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Allergic Rhinitis Treatment & Management

  • Author: Javed Sheikh, MD; Chief Editor: Michael A Kaliner, MD  more...
 
Updated: Feb 16, 2015
 

Medical Care

The management of allergic rhinitis consists of 3 major categories of treatment, (1) environmental control measures and allergen avoidance, (2) pharmacological management, and (3) immunotherapy.

Environmental control measures and allergen avoidance involve both the avoidance of known allergens (substances to which the patient has IgE-mediated hypersensitivity) and avoidance of nonspecific, or irritant, triggers. Consider environmental control measures, when practical, in all cases of allergic rhinitis.[47] However, global environmental control without identification of specific triggers is inappropriate.

Pollens and outdoor molds

Because of their widespread presence in the outdoor air, pollens can be difficult to avoid. Reduction of outdoor exposure during the season in which a particular type of pollen is present can be somewhat helpful. In general, tree pollens are present in the spring, grass pollens from the late spring through summer, and weed pollens from late summer through fall, but exceptions to these seasonal patterns exist (see Causes).

Pollen counts tend to be higher on dry, sunny, windy days. Outdoor exposure can be limited during this time, but this may not be reliable because pollen counts can also be influenced by a number of other factors. Keeping the windows and doors of the house and car closed as much as possible during the pollen season (with air conditioning, if necessary, on recirculating mode) can be helpful. Taking a shower after outdoor exposure can be helpful by removing pollen that is stuck to the hair and skin.

Despite all of these measures, patients who are allergic to pollens usually continue to be symptomatic during the pollen season and usually require some other form of management. As with pollens, avoidance of outdoor/seasonal molds may be difficult.

Indoor allergens

Depending on the allergen, environmental control measures for indoor allergens can be quite helpful. For dust mites, covering the mattress and pillows with impermeable covers helps reduce exposure.[48] Bed linens should be washed every 2 weeks in hot (at least 130°F) water to kill any mites present.[49, 50] Thorough and efficient vacuum cleaning of carpets and rugs can help, but, ultimately, carpeting should be removed. The carpet can be treated with one of a number of chemical agents that kill the mites or denature the protein, but the efficacy of these agents does not appear to be dramatic. Dust mites thrive when indoor humidity is above 50%, so dehumidification, air conditioning, or both is helpful.[51]

Indoor environmental control measures for mold allergy focus on reduction of excessive humidity and removal of standing water. The environmental control measures for dust mites can also help reduce mold spores.

For animal allergy, complete avoidance is the best option. For patients who cannot, or who do not want to, completely avoid an animal or pet, confinement of the animal to a noncarpeted room and keeping it entirely out of the bedroom can be of some benefit.[52] Cat allergen levels in the home can be reduced with high-efficiency particulate air (HEPA) filters and by bathing the cat every week (although this may be impractical). Cockroach extermination may be helpful for cases of cockroach sensitivity.

Occupational allergens

As with indoor allergens, avoidance is the best measure. When this is not possible, a mask or respirator might be needed.

Nonspecific triggers

Exposure to smoke, strong perfumes and scents, fumes, rapid changes in temperature, and outdoor pollution can be nonspecific triggers in patients with allergic rhinitis. Consider avoidance of these situations or triggers if they seem to aggravate symptoms.

Pharmacotherapy

See Medication.

Immunotherapy injections (desensitization)

A considerable body of clinical research has established the effectiveness of high-dose allergy shots in reducing symptoms and medication requirements.[53] Success rates have been demonstrated to be as high as 80-90% for certain allergens. It is a long-term process; noticeable improvement is often not observed for 6-12 months, and, if helpful, therapy should be continued for 3-5 years. Immunotherapy is not without risk because severe systemic allergic reactions can sometimes occur. For these reasons, carefully consider the risks and benefits of immunotherapy in each patient and weigh the risks and benefits of immunotherapy against the risks and benefits of the other management options.

Sublingual immunotherapy (SLIT) is currently increasing in use, particularly in Europe. Differences between SLIT and subcutaneous immunotherapy (SCIT) need further study, including research on differences in efficacy, durability, and safety.

