Kennebec Region Health Alliance

Promoting Healthy Communities Since 1997

Management of Rhinitis

Author: Dr. Scott Dyer
6/1/2016 Final Draft
The following is a list of recommendations from the practice parameters for treatment of rhinitis. These are the best known methods to control rhinitis to date. This is a great place to start when trying to treat rhinitis for your patients. I hope you find this information is helpful as I do in my practice.
  1. Avoidance of Triggers
    The most common allergic triggers for rhinitis include pollen, fungi, dust mites, animal dander and cockroach feces.
    Highly pollen allergic individuals should limit exposure to the outdoors when high pollen season counts are present.
    Reduction of indoor fungal exposure involves removal of moisture sources, replacement of contaminated materials, and the use of dilute bleach solutions on nonporous surfaces.
    Clinically effective dust mite avoidance requires humidity control, dust mite covers for bedding, and HEPA vacuuming of carpeting.
    Avoidance is the most effective way to manage animal sensitivity.
    The best treatment for rhinitis triggered by irritants, such as tobacco smoke and fragrances is avoidance.
  2. If avoidance of triggers is not possible or does not work pharmacology therapy is then recommended.
    1. Oral Antihistamines
      Second or third generation oral Antihistamines such as Loratadine, Cetirizine, and Fexofenadine are preferred over first-generation Antihistamines for treatment of allergic rhinitis.
      Nonsedating antihistamines are Fexofenadine, Loratadine and Desoratadine.
    2. Intranasal Antihistamines
      Should be considered as first line treatment for allergic and nonallergic rhinitis.
      Equal or superior to oral second-generation antihistamines for treatment of seasonal allergic rhinitis.
      May cause sedation.
      Generally less effective than intranasal Steroids for treatment of allergic rhinitis.
    3. Oral Decongestants
      Pseudoephedrine is the only recommended over-the-counter decongestant. Phenylephrine is not efficacious.
    4. Topical Decongestants
      May be used for up to 5 days for temporary relief of congestion. Risk of rebound nasal congestion is minimal with short term use.
    5. Intranasal Steroids
      Intranasal Steroids are the most effective medication class for controlling symptoms of allergic rhinitis.

      Intranasal Steroids have been shown to be more effective than the combined use of Antihistamines and Leukotriene antagonists in treating seasonal allergic rhinitis.
      Intranasal Steroids can be drying to nasal passages and cause nasal bleeding. Instruct patients to spray them away from the nasal septum and to discontinue use of them if they have nasal bleeding.
    6. Oral Steroids
      A short course of oral Steroids 5-7 days, may be appropriate for severe or intractable nasal symptoms.
      Single administration of parenteral Corticosteroids is discouraged.
    7. Oral Leukotriene receptor antagonists
      The use of an antagonist, such as Montelukast, alone or in combination with Antihistamines has been proven to be useful in the treatment of allergic rhinitis.
    8. Nasal saline
      There is evidence that topical saline is beneficial in the treatment of chronic rhinorrhea and rhinosinusitis when used solely, or as an adjunct treatment.
  3. Referral to allergy
    1. Patients are not receiving appropriate symptom control from a combination of the above therapies.
    2. They do not wish to take medications and would prefer immunotherapy.
    3. They wish to identify their allergens through further testing.

When making referral to allergist, please include any pertinent clinical information concerning possible allergy triggers as well as all previous therapies tried prior to referral.

Reference: The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clin Immunol 2008;S1-84.
Practice Guidelines and Standard Processes Disclaimer
To promote the provision of efficient and effective healthcare services, Kennebec Region Health Alliance helps develop and disseminates practice guidelines for use by its member practices. Such guidelines are based upon various sources that KRHA believes to be reliable, which may include but is not limited to, guidelines from widely recognized professional societies, boards and colleges such as the American Medical Association (AMA). Practice guidelines are reviewed at least every two years and updated as necessary to reflect changes in medical practice.
These practice guidelines are not meant to express standards of care and should not be regarded as evidence of such standards. These Guidelines describe criteria for general operating practice and procedure and are for voluntary use. Guidelines are not a substitute for a physician’s or healthcare professional’s independent judgment.
Information on this website should not be relied on as an alternative to medical advice from a physician or other healthcare professional. If there are specific questions on any medical matter, a physician or healthcare professional should be consulted.

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