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Pharmacotherapy of allergic rhinitis

Richard D deShazo, MD
Stephen F Kemp, MD
Section Editor
Jonathan Corren, MD
Deputy Editor
Anna M Feldweg, MD


Allergic rhinitis is characterized by paroxysms of sneezing, rhinorrhea, nasal obstruction, and itching of the eyes, nose, and palate. It is also frequently associated with postnasal drip, cough, irritability, and fatigue.

The pharmacologic management of allergic rhinitis is presented in this topic review. The clinical manifestations, diagnosis, differential diagnosis, and pathogenesis of allergic rhinitis are discussed elsewhere. (See "Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis" and "Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis" and "Pathogenesis of allergic rhinitis (rhinosinusitis)".)


The management of allergic rhinitis involves the following components:

Allergen avoidance, which is reviewed separately. (See "Allergen avoidance in the treatment of asthma and allergic rhinitis".)

Pharmacotherapy, which is discussed in detail in this review.

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Literature review current through: Nov 2017. | This topic last updated: Aug 29, 2016.
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  1. Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol 1998; 81:478.
  2. Wallace DV, Dykewicz MS, Bernstein DI, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008; 122:S1.
  3. van Cauwenberge P, Bachert C, Passalacqua G, et al. Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology. Allergy 2000; 55:116.
  4. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8.
  5. Bousquet J, van Cauwenberge P, Aït Khaled N, et al. Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN). Allergy 2006; 61:1086.
  6. Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010; 126:466.
  7. Angier E, Willington J, Scadding G, et al. Management of allergic and non-allergic rhinitis: a primary care summary of the BSACI guideline. Prim Care Respir J 2010; 19:217.
  8. Siow JK, Alshaikh NA, Balakrishnan A, et al. Ministry of Health clinical practice guidelines: Management of Rhinosinusitis and Allergic Rhinitis. Singapore Med J 2010; 51:190.
  9. Scadding GK, Durham SR, Mirakian R, et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy 2008; 38:19.
  10. Okubo K, Kurono Y, Fujieda S, et al. Japanese guideline for allergic rhinitis. Allergol Int 2011; 60:171.
  11. Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg 2015; 152:S1.
  12. Cutler DL, Banfield C, Affrime MB. Safety of Mometasone Furoate Nasal Spray in Children with Allergic Rhinitis as Young as 2 Years of Age: A Randomized Controlled Trial. Pediatr Asthma Allergy Immunol 2006; 19:146.
  13. Weinstein S, Qaqundah P, Georges G, Nayak A. Efficacy and safety of triamcinolone acetonide aqueous nasal spray in children aged 2 to 5 years with perennial allergic rhinitis: a randomized, double-blind, placebo-controlled study with an open-label extension. Ann Allergy Asthma Immunol 2009; 102:339.
  14. Centers for Disease Control and Prevention (CDC). Infant deaths associated with cough and cold medications--two states, 2005. MMWR Morb Mortal Wkly Rep 2007; 56:1.
  15. Kaszuba SM, Baroody FM, deTineo M, et al. Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis. Arch Intern Med 2001; 161:2581.
  16. Dykewicz MS, Kaiser HB, Nathan RA, et al. Fluticasone propionate aqueous nasal spray improves nasal symptoms of seasonal allergic rhinitis when used as needed (prn). Ann Allergy Asthma Immunol 2003; 91:44.
  17. Carr W, Bernstein J, Lieberman P, et al. A novel intranasal therapy of azelastine with fluticasone for the treatment of allergic rhinitis. J Allergy Clin Immunol 2012; 129:1282.
  18. Ratner PH, Hampel F, Van Bavel J, et al. Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2008; 100:74.
  19. Stempel DA, Thomas M. Treatment of allergic rhinitis: an evidence-based evaluation of nasal corticosteroids versus nonsedating antihistamines. Am J Manag Care 1998; 4:89.
  20. Can D, Tanaç R, Demir E, et al. Is the usage of intranasal glucocorticosteroids alone in allergic rhinitis sufficient? Allergy Asthma Proc 2006; 27:248.
