Managing allergic rhinitis

Below are medication recommendations for treating allergic rhinitis. All recommendations are available to Texas Children’s Health Plan members without prior authorization!

Oral Antihistamines: Oral cetirizine or loratadine (once daily) offers relief for itchy eyes/nose/throat and congestion. Available in liquid and tablet formulations. Cetirizine can be prescribed in patients as young as 6 months of age whereas loratadine is only approved in patients 2 years of age and older. Headache and drowsiness are the most common side effects. If side effects are a concern, try a different oral antihistamine.

Intranasal Corticosteroid: Intranasal fluticasone (1-2 sprays per nostril once daily) offers relief for itchy eyes/nose/throat and congestion. Although administered nasally, intranasal fluticasone is absorbed systemically and should be used only as needed to avoid overexposure to corticosteroids. Remind caregivers not to share an intranasal device between family members. Review instructions for use (aim for outer nares) to avoid swallowing the medication when given. Patients who experience bloody nose after use should avoid continued use.

Ophthalmic Agents: Ophthalmic cromolyn solution (1-2 drops four times daily) offers relief for itchy eyes. Instruct caregivers to clean hands before administering and to instill drops into lower eyelid (not directly on cornea).

Oral Decongestant: Oral pseudoephedrine (15-30 mg every 4-6 hours as needed) offers temporary relief of nasal congestion. Pseudoephedrine may only be prescribed in patients 4 years of age and older. Due to its stimulant-like effects, use pseudoephedrine with caution in patients with cardiovascular conditions. Advise last dose to be taken no later than 6 hours before desired bedtime to avoid sleep disruption.