Four Major Approaches to Allergic Rhinitis

There are 4 basic approaches to the management of AR: (1) environmental controls; (2) education; (3) pharmacotherapy; and (4) allergen immunotherapy.

Environmental controls need to be individualized depending on what the patient's allergens are. Examples includ washing linen in hot water, decreasing exposure to pets & dander, keeping tubs, sinks, toilets on a regular cycle for cleaning to decrease molds, using air purifiers and airconditioning, minimizing exposure to tobacco smoke and other pollutants. Any other changes which might trigger reactions also need to be minimized, such as exposure to extreme temperature changes, or not exercising when initially explosing self to change in weather/temperature.
Education is possibly the most critical element to helping any person managing their disease most effectively. Education needs to include the causes of the disease, as well as common signs and symptoms. Strategies for minimizing exposure to allergens is central to any home treatment. How and when to take medications is important, if patient compliance is expected (i.e. if using inhalers, a return demonstration is always essential).

Pharmacotherapy
In addition to medications for the allergy itself, medication needs to be considered for any co-morbid condition (i.e. a secondary illness as a result of the allergy, such as otitis media or sinusitis). As some of the newer antihistamines are expensive, cost of any medication also needs to be a consideration. As compliance is always an issue, if the dosing can be decreased, this would be extremely beneficial to the patient.

Allergen immunotherapy
There are currently medications on the market which will help with the delayed phase of any allergy response. Particularly, leukotrines are available which will diminish the chemicals which cause the continual congestion which is associated with allergic rhinitis. Needless to say, these type of medications are usually only prescribed by a trained immunologist, and only for severe, unremitting symptoms. As asthma is now seen as on a continuum with allergic rhinitis, and can lead to medical emergency situations, asthma would always be a disease which would necessitate a specialist.
Additionally, the older corticosteroids were at times related to stunted growth in children, however, the newer corticosteroids on the market no longer show this relationship. Tailoring all approaches to the individual patient is absolutely essential in treating this disease which is on the rise, affects the quality of life, and has associated co-morbid conditions, some of which are very serious.