  21. Lanier BQ, Abelson MB, Berger WE, et al. Comparison of the efficacy of combined fluticasone propionate and olopatadine versus combined fluticasone propionate and fexofenadine for the treatment of allergic rhinoconjunctivitis induced by conjunctival allergen challenge. Clin Ther 2002; 24:1161.
  22. Ousler GW 3rd, Workman DA, Torkildsen GL. An open-label, investigator-masked, crossover study of the ocular drying effects of two antihistamines, topical epinastine and systemic loratadine, in adult volunteers with seasonal allergic conjunctivitis. Clin Ther 2007; 29:611.
  23. Prenner BM, Lanier BQ, Bernstein DI, et al. Mometasone furoate nasal spray reduces the ocular symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol 2010; 125:1247.
  24. Kaiser HB, Naclerio RM, Given J, et al. Fluticasone furoate nasal spray: a single treatment option for the symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol 2007; 119:1430.
  25. Martin BG, Ratner PH, Hampel FC, et al. Optimal dose selection of fluticasone furoate nasal spray for the treatment of seasonal allergic rhinitis in adults and adolescents. Allergy Asthma Proc 2007; 28:216.
  26. Ratner P, Van Bavel J, Mohar D, et al. Efficacy of daily intranasal fluticasone propionate on ocular symptoms associated with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2015; 114:141.
  27. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108:776.
  28. LactMed is available on line at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT (Accessed on December 22, 2011).
  29. Incaudo GA, Takach P. The diagnosis and treatment of allergic rhinitis during pregnancy and lactation. Immunol Allergy Clin North Am 2006; 26:137.
  30. Kaliner MA. H1-antihistamines in the elderly. Clin Allergy Immunol 2002; 17:465.
  31. Slavin RG. Treating rhinitis in the older population: special considerations. Allergy Asthma Clin Immunol 2009; 5:9.
  32. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ 1998; 317:1624.
  33. van Bavel J, Findlay SR, Hampel FC Jr, et al. Intranasal fluticasone propionate is more effective than terfenadine tablets for seasonal allergic rhinitis. Arch Intern Med 1994; 154:2699.
  34. Welsh PW, Stricker WE, Chu CP, et al. Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy. Mayo Clin Proc 1987; 62:125.
  35. Rak S, Heinrich C, Jacobsen L, et al. A double-blinded, comparative study of the effects of short preseason specific immunotherapy and topical steroids in patients with allergic rhinoconjunctivitis and asthma. J Allergy Clin Immunol 2001; 108:921.
  36. Pullerits T, Praks L, Ristioja V, Lötvall J. Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol 2002; 109:949.
  37. Berger WE, Kaiser H, Gawchik SM, et al. Triamcinolone acetonide aqueous nasal spray and fluticasone propionate are equally effective for relief of nasal symptoms in patients with seasonal allergic rhinitis. Otolaryngol Head Neck Surg 2003; 129:16.
  38. Mandl M, Nolop K, Lutsky BN. Comparison of once daily mometasone furoate (Nasonex) and fluticasone propionate aqueous nasal sprays for the treatment of perennial rhinitis. The 194-079 Study Group. Ann Allergy Asthma Immunol 1997; 79:237.
  39. Patel P, Patel D, Kunjibettu S, et al. Onset of action of ciclesonide once daily in the treatment of seasonal allergic rhinitis. Ear Nose Throat J 2008; 87:340.
  40. Patel D, Garadi R, Brubaker M, et al. Onset and duration of action of nasal sprays in seasonal allergic rhinitis patients: olopatadine hydrochloride versus mometasone furoate monohydrate. Allergy Asthma Proc 2007; 28:592.
  41. Couroux P, Kunjibettu S, Hall N, Wingertzahn MA. Onset of action of ciclesonide once daily in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2009; 102:62.
  42. Borish L. Allergic rhinitis: systemic inflammation and implications for management. J Allergy Clin Immunol 2003; 112:1021.
  43. Barnes ML, Menzies D, Fardon TC, et al. Combined mediator blockade or topical steroid for treating the unified allergic airway. Allergy 2007; 62:73.
