Treatment selection should aim to address the severity, type and persistence of symptoms.

Antihistamines may be used for mild cases and they can be added to nasal steroids for more severe cases. Antihistamines are useful where there are known obvious allergens. Where symptoms are predominantly nasal treatment with intranasal steroids should be used, either alone or in combination with an antihistamine. In the case of ocular symptoms use sodium cromoglicate eye drops either alone or with a systemic antihistamine.

Many of these products are cheap to buy and are readily available, along with advice, from pharmacies. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet

Antihistamines

See section 3.4.1 Antihistamines

As there is individual variation in response to antihistamines, it may be necessary to try a range in an individual patient. Where response to formulary choices has been inadequate, we suggest trying structurally distinct agents such as fexofenadine rather than single isomeric forms or metabolites of the formulary drugs already tried (i.e. not using levocetirizine or desloratadine).

Non-sedative antihistamines

Although non-sedating antihistamines are generally less sedating than chlorphenamine, some people may be affected by drowsiness.

Cetirizine

• Adult and child over 12 years, 10mg once daily

Loratadine

• Adult and child over 12 years, 10mg once daily

Sedative antihistamines

Chlorphenamine

• Adult and child over 12 years, 4mg every 4-6 hours (maximum 24mg daily)

Notes

1. If a sedative antihistamine is used, appropriate warnings must be given to the patient about driving, using machinery and the avoidance of alcohol.

Nasal corticosteroids

Beclometasone

Fluticasone furoate

Mometasone

See section 12.2.1 Drugs used in nasal allergy

Topical nasal decongestants

Xylometazoline

• Short-term use only due to risk of rebound congestion

Ipratropium Bromide

• Ipratropium may be useful to treat non-allergic watery rhinorrhoea.

See section 12.2.2 Topical nasal decongestants