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Allergic rhinitis - Prescribing information
Which antihistamines should I use to treat allergic rhinitis?

  • Oral non-sedating antihistamines — once-daily cetirizine, fexofenadine, and loratadine are recommended for the treatment of allergic rhinitis.
  • In pregnant and breastfeeding women, CKS recommends the use of loratadine first-line. For more information, see First-line treatment for allergic rhinitis.
  • Intranasal antihistamine — azelastine (applied two to four times daily) is the only intranasal antihistamine that is available and licensed in the UK for the treatment of allergic rhinitis.
Basis for recommendation
  • CKS does not routinely recommend the older sedating antihistamines for allergic rhinitis, although recommends chlorphenamine as an alternative option to loratadine in pregnant women. Although older sedating antihistamines are effective, they are much more likely than the newer non-sedating antihistamines to cause drowsiness (which can affect a person's ability to drive or perform other skilled tasks) and several other options are available [BNF 54, 2007].
  • Desloratadine (a metabolite of loratadine) and levocetirizine (an isomer of cetirizine) are more recently marketed products, but there is little evidence to confirm whether they confer any additional benefit over the more established non-sedating antihistamines [MeReC, 2004].
  • Mizolastine has been implicated in causing an abnormal prolongation of the QT interval and is therefore not recommended as a first-line treatment option.
  • Acrivastine is not recommended because it needs to be taken three times daily and is therefore less desirable from the perspective of adherence to therapy.

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