Case Study: Treatment of Allergic Rhinitis

Q: TZ, a 37-year-old man, is looking for a recommendation for treating his runny nose and clear nasal discharge. He says he experiences these symptoms annually around this same time of year, adding that he is also suffering from irritated, itchy eyes and a sore throat. TZ says the symptoms are so bothersome that they are interrupting his sleep at night and causing daytime drowsiness. He wants something over the counter that will alleviate his congestion and allow him to sleep normally and does not want to see his physician, if possible. TZ reports no significant medical history and says he does not use other nonprescription or prescription medications. What self-care recommendations can you provide?

A: TZ’s clear nasal discharge and cyclic, seasonal symptom occurrence are characteristic symptoms consistent with allergic rhinitis (AR). Although not life-threatening, the symptoms of AR, including watery rhinorrhea, sneezing, nasal obstruction, and nasal pruritus with or without irritation and watering of the eyes, can be particularly bothersome and disruptive to a patient’s sleep and overall quality of life.1 In addition to counseling on allergen avoidance and other nonpharmacologic approaches to minimizing allergen exposure, consideration for nonprescriptive pharmacologic interventions to reduce symptoms and restore TZ’s ability to function is warranted.1,2 Based on his symptoms and disrupted sleep, recommend that he consider either monotherapy with use of an intranasal corticosteroid or an oral antihistamine, based on his preference, in accordance with recent guideline updates.2 Recent evidence suggests that to manage seasonal AR symptoms, monotherapy rather than a combination of medications from these classes should be used, based on a lack of superiority of the combination in reducing symptoms. Ocular symptoms can be particularly troubling as well. For persistent eye symptoms, an artificial tears solution or topical ketotifen could be used.
 
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References
  1. Scolaro KL. Colds and allergy. In: Krinsky DL, Ferreri SP, Hemstreet B, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 19th ed. Washington, DC: American Pharmacists Association; 2017.
  2. Dykewicz MS, Wallace DV, Baroody F, et al. Treatment of seasonal allergic rhinitis: an evidence-based focus 2017 guideline update. Ann Allergy Asthma Immunol. 2017;119(6):489-511.e41. doi: 10.1016/j.anai.2017.08.012.