistamine

See intranasal corticosteroids and intranasal antihistamines

See intranasal corticosteroids and intranasal antihistamines

Azelastine/fluticasone (Dymista)

C

6 years

NA ($) for 1 nasal spray

Intranasal antihistamines

Azelastine (Astelin)

C

5 years

Block H1 receptors; onset of action is 15 minutes

Bitter aftertaste, epistaxis, headache, nasal irritation, sedation

$50 ($) for 1 nasal spray

Olopatadine (Patanol) [corrected]

C

6 years

Block H1 receptors; onset of action is 30 minutes

Bitter aftertaste, epistaxis, headache, nasal irritation, sedation

$50 ($) for 1 nasal sprays

Oral decongestants

Pseudoephedrine

C

2 years (usually not started until 4 years)

Vasoconstriction; onset of action is 15 to 30 minutes

Headache, elevated blood pressure and intraocular pressure, tremor, urinary retention, dizziness, tachycardia, and insomnia

$5 ($10) for 24 tablets

Intranasal cromolyns

Cromolyn

B

2 years

Inhibits histamine release

Epistaxis, nasal irritation, sneezing

NA ($18) for 1 nasal spray

Intranasal anticholinergics

Ipratropium (Atrovent)

B

5 years

Block acetylcholine receptors; onset of action is 15 minutes

Epistaxis, headache, nasal dryness

$30 ($) for 1 nasal spray

Leukotriene receptor antagonists

Montelukast (Singulair)

B

6 months

Block leukotriene receptors; onset of action is 2 hours

Elevated levels of alanine transaminase, aspartate transaminase, and bilirubin

$15 ($) for 30 tablets

Immunotherapy

Not well understood, believed to shift immune response from immunoglobulin E mediated to immunoglobulin G mediated

Minor local mouth irritation, diarrhea, vomiting; rare anaphylaxis

Sublingual Grastek (timothy grass pollen extract, cross reactive with 6 other grass pollens)

B

5 years

NA ($) for 30 tablets

Sublingual Oralair (5-grass pollen extract)

B

10 years

NA ($) for 30 tablets

Sublingual Ragwitek (short ragweed pollen extract)

C

18 years

NA ($) for 30 tablets

Subcutaneous allergen extracts: several tree, grass, weed pollens; cat and dog dander; dust mites; certain molds; and cockroaches; istered by a physician

Should not be initiated during pregnancy; maintenance therapy is considered safe

Has not been established; generally 5 years so that the kid is ancient enough to cooperate

Local injection site reactions and, less commonly, systemic allergic reactions

Varies

Table 2.

Summary of Treatments for Allergic Rhinitis

Type of therapy FDA pregnancy category Minimum age for use Mechanism/onset of action Adverse effects Cost*

Intranasal corticosteroids

Decrease the influx of inflammatory cells and inhibit the release of cytokines; onset of action is less than 30 minutes

Bitter aftertaste, burning, epistaxis, headache, nasal dryness; possible systemic absorption, rhinitis medicamentosa, stinging, throat irritation

Beclomethasone

C

4 years

NA ($) for 1 inhaler

Budesonide (Rhinocort Aqua)

B

6 years

$ ($) for 1 nasal spray

Ciclesonide (Omnaris)

C

6 years

NA ($) for 1 nasal spray

Flunisolide

C

6 years

$55 (NA) for 1 nasal spray

Fluticasone furoate (Veramyst)

C

2 years

NA ($) for 1 nasal spray

Fluticasone propionate (Flonase)

C

4 years

$15 ($15) for 1 nasal spray

Mometasone (Nasonex)

C

2 years

NA ($) for 1 nasal spray

Triamcinolone acetonide

C

2 years

$70 ($) for 1 nasal spray

Oral antihistamines

Block histamine H1 receptors; onset of action is 15 to 30 minutes

Dry mouth, sedation at higher than recommended doses

Cetirizine (Zyrtec)

B

6 months

$10 ($20) for 30 tablets

Desloratadine (Clarinex)

C

6 months

$40 ($) for 30 tablets

Fexofenadine (Allegra)

C

2 years (allergic rhinitis)

$15 ($20) for 30 tablets

Loratadine (Claritin)

B

2 years

$13 ($25) for 30 tablets

Combination intranasal corticosteroid and antihistamine

See intranasal corticosteroids and intranasal antihistamines

See intranasal corticosteroids and intranasal antihistamines

Azelastine/fluticasone (Dymista)

C

6 years

NA ($) for 1 nasal spray

Intranasal antihistamines

Azelastine (Astelin)

C

5 years

Block H1 receptors; onset of action is 15 minutes

Bitter aftertaste, epistaxis, headache, nasal irritation, sedation

$50 ($) for 1 nasal spray

Olopatadine (Patanol) [corrected]