  44. LaForce C. Use of nasal steroids in managing allergic rhinitis. J Allergy Clin Immunol 1999; 103:S388.
  45. Onrust SV, Lamb HM. Mometasone furoate. A review of its intranasal use in allergic rhinitis. Drugs 1998; 56:725.
  46. Juniper EF, Ståhl E, Doty RL, et al. Clinical outcomes and adverse effect monitoring in allergic rhinitis. J Allergy Clin Immunol 2005; 115:S390.
  47. Zitt M, Kosoglou T, Hubbell J. Mometasone furoate nasal spray: a review of safety and systemic effects. Drug Saf 2007; 30:317.
  48. Daley-Yates PT, Price AC, Sisson JR, et al. Beclomethasone dipropionate: absolute bioavailability, pharmacokinetics and metabolism following intravenous, oral, intranasal and inhaled administration in man. Br J Clin Pharmacol 2001; 51:400.
  49. Derendorf H, Meltzer EO. Molecular and clinical pharmacology of intranasal corticosteroids: clinical and therapeutic implications. Allergy 2008; 63:1292.
  50. Blaiss MS. Safety considerations of intranasal corticosteroids for the treatment of allergic rhinitis. Allergy Asthma Proc 2007; 28:145.
  51. Salib RJ, Howarth PH. Safety and tolerability profiles of intranasal antihistamines and intranasal corticosteroids in the treatment of allergic rhinitis. Drug Saf 2003; 26:863.
  52. Brogden RN, McTavish D. Budesonide. An updated review of its pharmacological properties, and therapeutic efficacy in asthma and rhinitis. Drugs 1992; 44:375.
  53. Lee LA, Sterling R, Máspero J, et al. Growth velocity reduced with once-daily fluticasone furoate nasal spray in prepubescent children with perennial allergic rhinitis. J Allergy Clin Immunol Pract 2014; 2:421.
  54. Brannan MD, Herron JM, Affrime MB. Safety and tolerability of once-daily mometasone furoate aqueous nasal spray in children. Clin Ther 1997; 19:1330.
  55. Rachelefsky GS. Pharmacologic management of allergic rhinitis. J Allergy Clin Immunol 1998; 101:S367.
  56. Schenkel EJ, Skoner DP, Bronsky EA, et al. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics 2000; 105:E22.
  57. Allen DB, Meltzer EO, Lemanske RF Jr, et al. No growth suppression in children treated with the maximum recommended dose of fluticasone propionate aqueous nasal spray for one year. Allergy Asthma Proc 2002; 23:407.
  58. Galant SP, Melamed IR, Nayak AS, et al. Lack of effect of fluticasone propionate aqueous nasal spray on the hypothalamic-pituitary-adrenal axis in 2- and 3-year-old patients. Pediatrics 2003; 112:96.
  59. Benninger MS, Ahmad N, Marple BF. The safety of intranasal steroids. Otolaryngol Head Neck Surg 2003; 129:739.
  60. Kim KT, Rabinovitch N, Uryniak T, et al. Effect of budesonide aqueous nasal spray on hypothalamic-pituitary-adrenal axis function in children with allergic rhinitis. Ann Allergy Asthma Immunol 2004; 93:61.
  61. Kim K, Weiswasser M, Ruediger N. Safety of once daily ciclesonide nasal spray in children 2 to 5 years of age with perennial allergic rhinitis. Pediatr Asthma Allergy Immunol 2007; 20:229.
  62. Murphy K, Uryniak T, Simpson B, O'Dowd L. Growth velocity in children with perennial allergic rhinitis treated with budesonide aqueous nasal spray. Ann Allergy Asthma Immunol 2006; 96:723.
  63. Passalacqua G, Albano M, Canonica GW, et al. Inhaled and nasal corticosteroids: safety aspects. Allergy 2000; 55:16.
  64. Bui CM, Chen H, Shyr Y, Joos KM. Discontinuing nasal steroids might lower intraocular pressure in glaucoma. J Allergy Clin Immunol 2005; 116:1042.
  65. Opatowsky I, Feldman RM, Gross R, Feldman ST. Intraocular pressure elevation associated with inhalation and nasal corticosteroids. Ophthalmology 1995; 102:177.
  66. Foisy MM, Yakiwchuk EM, Chiu I, Singh AE. Adrenal suppression and Cushing's syndrome secondary to an interaction between ritonavir and fluticasone: a review of the literature. HIV Med 2008; 9:389.