SLIT can produce significant clinical improvement in elderly patients with allergic rhinitis caused by house dust mites (HDMs), according to a study by Bozek et al. The report looked at a group of patients aged 60-75 years with allergic rhinitis, as well as allergies to Dermatophagoides pteronyssinus and D farinae.[54]

In 47 patients who underwent 3 years of SLIT, the total nasal symptom score fell by 44%, while in the 48 patients in the placebo group, the score dropped by just 6%. In addition, the total medication score for the SLIT patients fell by a maximum of 51%, while only an insignificant score decrease was seen in the placebo group.[54]

Whether SLIT will be effective for non-pollen allergens as well as pollens also needs additional study. A 2012 meta-analysis of existing studies of SLIT for grass pollen reported that SCIT is more effective than SLIT in controlling symptoms and in reducing the use of allergy medications in patients with seasonal allergic rhinoconjuntivitis to grass pollen.[55]

  • Indications: Immunotherapy may be considered more strongly with severe disease, poor response to other management options, and the presence of comorbid conditions or complications. Immunotherapy is often combined with pharmacotherapy and environmental control.
  • Administration: Administer immunotherapy with allergens to which the patient is known to be sensitive and that are present in the patient's environment (and cannot be easily avoided). The value of immunotherapy for pollens, dust mites, and cats is well established. [56, 57, 58, 59, 60] The value of immunotherapy for dogs and mold is less well established. [53, 56]
  • Contraindication: A number of potential contraindications to immunotherapy exist and need to be considered. Immunotherapy should only be performed by individuals who have been appropriately trained, who institute appropriate precautions, and who are equipped for potential adverse events.

SLIT immunotherapy may not be appropriate for everyone. Those affected by multiple allergens may not obtain relief of all of their symptoms by taking immunotherapy for only a single or several allergens. SLIT is more convenient in than weekly injections for individuals with limited, specific allergies that match the SL product.

In April 2014, the FDA approved an SL tablet consisting of 5 calibrated grass pollen extracts (Oralair). It contains Perennial Ryegrass (Lolium perenne), Kentucky bluegrass (Poa pratensis), Timothy grass (Phleum pratense), Orchard grass (Dactylis glomerata), and Sweet Vernal grass (Anthoxanthum odoratum).[61]

The Oralair SL tablet needs to be initiated 4 months prior to the season for the specific allergen.

A second SL immunotherapy for Timothy grass (Grastek) was also approved in April 2014 for adults and children aged 5 years or older. It should be initiated at least 12 weeks before the start of the grass pollen season.[62] Efficacy and safety in North America was established in a large study (n=1500) of adults and children aged 5-65 years. Results showed a 23% improvement of symptoms in the entire grass pollen season.[63]

A third SL immunotherapy for ragweed (Ragwitek) was also approved in April 2014 for adults aged 18 years or older. Effectiveness studies included about 760 patients. Phase 3 clinical trials showed reduced rhinoconjunctivitis symptoms over the entire season by 27-43% compared with placebo. Ragwitek is approved for adults aged 18 years or older.[64, 65]

Next

Surgical Care

Surgical care is not indicated for allergic rhinitis but may be indicated for comorbid or complicating conditions, such as chronic sinusitis, severe septal deviation (causing severe obstruction), nasal polyps, or other anatomical abnormalities. The value of turbinectomy is not established.

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Consultations

While the general practitioner can effectively treat most cases of straightforward allergic rhinitis, consider consultation with an allergist or immunologist for severe disease, poor response to pharmacotherapy, and the presence of comorbid conditions or complications. Consultation with other specialists also might be needed for comorbid conditions or complications. Consult with an allergy specialist when identification or clarification of specific allergic triggers is needed, when detailed counseling regarding environmental control measures is needed, when quality of life is significantly impaired, or when immunotherapy may be a consideration.

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Contributor Information and Disclosures
Author

Javed Sheikh, MD Assistant Professor of Medicine, Harvard Medical School; Clinical Director, Division of Allergy and Inflammation, Clinical Director, Center for Eosinophilic Disorders, Beth Israel Deaconess Medical Center

Javed Sheikh, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology

Disclosure: Received grant/research funds from Genentech for other.

