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.
It causes smooth muscle constriction, mucus secretion, vascular permeability, and sensory nerve stimulation, resulting in the symptoms of allergic rhinitis.21 The first-generation antihistamines include brompheniramine, chlorpheniramine, clemastine, and diphenhydramine (Benadryl).Antihistamines are a class of agents that block histamine release from histamine-1 receptors and are used to treat the symptoms of an allergic reaction, such as edema (swelling), itch, inflammation (redness), sneezing, or a runny nose or watery eyes.Antihistamines can be further divided into those unlikely to cause drowsiness (non-sedating antihistamines) or those likely to cause drowsiness (sedating antihistamines).Antihistamines are used in the treatment of allergic reactions, colds, hay fever, hives, and insect bites and stings.Some antihistamines may also be helpful in reducing anxiety, inducing sleep, or at preventing or treating motion sickness.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.