Intranasal medication antihistamines

Patients who may benefit from allergen immunotherapy include those who do not tolerate traditional drug therapy (e.g., nosebleeds with intranasal steroids or sedation with antihistamines), suffer from severe symptoms, have comorbid conditions (e.g., asthma or sinusitis), fail drug therapy, or prefer not to take long-term medication. 

Pharmacotherapy has an important role in managing AR symptoms (Table 59-2). Intranasal corticosteroids, systemic and topical antihistamines and decongestants, mast cell stabilizers, and immunotherapy all are beneficial in treating symptoms of AR.9 Antihistamines and intranasal corticosteroids are considered first-line therapy for AR, whereas decongestants, mast cell stabilizers, leukotriene modifiers, and systemic corticosteroids are secondary treatment options10-12 (Fig. 59-2). Whenever exposure to allergens can be predicted (e.g., SAR or visiting homes with a pet), medications should be used pro-phylactically to maximize effectiveness.11... 

In case of an obstruction of the nasal airways, the swelling should first be reduced and then the patient should apply the anti-inflammatory medication to ensure its necessary distribution over the complete mucosa. Antihistamines in addition to oral therapy may also be applied locally, intranasally or conjunctivally. The combination of all three substance groups (H, antihistamines, topic glucocorticoids and antileukotrienes) as a pretreatment as well as a symptomatic treatment during immunotherapy increases the chances of success of hyposensitization in our experience [unpubl. data]. 

Medications. Medications used for treatment should be explained to the patient. Instruction of how to correctly use intranasal corticosteroids should be given [145]. Intranasal steroids provide better control when used regularly than on an as needed basis. Such explanations increase compliance. The mode of action of antihistamines and nasal decongestants on nasal symptoms should be clarified. The side-effects and safety of long-term use of the newer antihistamines and intranasal steroids should be explained. 

For seasonal allergic rhinitis, an intranasal antihistamine, aze-lastine, is available. Azelastine has been used successfully in patients who did not respond to loratadine. Using the nasal route offers an alternative to switching to another oral antihistamine. Patient satisfaction has been varied because while the product produces rapid symptom relief, patients complain of drying effects, headache, and diminished effectiveness over time. Patients should be warned of the medication s potential to produce drowsiness, as its systemic availability is approximately 40%. " ... 

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