Coauthor(s)

Umer Najib, MD Clinical Research Fellow, Department of Medicine, Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Stephen C Dreskin, MD, PhD Professor of Medicine, Departments of Internal Medicine, Director of Allergy, Asthma, and Immunology Practice, University of Colorado Health Sciences Center

Stephen C Dreskin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association for the Advancement of Science, American College of Allergy, Asthma and Immunology, Clinical Immunology Society, Joint Council of Allergy, Asthma and Immunology, American Association of Immunologists

Disclosure: Received consulting fee from Genentech for consulting; Received grant support from NIH for research; Received consulting fee from Clinical Immunization and Safety Assessment (CISA) Network (administered by Vanderbilt University) for consulting; Received consulting fee from o Member, Medical Expert Panel, Division of Vaccine Injury Compensation (DVIC), Department of Health and Human Services. for med legal reviews; Received consulting fee from o Member, Medical Expert Panel, Vaccine Review, Pfize.

Chief Editor

Michael A Kaliner, MD Clinical Professor of Medicine, George Washington University School of Medicine; Medical Director, Institute for Asthma and Allergy

Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, Association of American Physicians

Disclosure: Nothing to disclose.

Additional Contributors

William F Schoenwetter, MD Consultant in Allergic Diseases, Brainerd Medical Center, Brainerd, Minnesota

William F Schoenwetter, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, American Medical Association, Joint Council of Allergy, Asthma and Immunology, Minnesota Medical Association

Disclosure: Nothing to disclose.

References
  1. Togias AG. Systemic immunologic and inflammatory aspects of allergic rhinitis. J Allergy Clin Immunol. 2000 Nov. 106(5 Suppl):S247-50. [Medline].

  2. Druce HM. Allergic and nonallergic rhinitis. Middleton EM Jr, Reed CE, Ellis EF, Adkinson NF Jr, Yunginger JW, Busse WW, eds. Allergy: Principles and Practice. 5th ed. St. Louis, Mo: Mosby Year-Book; 1998. 1005-16.

  3. Blaiss MS. Quality of life in allergic rhinitis. Ann Allergy Asthma Immunol. 1999 Nov. 83(5):449-54. [Medline].

  4. Thompson AK, Juniper E, Meltzer EO. Quality of life in patients with allergic rhinitis. Ann Allergy Asthma Immunol. 2000 Nov. 85(5):338-47; quiz 347-8. [Medline].

  5. Ray NF, Baraniuk JN, Thamer M, Rinehart CS, Gergen PJ, Kaliner M. Direct expenditures for the treatment of allergic rhinoconjunctivitis in 1996, including the contributions of related airway illnesses. J Allergy Clin Immunol. 1999 Mar. 103(3 Pt 1):401-7. [Medline].

  6. Bhattacharyya N. Incremental healthcare utilization and expenditures for allergic rhinitis in the United States. Laryngoscope. 2011 Sep. 121(9):1830-3.

  7. Henderson, D. New Guidelines for Allergic Rhinitis Released. Medscape Medical News. Available at http://www.medscape.com/viewarticle/839130. Accessed: February 9, 2015.

  8. Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol. 2001 Jul. 108(1 Suppl):S2-8. [Medline].

  9. Walls AF, He S, Buckley MG, McEuen AR. Roles of the mast cell and basophil in asthma. Clin Exp Allergy. 2001. 1:68.

  10. Haberal I, Corey JP. The role of leukotrienes in nasal allergy. Otolaryngol Head Neck Surg. 2003 Sep. 129(3):274-9. [Medline].

  11. Iwasaki M, Saito K, Takemura M, Sekikawa K, Fujii H, Yamada Y. TNF-alpha contributes to the development of allergic rhinitis in mice. J Allergy Clin Immunol. 2003 Jul. 112(1):134-40. [Medline].

  12. Cates EC, Gajewska BU, Goncharova S, Alvarez D, Fattouh R, Coyle AJ. Effect of GM-CSF on immune, inflammatory, and clinical responses to ragweed in a novel mouse model of mucosal sensitization. J Allergy Clin Immunol. 2003 May. 111(5):1076-86. [Medline].

  13. Salib RJ, Kumar S, Wilson SJ, Howarth PH. Nasal mucosal immunoexpression of the mast cell chemoattractants TGF-beta, eotaxin, and stem cell factor and their receptors in allergic rhinitis. J Allergy Clin Immunol. 2004 Oct. 114(4):799-806. [Medline].

  14. Hansen I, Klimek L, Mosges R, Hormann K. Mediators of inflammation in the early and the late phase of allergic rhinitis. Curr Opin Allergy Clin Immunol. 2004 Jun. 4(3):159-63. [Medline].

