The goal of rhinitis treatment is to reduce the symptoms caused by the inflammation of affected tissues. In cases of allergic rhinitis, the most effective way to decrease allergic symptoms is to completely avoid the allergen. Vasomotor rhinitis can be brought under a measure of control through avoidance of irritants, though many irritants, such as weather changes, are uncontrollable.
Allergic rhinitis can typically be treated much like any other allergic condition.
Eliminating exposure to allergens is the most effective preventive measure, but requires consistent effort.
Many people with pollen allergies reduce their exposure by remaining indoors during hay fever season, particularly in the morning and evening, when outdoor pollen levels are at their highest. Closing all the windows and doors prevents wind-borne pollen from entering the home or office. When traveling in a vehicle, closing all the windows reduces exposure. Air conditioners are reasonably effective filters, and special pollen filters can be fitted to both home and vehicle air conditioning systems.
Because many allergens cling to clothing, skin, and hair, regular cleaning reduces exposure and therefore symptoms. Many people bathe before sleeping, to minimize their exposure to potential allergens that could have stuck to their bodies during the day. Some people use nasal irrigation to physically remove contaminants from their noses.
Frequently cleaning floors and washing bedding can significantly reduce local irritants such as house dust mite, as well as those tracked in by family, pets and visitors.
Several antagonistic drugs are used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include antihistamines, cortisone, dexamethasone, hydrocortisone, epinephrine (adrenaline), theophylline and cromolyn sodium. Anti-leukotrienes, such as Montelukast (Singulair) or Zafirlukast (Accolate), are FDA approved for treatment of allergic diseases. One antihistamine, Azelastine (Astelin), is available as a nasal spray.
More severe cases of allergic rhinitis require immunotherapy (allergy shots) or removal of tissue in the nose (e.g., nasal polyps) or sinuses.
Many allergy medications can have unpleasant side-effects, most notably drowsiness; more serious side-effects such as asthma, sinusitis, and even nasal polyps have also been reported however.
A case-control study found "symptomatic allergic rhinitis and rhinitis medication use are associated with a significantly increased risk of unexpectedly dropping a grade in summer examinations".
Systemic Glucocorticoids such as Triamcinolone or Prednisone are effective at reducing nasal inflammation, but their use is limited by their short duration of effect and the side effects of prolonged steroid therapy. Steroid nasal sprays are effective and safe, and may be effective without oral antihistamines. These medications include, in order of potency: beclomethasone (Beconase), budesonide (Rhinocort, Noex), flunisolide (Syntaris), mometasone (Nasonex), fluticasone (Flonase, Flixonase), triamcinolone (Nasacort AQ). They take several days to act and so need be taken continually for several weeks as their therapeutic effect builds up with time.
Pseudoephedrine is also indicated for vasomotor rhinitis,
Topical decongestants: may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods as stopping them after protracted use can lead to a rebound nasal congestion (Rhinitis medicamentosa).
Saltwater sprays, rinses or steam: this removes dust, secretions and allergenic molecules from the mucosa, as they are all instant water soluble.
For some patients, especially those with severe non-allergenic rhinitis which at times can produce large amounts of thick mucous, rinsing is the preferred treatment. The nasal passages and sinuses are flooded with warm salty water. The solution should be pH balanced. It should contain Sodium Chloride and Sodium Bicarbonate. There are commercially available preparations which speed the rinsing process as patients may need to repeate the rinse many times during a day.
Rinsing is very often recommended as part of the healing process after sinus or nasal surgery. For this rinse, boiled or distilled water is only necessary during recovery from surgery, as the entire contents of the bottle is used..
A large number of over-the-counter treatments are sold, including herbs like eyebright (''Euphrasia officinalis''), nettle (''Urtica dioica''), and bayberry (''Myrica cerifera''), which have not been shown to reduce the symptoms of nasal-pharynx congestion. In addition, feverfew (''Tanacetum parthenium'') and turmeric (''Curcuma longa'') has been shown to inhibit phospholipase A2, the enzyme which releases the inflammatory precursor arachidonic acid from the bi-layer membrane of mast cells (the main cells which respond to respiratory allergens and lead to inflammation) but this is only in test tubes and it is not established as anti-inflammatory in humans.
It has been claimed that homeopathy provides relief free of side-effects. However, this is strongly disputed by the medical profession on the grounds that there is no valid evidence to support this claim.
Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence.
Nevertheless, there have been some attempts with controlled trials to show that acupuncture is more effective than antihistamine drugs in treatment of hay fever. Complementary-alternative medicines such as acupuncture are extensively offered in the treatment of allergic rhinitis by non-physicians but evidence-based recommendations are lacking. The methodology of clinical trials with complementary-alternative medicine is frequently inadequate. Meta-analyses provides no clear evidence for the efficacy of acupuncture in rhinitis (or asthma). Currently, evidence-based recommendations for acupuncture or homeopathy cannot be made in the treatment of allergic rhinitis.
Eating locally produced unfiltered honey is believed by many to be a treatment for hayfever, supposedly by introducing manageable amounts of pollen to the body. Clinical studies have not provided any evidence for this belief. However, the 2002 study, widely cited as evidence against the efficacy of honey treated patients, was conducted strictly during the pollen season while advocates of honey recommend beginning treatment well before the season begins, or even year round.
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