Treatment

Treatment can be divided into:

1. Avoidance of allergen

2. Treatment with drugs

3. Immunotherapy

1. Avoidance of allergen. This is most successful if the antigen involved is single. Removal of a pet from the house, encasing the pillow or mattress with plastic sheet, change of place of work or sometimes change of job may be required. A particular food article



to which the patient is found allergic can be eliminated from the diet.

2. Treatment with drugs.

(a) Antihistaminics. They control rhinorrhoea, sneezing andpruritis. All antihistaminics have the side effects of drowsiness;some more than the other. The dose and type of the antihistaminichas to be individualised. If one antihistaniinic is not effective, anothermay be tried from a different class.

(b) Sympathomimetic drugs (oral or topical). Alpha-adrenergic drugs constrict blood vessels and reduce nasal congestionand oedema. They also cause CNS stimulation and are often givenin combination with antihistaminics to counteract drowsiness.Pseudoephedrine and phenyl-propanolamine are often combinedwith antihistamanics for oral administration.
Topical use of sympathomimetic drugs cause nasal decongestion. Phenylephrine, oxymetazoline and xylometazoline are often used to relieve nasal obstruction, but are notorious to cause severe rebound congestion. Patient resorts to using more and more of them to relieve nasal obstruction. This vicious cycle leads to rhinitis medicamentosa.

(c) Corticosteroids. Oral corticosteroids are very effectivein controlling the symptoms of allergic rhinitis but their use shouldbe limited to acute episodes which have not been controlled byother measures. They have several systemic side effects.

Topical steroids such as beclomethasone dipropionate, budesomide, flunisolide acetate fluticasone and mometasone inhibit recruitment of inflammatory cells into the nasal mucosa and suppress late-phase allergic reaction, are used as aerosols and are very effective in the control of symptoms. They have also been used in rhinitis medicamentosa while withdrawing topical use of decongestant nasal drops. Topical steroids have fewer systemic side effects but their continuous use may cause mucosal atrophy and even septal perforation. It is wise to break their use for 1-2


weeks every 2-3 months. They may promote growth of fungus.

(d) Sodium chromoglycate. It stabilises the mast cells and prevents them from degranulation despite the formation of 19B-antigen complex. It is used as 2% solution for nasal drops or spray or as an aerosol powder. It is useful both in seasonal and perennial allergic rhinitis.

3. Immunotherapy.

Immunotherapy or hyposensitisation is used when drug treatment fails to control symptoms or produces intolerable side effects. Allergen is given in gradually increasing doses till the maintenance dose is reached. Immunotherapy suppresses the formation of 19B. It also raises the litre of specific IgG antibody. Immunotherapy has to be given for a year or so before significant improvement of symptoms can be noticed. It is discontinued if uninterrupted treatment for 3 years shows no clinical improvement.


Epistaxis