  67. Baroody FM, Brown D, Gavanescu L, et al. Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. J Allergy Clin Immunol 2011; 127:927.
  68. Church MK. H(1)-antihistamines and inflammation. Clin Exp Allergy 2001; 31:1341.
  69. Hasala H, Moilanen E, Janka-Junttila M, et al. First-generation antihistamines diphenhydramine and chlorpheniramine reverse cytokine-afforded eosinophil survival by enhancing apoptosis. Allergy Asthma Proc 2007; 28:79.
  70. Simons FE, Simons KJ. Clinical pharmacology of new histamine H1 receptor antagonists. Clin Pharmacokinet 1999; 36:329.
  71. Gengo FM, Manning C. A review of the effects of antihistamines on mental processes related to automobile driving. J Allergy Clin Immunol 1990; 86:1034.
  72. Verster JC, Volkerts ER. Antihistamines and driving ability: evidence from on-the-road driving studies during normal traffic. Ann Allergy Asthma Immunol 2004; 92:294.
  73. Church MK, Maurer M, Simons FE, et al. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Allergy 2010; 65:459.
  74. O'Hanlon JF, Ramaekers JG. Antihistamine effects on actual driving performance in a standard test: a summary of Dutch experience, 1989-94. Allergy 1995; 50:234.
  75. Ray WA, Thapa PB, Shorr RI. Medications and the older driver. Clin Geriatr Med 1993; 9:413.
  76. Cimbura G, Lucas DM, Bennett RC, et al. Incidence and toxicological aspects of drugs detected in 484 fatally injured drivers and pedestrians in Ontario. J Forensic Sci 1982; 27:855.
  77. United States Department of Transportation: Digest of State Alcohol-Highway Related Legislation. 147th ed, 1996.
  78. Sen A, Akin A, Craft KJ, et al. First-generation H1 antihistamines found in pilot fatalities of civil aviation accidents, 1990-2005. Federal Aviation Administration, Publication AM-07/12, US Department of Transportation, Washington, DC, 2007. www.faa.gov/library/reports/medical/oamtechreports/2000s/media/200712.pdf (Accessed on August 08, 2007).
  79. Kay GG. The effects of antihistamines on cognition and performance. J Allergy Clin Immunol 2000; 105:S622.
  80. Simons FE, Reggin JD, Roberts JR, Simons KJ. Benefit/risk ratio of the antihistamines (H1-receptor antagonists) terfenadine and chlorpheniramine in children. J Pediatr 1994; 124:979.
  81. Vuurman EF, van Veggel LM, Uiterwijk MM, et al. Seasonal allergic rhinitis and antihistamine effects on children's learning. Ann Allergy 1993; 71:121.
  82. Busse PJ. Allergic respiratory disease in the elderly. Am J Med 2007; 120:498.
  83. Kay GG, Plotkin KE, Quig MB. Sedating effects of AM/PM antihistamine dosing with evening chlorpheniramine and morning terfenadine. Am J Manag Care 1997; 3:1843.
  84. Starbuck VN, Kay GG, Platenberg RC, et al. Functional magnetic resonance imaging reflects changes in brain functioning with sedation. Hum Psychopharmacol 2000; 15:613.
  85. Berkowitz RB, McCafferty F, Lutz C, et al. Onset of action of fexofenadine hydrochloride 60 mg/pseudoephedrine hydrochloride 120 mg in subjects aged 12 years with moderate to severe seasonal allergic rhinitis: a pooled analysis of two single-dose, randomized, double-blind, placebo-controlled allergen exposure unit studies. Clin Ther 2006; 28:1658.
  86. Berkowitz RB, McCafferty F, Lutz C, et al. Fexofenadine HCl 60 mg/ pseudoephedrine HCl 120 mg has a 60-minute onset of action in the treatment of seasonal allergic rhinitis symptoms, as assessed in an allergen exposure unit. Allergy Asthma Proc 2004; 25:335.
  87. Kakutani C, Ogino S, Ikeda H, Enomoto T. [Comparison of clinical efficacy and cost-quality of antihistamines in early treatment for Japanese cedar pollinosis]. Arerugi 2006; 55:554.