  15. Meltzer EO. The prevalence and medical and economic impact of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997 Jun. 99(6 Pt 2):S805-28. [Medline].

  16. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Management of Alllergic and Nonallergic rhinitis. May 2002. AHQR publication 02:E023, Boston, MA. Summary, Evidence Report/Technology Assessment: No 54. http://www.ahrq.gov/clinic/epcsums/rhinsum.htm. Last accessed August 3, 2007.

  17. Settipane RA. Demographics and epidemiology of allergic and nonallergic rhinitis. Allergy Asthma Proc. 2001 Jul-Aug. 22(4):185-9. [Medline].

  18. Nihlen U, Greiff L, Montnemery P, Lofdahl CG, Johannisson A, Persson C. Incidence and remission of self-reported allergic rhinitis symptoms in adults. Allergy. 2006 Nov. 61(11):1299-304. [Medline].

  19. Sly RM. Changing prevalence of allergic rhinitis and asthma. Ann Allergy Asthma Immunol. 1999 Mar. 82(3):233-48; quiz 248-52. [Medline].

  20. Von Mutius E, Weiland SK, Fritzsch C, et al. Increasing prevalence of hay fever and atopy among children in Leipzig, East Germany. Lancet. 1998. 351:862.

  21. Romano-Zelekha O, Graif Y, Garty BZ, Livne I, Green MS, Shohat T. Trends in the prevalence of asthma symptoms and allergic diseases in Israeli adolescents: results from a national survey 2003 and comparison with 1997. J Asthma. 2007 Jun. 44(5):365-9. [Medline].

  22. Lima RG, Pastorino AC, Casagrande RR, et al. Prevalence of asthma, rhinitis and eczema in 6 - 7 years old students from the western districts of Sao Paulo City, using the standardized questionnaire of the "International Study of Asthma and Allergies in Childhood" (ISAAC)-phase IIIB. Clinics. 2007. 62:225.

  23. Watson WT, Becker AB, Simons FE. Treatment of allergic rhinitis with intranasal corticosteroids in patients with mild asthma: effect on lower airway responsiveness. J Allergy Clin Immunol. 1993 Jan. 91(1 Pt 1):97-101. [Medline].

  24. Meltzer EO, Grant JA. Impact of cetirizine on the burden of allergic rhinitis. Ann Allergy Asthma Immunol. 1999 Nov. 83(5):455-63. [Medline].

  25. Nayak AS. The asthma and allergic rhinitis link. Allergy Asthma Proc. 2003 Nov-Dec. 24(6):395-402. [Medline].

  26. Kiyohara C, Tanaka K, Miyake Y. Genetic susceptibility to atopic dermatitis. Allergol Int. 2008 Mar. 57(1):39-56. [Medline].

  27. Fireman P. Otitis media and eustachian tube dysfunction: connection to allergic rhinitis. J Allergy Clin Immunol. 1997 Feb. 99(2):S787-97. [Medline].

  28. McColley SA, Carroll JL, Curtis S, Loughlin GM, Sampson HA. High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea. Chest. 1997 Jan. 111(1):170-3. [Medline].

  29. Craig TJ, Teets S, Lehman EB, Chinchilli VM, Zwillich C. Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. J Allergy Clin Immunol. 1998 May. 101(5):633-7. [Medline].

  30. Dykewicz MS, Fineman S, Skoner DP, Nicklas R, Lee R, Blessing-Moore J. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol. 1998 Nov. 81(5 Pt 2):478-518. [Medline].

  31. Banov CH, Lieberman P,. Efficacy of azelastine nasal spray in the treatment of vasomotor (perennial nonallergic) rhinitis. Ann Allergy Asthma Immunol. 2001 Jan. 86(1):28-35. [Medline].

  32. Colás C, Galera H, Añibarro B, Soler R, Navarro A, Jáuregui I, et al. Disease severity impairs sleep quality in allergic rhinitis (The SOMNIAAR study). Clin Exp Allergy. 2012 Jan 18. [Medline].

  33. Tsai JD, Chang SN, Mou CH, Sung FC, Lue KH. Association between atopic diseases and attention-deficit/hyperactivity disorder in childhood: a population-based case-control study. Ann Epidemiol. 2013 Apr. 23(4):185-8. [Medline].

