Allergic Rhinitis [2013 update]

Description: Allergic rhinitis, the most common form of rhinitis, affects 20-40 million people in the United States annually, including 10-30% of adults and up to 40% of children. This CME activity addresses the diagnosis and cost-effective treatment of allergic rhinitis in children and adults. The educational material provides useful summaries on practical aspects of care, including an algorithm for steps in diagnosis and treatment, alternative diagnoses to consider, advantages and disadvantages of pharmacologic and immunotherapy, and information on most types of pharmacologic therapy commonly used.

New information in this revision:

• Oral second generation (non-sedating) antihistamines are recommended over first generation antihistamines due to significant side-effects of sedating antihistamines.
  • Multiple second generation antihistamines are now available over-the-counter. A second generation antihistamine can often be tried as initial therapy, as it will provide relief in most cases.
  • Inhaled nasal steroids can be used as effective monotherapy.
  
  
• Drug table (Table 6) is updated with new medications, generic status, and pricing. Additionally, drug table information is reformatted to view pediatric and adult dosing separately.

Key aspects of care include:

• Avoidance of allergen exposure is the first step in treatment.
• Multiple therapies are available, with nasal corticosteroids considered the most potent medications available for treating allergic rhinitis.
• Consider referral if patients:
  • have contraindication to or have failed medical therapy
  • need testing to identify specific allergens for avoidance
  • have comorbidities (asthma, nasal polyps, recurrent sinusitis).