  88. Stübner P, Zieglmayer R, Horak F. A direct comparison of the efficacy of antihistamines in SAR and PAR: randomised, placebo-controlled studies with levocetirizine and loratadine using an environmental exposure unit - the Vienna Challenge Chamber (VCC). Curr Med Res Opin 2004; 20:891.
  89. Horak F, Zieglmayer PU, Zieglmayer R, et al. Levocetirizine has a longer duration of action on improving total nasal symptoms score than fexofenadine after single administration. Br J Clin Pharmacol 2005; 60:24.
  90. Day JH, Briscoe MP, Rafeiro E, et al. Randomized double-blind comparison of cetirizine and fexofenadine after pollen challenge in the Environmental Exposure Unit: duration of effect in subjects with seasonal allergic rhinitis. Allergy Asthma Proc 2004; 25:59.
  91. Day JH, Briscoe M, Widlitz MD. Cetirizine, loratadine, or placebo in subjects with seasonal allergic rhinitis: effects after controlled ragweed pollen challenge in an environmental exposure unit. J Allergy Clin Immunol 1998; 101:638.
  92. Deruaz C, Leimgruber A, Berney M, et al. Levocetirizine better protects than desloratadine in a nasal provocation with allergen. J Allergy Clin Immunol 2004; 113:669.
  93. Simons FE, Prenner BM, Finn A Jr, Desloratadine Study Group. Efficacy and safety of desloratadine in the treatment of perennial allergic rhinitis. J Allergy Clin Immunol 2003; 111:617.
  94. Layton D, Wilton L, Boshier A, et al. Comparison of the risk of drowsiness and sedation between levocetirizine and desloratadine: a prescription-event monitoring study in England. Drug Saf 2006; 29:897.
  95. Gentile DA, Friday GA, Jr Skoner. Management of allergic rhinitis: Antihistamines and decongestants. Immunol Allergy Clin North Am 2000; 20:355.
  96. Schroeder JT, Schleimer RP, Lichtenstein LM, Kreutner W. Inhibition of cytokine generation and mediator release by human basophils treated with desloratadine. Clin Exp Allergy 2001; 31:1369.
  97. Meltzer EO, Malmstrom K, Lu S, et al. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol 2000; 105:917.
  98. Simons FE. Advances in H1-antihistamines. N Engl J Med 2004; 351:2203.
  99. Hansen GR. Loratadine in the high performance aerospace environment. Aviat Space Environ Med 1999; 70:919.
  100. Meltzer EO. Performance effects of antihistamines. J Allergy Clin Immunol 1990; 86:613.
  101. Vacchiano C, Moore J, Rice GM, Crawley G. Fexofenadine effects on cognitive performance in aviators at ground level and simulated altitude. Aviat Space Environ Med 2008; 79:754.
  102. Newer antihistamines. Med Lett Drugs Ther 2001; 43:35.
  103. Hindmarch I, Shamsi Z, Kimber S. An evaluation of the effects of high-dose fexofenadine on the central nervous system: a double-blind, placebo-controlled study in healthy volunteers. Clin Exp Allergy 2002; 32:133.
  104. Hindmarch I, Shamsi Z, Stanley N, Fairweather DB. A double-blind, placebo-controlled investigation of the effects of fexofenadine, loratadine and promethazine on cognitive and psychomotor function. Br J Clin Pharmacol 1999; 48:200.
  105. Ridout F, Shamsi Z, Meadows R, et al. A single-center, randomized, double-blind, placebo-controlled, crossover investigation of the effects of fexofenadine hydrochloride 180 mg alone and with alcohol, with hydroxyzine hydrochloride 50 mg as a positive internal control, on aspects of cognitive and psychomotor function related to driving a car. Clin Ther 2003; 25:1518.
  106. Ousler GW, Wilcox KA, Gupta G, Abelson MB. An evaluation of the ocular drying effects of 2 systemic antihistamines: loratadine and cetirizine hydrochloride. Ann Allergy Asthma Immunol 2004; 93:460.
  107. Ratliff JC, Barber JA, Palmese LB, et al. Association of prescription H1 antihistamine use with obesity: results from the National Health and Nutrition Examination Survey. Obesity (Silver Spring) 2010; 18:2398.