  34. Torres-Borrego J, Molina-Teran AB, Montes-Mendoza C. Prevalence and associated factors of allergic rhinitis and atopic dermatitis in children. Allergol Immunopathol (Madr). 2008 Mar-Apr. 36(2):90-100. [Medline].

  35. Frew AJ. Advances in environmental and occupational diseases 2003. J Allergy Clin Immunol. 2004 Jun. 113(6):1161-6. [Medline].

  36. Boulet LP, Turcotte H, Laprise C, Lavertu C, Bedard PM, Lavoie A. Comparative degree and type of sensitization to common indoor and outdoor allergens in subjects with allergic rhinitis and/or asthma. Clin Exp Allergy. 1997 Jan. 27(1):52-9. [Medline].

  37. Fornadley JA, Corey JP, Osguthorpe JD, Powell JP, Emanuel IA, Boyles JH. Allergic rhinitis: clinical practice guideline. Committee on Practice Standards, American Academy of Otolaryngic Allergy. Otolaryngol Head Neck Surg. 1996 Jul. 115(1):115-22. [Medline].

  38. Hadley JA. Evaluation and management of allergic rhinitis. Med Clin North Am. 1999 Jan. 83(1):13-25. [Medline].

  39. Vazquez-Nava F, Quezada-Castillo JA, Oviedo-Trevino S, Saldivar-Gonzalez AH, Sanchez-Nuncio HR, Beltran-Guzman FJ. Association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition. Arch Dis Child. 2006 Oct. 91(10):836-40. [Medline].

  40. Siracusa A, Desrosiers M, Marabini A. Epidemiology of occupational rhinitis: prevalence, aetiology and determinants. Clin Exp Allergy. 2000 Nov. 30(11):1519-34. [Medline].

  41. Gelber LE, Seltzer LH, Bouzoukis JK, Pollart SM, Chapman MD, Platts-Mills TA. Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital. Am Rev Respir Dis. 1993 Mar. 147(3):573-8. [Medline].

  42. Kang B, Vellody D, Homburger H, Yunginger JW. Cockroach cause of allergic asthma. Its specificity and immunologic profile. J Allergy Clin Immunol. 1979 Feb. 63(2):80-6. [Medline].

  43. Eggleston PA, Ansari AA, Ziemann B, Adkinson NF Jr, Corn M. Occupational challenge studies with laboratory workers allergic to rats. J Allergy Clin Immunol. 1990 Jul. 86(1):63-72. [Medline].

  44. Phipatanakul W, Eggleston PA, Wright EC, Wood RA,. Mouse allergen. II. The relationship of mouse allergen exposure to mouse sensitization and asthma morbidity in inner-city children with asthma. J Allergy Clin Immunol. 2000 Dec. 106(6):1075-80. [Medline].

  45. Matsui EC, Simons E, Rand C, Butz A, Buckley TJ, Breysse P. Airborne mouse allergen in the homes of inner-city children with asthma. J Allergy Clin Immunol. 2005 Feb. 115(2):358-63. [Medline].

  46. Gendo K, Larson EB. Evidence-based diagnostic strategies for evaluating suspected allergic rhinitis. Ann Intern Med. 2004 Feb 17. 140(4):278-89. [Medline].

  47. Platts-Mills TA. Allergen avoidance. J Allergy Clin Immunol. 2004 Mar. 113(3):388-91. [Medline].

  48. Morgan WJ, Crain EF, Gruchalla RS, O'Connor GT, Kattan M, Evans R 3rd. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004 Sep 9. 351(11):1068-80. [Medline].

  49. McDonald LG, Tovey E. The role of water temperature and laundry procedures in reducing house dust mite populations and allergen content of bedding. J Allergy Clin Immunol. 1992 Oct. 90(4 Pt 1):599-608. [Medline].

  50. Miller JD, Miller A. Ten minutes in a clothes dryer kills all mites in blankets. J Allergy Clin Immunol. 1996. 97:423.

  51. Korsgaard J. House-dust mites and absolute indoor humidity. Allergy. 1983 Feb. 38(2):85-92. [Medline].

  52. de Blay F, Chapman MD, Platts-Mills TA. Airborne cat allergen (Fel d I). Environmental control with the cat in situ [see comments]. Am Rev Respir Dis. 1991. 143:1334.

