Rhinitis Treatment Care

With so many therapeutic options, a systematic approach to the rhinitic patient is necessary.

1. This begins with a thorough evaluation and accurate diagnosis. The general approach to the management of a patient with allergic rhinitis is to maximize allergen avoidance, minimize the number of medications to insure compliance, and to watch for potential co-morbidities or complications.
2. Go for skin testing. Skin testing or RAST can not only help direct allergen avoidance, but can also help customize treatment plans so that during patients’ high allergen season(s), maximum therapy can be delivered.
3. Almost all patients benefit from nasal corticosteroids. The frequency of administration (once or twice daily) largely depends on the severity of symptoms. Antihistamines can be added as an as needed medication for breakthrough itching and sneezing, or as a part of the daily regimen. The combination of nasal corticosteroids and azelastine has proved very useful in treating non-allergic rhinitis.
4. Oral decongestants can be considered primarily as an as needed medication in normotensive patients with nasal congestion not adequately controlled by anthistamines and corticosteroids.
5. Antileukotrienes may also have an additive benefit and are most strongly considered in patients with concomitant asthma.

6. Finally, allergen immunotherapy is worth considering in all patients with allergic rhinitis who have symptoms lasting more than 3-4 months per year and for whom medications are used perennially. Immunotherapy when given properly is the only treatment that can potentially affect a cure.
7. The general approach to managing non-allergic rhinitis is to treat any underlying conditions that may be contributing to rhinitic symptoms. This may mean finding alternative medications in patients with medication-induced rhinitis, treating underlying sinus disease or hypothyroidism, or asking patients to experiment with different oral contraceptive preparations.
8. If no underlying cause is found, nasal corticosteroids should be considered as first line therapy. Intranasal azelastine is frequently beneficial in non-allergic rhinitis. Like in allergic rhinitis, oral decongestants warrant consideration typically on an as needed basis for breakthrough nasal congestion.