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Allergic rhinitis - Management
Basis for recommendation

  • Basis for recommending antihistamines for people preferring 'as-required' treatment for occasional symptoms:
    • This is a pragmatic recommendation supported by experts, based on evidence of the comparative speed of onset and efficacy of oral antihistamines compared with other treatments for allergic rhinitis.
  • Basis for recommending either an oral antihistamine or an intranasal corticosteroid for people who want regular treatment to control more frequent or persistent symptoms:
    • This is a pragmatic recommendation, based on evidence of the efficacy of intranasal corticosteroids and evidence of the efficacy of oral antihistamines to control the symptoms of allergic rhinitis.
  • Basis for treatment recommendations of pregnant and breastfeeding women [ARIA, 2001a; Scadding et al, 2008]:
    • Topical corticosteroids are recommended by experts in pregnancy and breastfeeding because their benefits are thought to outweigh their risks. Although there is a lack of safety data available in pregnant women with allergic rhinitis their use in pregnant women with asthma appears to be safe [Demoly et al, 2003].
    • Topical antihistamines are preferred to oral antihistamines by experts because they have a faster onset of action, minimal systemic absorption and do not expose the baby to potential adverse effects [ABPI Medicines Compendium, 2007].
    • The oral antihistamines chlorphenamine, loratadine and cetirizine are recommended by many experts for use in pregnancy if an oral antihistamine is required [Schaefer et al, 2007], and loratadine and cetirizine are recommended for use in breastfeeding [Schaefer et al, 2007]. CKS recommends loratadine because there is more safety data available than for cetirizine, and it is not associated with having the sedative properties of chlorphenamine.
    • Intranasal sodium cromoglicate is recommended by experts as an alternative treatment when other treatments are not acceptable. There is evidence that it is effective but because there are more effective alternatives it is not recommended first–line. However, it is the safest drug in the first 3 months of pregnancy.
  • The basis for recommending oral corticosteroids for severe symptoms:
    • This is a pragmatic recommendation supported by the consensus opinion of experts [ARIA, 2001a].
  • Basis for recommending use of intranasal decongestants:
  • Basis for not recommending sedating antihistamines, and depot corticosteroids [Scadding et al, 2008]:
    • Sedating antihistamines can affect a person's ability to drive or perform other skilled tasks, as well as impair academic and work ability, and they have no benefits over the newer non-sedating antihistamines available [BNF 54, 2007].
    • Depot corticosteroid injections are not recommended by experts because the risk–benefit profile for intramuscular corticosteroids is poor compared with other treatments available.

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