  53. Weber RW. Immunotherapy with allergens. JAMA. 1997 Dec 10. 278(22):1881-7. [Medline].

  54. Bozek A, Ignasiak B, Filipowska B, Jarzab J. House dust mite sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with allergic rhinitis. Clin Exp Allergy. 2013 Feb. 43(2):242-8. [Medline].

  55. Di Bona D, Plaia A, Leto-Barone MS, La Piana S, Di Lorenzo G. Efficacy of subcutaneous and sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: A meta-analysis-based comparison. J Allergy Clin Immunol. 2012 Sep 26. [Medline].

  56. Li JT. Immunotherapy for allergic rhinitis. Immunol Allergy Clin North Am. 2000. 20:383.

  57. Leynadier F, Banoun L, Dollois B, Terrier P, Epstein M, Guinnepain MT. Immunotherapy with a calcium phosphate-adsorbed five-grass-pollen extract in seasonal rhinoconjunctivitis: a double-blind, placebo-controlled study. Clin Exp Allergy. 2001 Jul. 31(7):988-96. [Medline].

  58. Walker SM, Pajno GB, Lima MT, Wilson DR, Durham SR. Grass pollen immunotherapy for seasonal rhinitis and asthma: a randomized, controlled trial. J Allergy Clin Immunol. 2001 Jan. 107(1):87-93. [Medline].

  59. Ewbank PA, Murray J, Sanders K, Curran-Everett D, Dreskin S, Nelson HS. A double-blind, placebo-controlled immunotherapy dose-response study with standardized cat extract. J Allergy Clin Immunol. 2003 Jan. 111(1):155-61. [Medline].

  60. Nanda A, O'connor M, Anand M, Dreskin SC, Zhang L, Hines B. Dose dependence and time course of the immunologic response to administration of standardized cat allergen extract. J Allergy Clin Immunol. 2004 Dec. 114(6):1339-44. [Medline].

  61. FDA OKs Oralair, First US Sublingual Allergy Immunotherapy. Medscape. Available at http://www.medscape.com/viewarticle/822975. Accessed: April 4, 2014.

  62. Grastek [package insert]. Whitehouse Station, NJ: Merck & Co, Inc. April 2014. Available at [Full Text].

  63. Maloney J, Bernstein DI, Nelson H, Creticos P, Hébert J, Noonan M, et al. Efficacy and safety of grass sublingual immunotherapy tablet, MK-7243: a large randomized controlled trial. Ann Allergy Asthma Immunol. 2014 Feb. 112(2):146-153.e2. [Medline].

  64. Creticos PS, Esch RE, Couroux P, Gentile D, D'Angelo P, Whitlow B, et al. Randomized, double-blind, placebo-controlled trial of standardized ragweed sublingual-liquid immunotherapy for allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2014 Mar. 133(3):751-8. [Medline].

  65. Creticos PS, Maloney J, Bernstein DI, Casale T, Kaur A, Fisher R, et al. Randomized controlled trial of a ragweed allergy immunotherapy tablet in North American and European adults. J Allergy Clin Immunol. 2013 May. 131(5):1342-9.e6. [Medline].

  66. Meltzer EO. Performance effects of antihistamines. J Allergy Clin Immunol. 1990 Oct. 86(4 Pt 2):613-9. [Medline].

  67. Vacchiano C, Moore J, Rice GM, Crawley G. Fexofenadine effects on cognitive performance in aviators at ground level and simulated altitude. Aviat Space Environ Med. 2008 Aug. 79(8):754-60. [Medline].

  68. Newer antihistamines. Med Lett Drugs Ther. 2001 Apr 30. 43(1103):35. [Medline].

  69. De Weck AL, Derer T, Bahre M. Investigation of the anti-allergic activity of azelastine on the immediate and late-phase reactions to allergens and histamine using telethermography. Clin Exp Allergy. 2000 Feb. 30(2):283-7. [Medline].

  70. Lee TA, Pickard AS. Meta-analysis of azelastine nasal spray for the treatment of allergic rhinitis. Pharmacotherapy. 2007 Jun. 27(6):852-9. [Medline].

  71. Berger W, Hampel F Jr, Bernstein J, Shah S, Sacks H, Meltzer EO. Impact of azelastine nasal spray on symptoms and quality of life compared with cetirizine oral tablets in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2006 Sep. 97(3):375-81. [Medline].

