Allergic Rhinitis
Presentation: Allergy shiners (dark, discolored areas beneath the lower eyelids resulting from
impedance of lymphatic and venous drainage), conjunctival injection, watery eyes, pale, boggy
mucosa with congestion and clear rhinorrhea, transverse crease on tip of nose due to “allergic
salute”, mouth breathing, dry lips, sore throat and dry mouth in morning, palpable lymph nodes,
enlarged tonsils and adenoids.
Diagnostics: Usually none are needed.
CBC to recognize acute eosinophilia reaction, cultures if infection suspected, CT scan, Allergy
testing (stop antihistamines one week prior to testing), Diagnostic allergen prick/droplet test,
radioallergosorbent test.
Non-pharmacological: Prevent exposure to cause allergies, adhere to pharmacological treatment,
if pharmacological treatment does not improve symptoms, then place referral for
immunotherapy, if nasal airway obstruction is suspected refer to ENT, acupuncture.
Pharmacological treatment: saline spray
Zyrtec may cause drowsiness: dose is 10 mg daily.
Loratadine/Claritin: 10 mg daily
Astepro or Flonase nasal spray.
Referral: If symptoms do not improve with OTC treatment refer to allergist or ENT
Follow up in 2-4 weeks initially and then 3-6 months.
Education: Treatment adherence is important. Avoiding first generation antihistamines and
cetirizine (Zyrtec) can help with preventing drowsiness, antihistamines can cause drying of
mucous membranes, increase fluid intake.99