  108. Yanai K, Rogala B, Chugh K, et al. Safety considerations in the management of allergic diseases: focus on antihistamines. Curr Med Res Opin 2012; 28:623.
  109. Borrelli F, Izzo AA. Herb-drug interactions with St John's wort (Hypericum perforatum): an update on clinical observations. AAPS J 2009; 11:710.
  110. Yumibe N, Huie K, Chen KJ, et al. Identification of human liver cytochrome P450 enzymes that metabolize the nonsedating antihistamine loratadine. Formation of descarboethoxyloratadine by CYP3A4 and CYP2D6. Biochem Pharmacol 1996; 51:165.
  111. Yumibe N, Huie K, Chen KJ, et al. Identification of human liver cytochrome P450s involved in the microsomal metabolism of the antihistaminic drug loratadine. Int Arch Allergy Immunol 1995; 107:420.
  112. Chen C, Hanson E, Watson JW, Lee JS. P-glycoprotein limits the brain penetration of nonsedating but not sedating H1-antagonists. Drug Metab Dispos 2003; 31:312.
  113. Katta A, Dhananjeyan M, Bykowski C, et al. Verapamil, but not probenecid, co-administration can convert desloratadine to a sedating antihistamine in mice. Drug Metab Lett 2007; 1:7.
  114. Whitten DL, Myers SP, Hawrelak JA, Wohlmuth H. The effect of St John's wort extracts on CYP3A: a systematic review of prospective clinical trials. Br J Clin Pharmacol 2006; 62:512.
  115. De Weck AL, Derer T, Bähre M. Investigation of the anti-allergic activity of azelastine on the immediate and late-phase reactions to allergens and histamine using telethermography. Clin Exp Allergy 2000; 30:283.
  116. Lee TA, Pickard AS. Meta-analysis of azelastine nasal spray for the treatment of allergic rhinitis. Pharmacotherapy 2007; 27:852.
  117. Berger W, Hampel F Jr, Bernstein J, et al. Impact of azelastine nasal spray on symptoms and quality of life compared with cetirizine oral tablets in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2006; 97:375.
  118. Shah SR, Nayak A, Ratner P, et al. Effects of olopatadine hydrochloride nasal spray 0.6% in the treatment of seasonal allergic rhinitis: a phase III, multicenter, randomized, double-blind, active- and placebo-controlled study in adolescents and adults. Clin Ther 2009; 31:99.
  119. LaForce CF, Carr W, Tilles SA, et al. Evaluation of olopatadine hydrochloride nasal spray, 0.6%, used in combination with an intranasal corticosteroid in seasonal allergic rhinitis. Allergy Asthma Proc 2010; 31:132.
  120. Azelastine hydrochloride (generic drug). www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory (Accessed on August 01, 2007).
  121. Yáñez A, Rodrigo GJ. Intranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 2002; 89:479.
  122. Carr WW, Ratner P, Munzel U, et al. Comparison of intranasal azelastine to intranasal fluticasone propionate for symptom control in moderate-to-severe seasonal allergic rhinitis. Allergy Asthma Proc 2012; 33:450.
  123. Kaliner MA, Storms W, Tilles S, et al. Comparison of olopatadine 0.6% nasal spray versus fluticasone propionate 50 microg in the treatment of seasonal allergic rhinitis. Allergy Asthma Proc 2009; 30:255.
  124. Berger WE, Meltzer EO. Intranasal spray medications for maintenance therapy of allergic rhinitis. Am J Rhinol Allergy 2015; 29:273.
  125. Bronsky E, Boggs P, Findlay S, et al. Comparative efficacy and safety of a once-daily loratadine-pseudoephedrine combination versus its components alone and placebo in the management of seasonal allergic rhinitis. J Allergy Clin Immunol 1995; 96:139.
  126. Hatton RC, Winterstein AG, McKelvey RP, et al. Efficacy and safety of oral phenylephrine: systematic review and meta-analysis. Ann Pharmacother 2007; 41:381.
  127. Horak F, Zieglmayer P, Zieglmayer R, et al. A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber. Ann Allergy Asthma Immunol 2009; 102:116.
  128. Norris AA, Alton EW. Chloride transport and the action of sodium cromoglycate and nedocromil sodium in asthma. Clin Exp Allergy 1996; 26:250.