  72. Chervinsky P, Philip G, Malice MP, Bardelas J, Nayak A, Marchal JL. Montelukast for treating fall allergic rhinitis: effect of pollen exposure in 3 studies. Ann Allergy Asthma Immunol. 2004 Mar. 92(3):367-73. [Medline].

  73. Perry TT, Corren J, Philip G, Kim EH, Conover-Walker MK, Malice MP. Protective effect of montelukast on lower and upper respiratory tract responses to short-term cat allergen exposure. Ann Allergy Asthma Immunol. 2004 Nov. 93(5):431-8. [Medline].

  74. Patel P, Philip G, Yang W, et al. Randomized, double-blind, placebo-controlled study of montelukast for treating perennial allergic rhinitis. Ann Allergy Asthma Immunol. 2005 Dec. 95(6):551-7. [Medline].

  75. Nayak A, Langdon RB. Montelukast in the treatment of allergic rhinitis: an evidence-based review. Drugs. 2007. 67(6):887-901. [Medline].

  76. Gengo FM, Manning C. A review of the effects of antihistamines on mental processes related to automobile driving. J Allergy Clin Immunol. 1990 Dec. 86(6 Pt 2):1034-9. [Medline].

  77. Verster JC, Volkerts ER. Antihistamines and driving ability: evidence from on-the-road driving studies during normal traffic. Ann Allergy Asthma Immunol. 2004 Mar. 92(3):294-303; quiz 303-5, 355. [Medline].

  78. O'Hanlon JF, Ramaekers JG. Antihistamine effects on actual driving performance in a standard test: a summary of Dutch experience, 1989-94. Allergy. 1995 Mar. 50(3):234-42. [Medline].

  79. Ray WA, Thapa PB, Shorr RI. Medications and the older driver. Clin Geriatr Med. 1993 May. 9(2):413-38. [Medline].

  80. Cimbura G, Lucas DM, Bennett RC, Warren RA, Simpson HM. Incidence and toxicological aspects of drugs detected in 484 fatally injured drivers and pedestrians in Ontario. J Forensic Sci. 1982 Oct. 27(4):855-67. [Medline].

  81. van Bavel J, Findlay SR, Hampel FC Jr, Martin BG, Ratner P, Field E. Intranasal fluticasone propionate is more effective than terfenadine tablets for seasonal allergic rhinitis. Arch Intern Med. 1994 Dec 12-26. 154(23):2699-704. [Medline].

  82. Welsh PW, Stricker WE, Chu CP, Naessens JM, Reese ME, Reed CE. Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy. Mayo Clin Proc. 1987 Feb. 62(2):125-34. [Medline].

  83. Kaszuba SM, Baroody FM, deTineo M, Haney L, Blair C, Naclerio RM. Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis. Arch Intern Med. 2001 Nov 26. 161(21):2581-7. [Medline].

  84. Rak S, Heinrich C, Jacobsen L, Scheynius A, Venge P. A double-blinded, comparative study of the effects of short preseason specific immunotherapy and topical steroids in patients with allergic rhinoconjunctivitis and asthma. J Allergy Clin Immunol. 2001 Dec. 108(6):921-8. [Medline].

  85. Pullerits T, Praks L, Ristioja V, Lotvall J. Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol. 2002 Jun. 109(6):949-55. [Medline].

  86. Brooks M. FDA OKs OTC Triamcinolone (Nasacort) Nasal Spray. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/812522. Accessed: October 21, 2013.

  87. Norris AA, Alton EW. Chloride transport and the action of sodium cromoglycate and nedocromil sodium in asthma. Clin Exp Allergy. 1996 Mar. 26(3):250-3. [Medline].

  88. Brown T. FDA OKs Oralair, first US sublingual allergy immunotherapy. Medscape Medical News. April 2, 2014. [Full Text].

  89. Brown T. FDA OKs Sublingual Grastek for Timothy Grass Pollen Allergy. Medscape Medical News. Available at http://www.medscape.com/viewarticle/823627. Accessed: April 22, 2014.

  90. Onrust SV, Lamb HM. Mometasone furoate. A review of its intranasal use in allergic rhinitis. Drugs. 1998 Oct. 56(4):725-45. [Medline].

  91. US Food and Drug Administration. FDA approves first sublingual allergen extract for the treatment of certain grass pollen allergies [press release]. April 2, 2014. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm391458.htm. Accessed: April 7, 2014.

 
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