C

6 years

Block H1 receptors; onset of action is 30 minutes

Bitter aftertaste, epistaxis, headache, nasal irritation, sedation

$50 ($) for 1 nasal sprays

Oral decongestants

Pseudoephedrine

C

2 years (usually not started until 4 years)

Vasoconstriction; onset of action is 15 to 30 minutes

Headache, elevated blood pressure and intraocular pressure, tremor, urinary retention, dizziness, tachycardia, and insomnia

$5 ($10) for 24 tablets

Intranasal cromolyns

Cromolyn

B

2 years

Inhibits histamine release

Epistaxis, nasal irritation, sneezing

NA ($18) for 1 nasal spray

Intranasal anticholinergics

Ipratropium (Atrovent)

B

5 years

Block acetylcholine receptors; onset of action is 15 minutes

Epistaxis, headache, nasal dryness

$30 ($) for 1 nasal spray

Leukotriene receptor antagonists

Montelukast (Singulair)

B

6 months

Block leukotriene receptors; onset of action is 2 hours

Elevated levels of alanine transaminase, aspartate transaminase, and bilirubin

$15 ($) for 30 tablets

Immunotherapy

Not well understood, believed to shift immune response from immunoglobulin E mediated to immunoglobulin G mediated

Minor local mouth irritation, diarrhea, vomiting; rare anaphylaxis

Sublingual Grastek (timothy grass pollen extract, cross reactive with 6 other grass pollens)

B

5 years

NA ($) for 30 tablets

Sublingual Oralair (5-grass pollen extract)

B

10 years

NA ($) for 30 tablets

Sublingual Ragwitek (short ragweed pollen extract)

C

18 years

NA ($) for 30 tablets

Subcutaneous allergen extracts: several tree, grass, weed pollens; cat and dog dander; dust mites; certain molds; and cockroaches; istered by a physician

Should not be initiated during pregnancy; maintenance therapy is considered safe

Has not been established; generally 5 years so that the kid is ancient enough to cooperate

Local injection site reactions and, less commonly, systemic allergic reactions

Varies

How to Stay Healthy, Breathe Easier, and Feel Energetic This Winter

Indoor allergies, freezing weather, less sunlight — winter can make it hard to stay well mentally and physically.

Discover out how to protect yourself against seasonal allergies, the winter blahs, freezing winds, comfort-eating traps, and fatigue this year.

Learn More About the Ultimate Winter Wellness Guide

Sinusitis can be a confusing thing to treat for anyone. Because a sinus infection can be so easily confused with a common freezing or an allergy, figuring out the best way to alleviate your symptoms can be difficult.

Even more challenging, a sinus infection can evolve over time from a viral infection to a bacterial infection, or even from a short-term acute infection to a long-term chronic illness.

We own provided for you the best sources of information on sinus infections to assist you rapidly define your ailment and get the best and most efficient treatment possible.


The Best Research Resources

American Academy of Allergy, Asthma, and Immunology

This academy’s website provides valuable information to assist readers determine the difference between colds, allergies, and sinusitis.

A primer guide on sinusitis also provides more specific information about the chronic version of the illness. Additional resources include a «virtual allergist» that helps you to review your symptoms, as well as a database on pollen counts.

American College of Allergy, Asthma, and Immunology (ACAAI)

In addition to providing a comprehensive guide on sinus infections, the ACAAI website also contains a wealth of information on allergies, asthma, and immunology.

The site’s useful tools include a symptom checker, a way to search for an allergist in your area, and a function that allows you to ask an allergist questions about your symptoms.

Asthma and Allergy Foundation of America (AAFA)

For allergy sufferers, the AAFA website contains an easy-to-understand primer on sinusitis. It also provides comprehensive information on various types of allergies, including those with risk factors for sinusitis.

Centers for Disease Control and Prevention (CDC)

The CDC website provides basic information on sinus infections and other respiratory illnesses, such as common colds, bronchitis, ear infections, flu, and sore throat.

It offers guidance on how to get symptom relief for those illnesses, as well as preventative tips on practicing good hand hygiene, and a recommended immunization schedule.

U.S. National Library of Medicine

The U.S. National Library of Medicine is the world’s largest biomedical library. As part of the National Institutes of Health, their website provides the basics on sinus infection. It also contains a number of links to join you with more information on treatments, diagnostic procedures, and related issues.


Environmental Control and Prevention

Patients 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.

Additional studies are needed to determine the optimal method and frequency of nasal irrigation and the preferred type of saline solution.5

Prevention has been a main focus in studies of allergic rhinitis, but few interventions own been proven effective. Although evidence does not support measures to avoid dust mites, such as mite-proof impermeable mattresses and pillow covers, numerous guidelines continue to recommend them.2,3,6 Other examples of proposed interventions without documented effectiveness include breastfeeding, air filtration systems, and delayed exposure to solid foods in infancy or to pets in childhood.7&#x;11


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