  129. Pitsios C, Papadopoulos D, Kompoti E, et al. Efficacy and safety of mometasone furoate vs nedocromil sodium as prophylactic treatment for moderate/severe seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2006; 96:673.
  130. Chervinsky P, Philip G, Malice MP, et al. Montelukast for treating fall allergic rhinitis: effect of pollen exposure in 3 studies. Ann Allergy Asthma Immunol 2004; 92:367.
  131. Perry TT, Corren J, Philip G, et al. Protective effect of montelukast on lower and upper respiratory tract responses to short-term cat allergen exposure. Ann Allergy Asthma Immunol 2004; 93:431.
  132. Patel P, Philip G, Yang W, et al. Randomized, double-blind, placebo-controlled study of montelukast for treating perennial allergic rhinitis. Ann Allergy Asthma Immunol 2005; 95:551.
  133. Ratner PH, Howland WC 3rd, Arastu R, et al. Fluticasone propionate aqueous nasal spray provided significantly greater improvement in daytime and nighttime nasal symptoms of seasonal allergic rhinitis compared with montelukast. Ann Allergy Asthma Immunol 2003; 90:536.
  134. Nathan RA. Do leukotriene receptor antagonists have a place in pharmacotherapy of allergic rhinitis? Ann Allergy Asthma Immunol 2003; 90:466.
  135. Wilson AM, O'Byrne PM, Parameswaran K. Leukotriene receptor antagonists for allergic rhinitis: a systematic review and meta-analysis. Am J Med 2004; 116:338.
  136. Nayak A, Langdon RB. Montelukast in the treatment of allergic rhinitis: an evidence-based review. Drugs 2007; 67:887.
  137. Cingi C, Gunhan K, Gage-White L, Unlu H. Efficacy of leukotriene antagonists as concomitant therapy in allergic rhinitis. Laryngoscope 2010; 120:1718.
  138. Moinuddin R, deTineo M, Maleckar B, et al. Comparison of the combinations of fexofenadine-pseudoephedrine and loratadine-montelukast in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2004; 92:73.
  139. Lieberman PL, Settipane RA. Azelastine nasal spray: a review of pharmacology and clinical efficacy in allergic and nonallergic rhinitis. Allergy Asthma Proc 2003; 24:95.
  140. Cingi C, Ozlugedik S. Effects of montelukast on quality of life in patients with persistent allergic rhinitis. Otolaryngol Head Neck Surg 2010; 142:654.
  141. Milgrom H, Biondi R, Georgitis JW, et al. Comparison of ipratropium bromide 0.03% with beclomethasone dipropionate in the treatment of perennial rhinitis in children. Ann Allergy Asthma Immunol 1999; 83:105.
  142. Aasbjerg K, Torp-Pedersen C, Vaag A, Backer V. Treating allergic rhinitis with depot-steroid injections increase risk of osteoporosis and diabetes. Respir Med 2013; 107:1852.
  143. Wang YH, Yang CP, Ku MS, et al. Efficacy of nasal irrigation in the treatment of acute sinusitis in children. Int J Pediatr Otorhinolaryngol 2009; 73:1696.
  144. Garavello W, Somigliana E, Acaia B, et al. Nasal lavage in pregnant women with seasonal allergic rhinitis: a randomized study. Int Arch Allergy Immunol 2010; 151:137.
  145. Li H, Sha Q, Zuo K, et al. Nasal saline irrigation facilitates control of allergic rhinitis by topical steroid in children. ORL J Otorhinolaryngol Relat Spec 2009; 71:50.
  146. Louisiana Department of Health and Hospitals. http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2332 (Accessed on January 22, 2012).
  147. The US FDA issued a consumer warning regarding the risk of N. fowleri infection. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm316375.htm (Accessed on September 04, 2012).
  148. Information about Naegleria infection is available online from the United States Centers for disease control. http://www.cdc.gov/parasites/naegleria/faqs.html#how_infect.
  149. Psaltis AJ, Foreman A, Wormald PJ, Schlosser RJ. Contamination of sinus irrigation devices: a review of the evidence and clinical relevance. Am J Rhinol Allergy 2012; 26:201.
  150. Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol 2002; 88:42.