Small and Kim Allergy, Asthma & Clinical Immunology 2011, 7(Suppl 1):S3 http://www.aacijournal.com/content/7/S1/S3 Page 7 of 8 symptoms and, therefore, will require a trial of intrana- sal corticosteroids. Other therapeutic options Oral and intranasal decongestants (e.g., pseudoephe- drine, phenylephrine) are useful for relieving nasal con- gestion in patients with allergic rhinitis. However, the side-effect profile associated with oral decongestants (i. e., agitation, insomnia, headache, palpitations) may limit their long-term use. Furthermore, these agents are con- traindicated in patients with uncontrolled hypertension and severe coronary artery disease. Prolonged use of intranasal decongestants carries the risk of rhinitis medi- camentosa (rebound nasal congestion) and, therefore, these agents should not be used for more than 5 to 10 days. Oral corticosteroids have also been shown to be effective in patients with severe allergic rhinitis that is refractory to treatment with oral antihistamines and intranasal corticosteroids. [1,4]. Although not as effective as intranasal corticosteroids, sodium cromoglycate (Cromolyn) has been shown to reduce sneezing, rhinorrhea and nasal itching and is, therefore, a reasonable therapeutic option for some patients. The anti-IgE antibody omalizumab has also been shown to be effective in seasonal allergic rhinitis and asthma [1]. Surgical therapy may be helpful for select patients with rhinitis, polyposis, or chronic sinus disease that is refractory to medical treatment. Most surgical interven- tions can be performed under local anesthesia in an office or outpatient setting [1]. It is important to note that allergic rhinitis may wor- sen during pregnancy and, as a result, may necessitate pharmacologic treatment. The benefit-to-risk ratio of pharmacological agents for allergic rhinitis needs to be considered before recommending any medical therapy to pregnant women. Intranasal sodium cromoglycate can be used as a first-line therapy for allergic rhinitis in pregnancy since no teratogenic effects have been noted with the cromones in humans or animals. The first-gen- eration antihistamines may also be considered for aller- gic rhinitis in pregnancy and, if required, chlorpheniramine and diphenhydramine should be recommended given their longer-term safety record. However, the patient should be warned of the risk of sedation with these medications. If an intranasal corti- costeroid is required during pregnancy, beclomethasone or budesonide nasal spray should be considered as first- line therapy because of its longer safety record. Starting or increasing allergen immunotherapy during pregnancy is not recommended because of the risk of anaphylaxis to the fetus. However, maintenance doses are considered to be safe and effective during pregnancy [1]. Conclusions Allergic rhinitis is a common disorder that can signifi- cantly impact patient quality of life. The diagnosis is made through a comprehensive history and physical examination. Further diagnostic testing using skin-prick tests or allergen-specific IgE tests is usually required to confirm that underlying allergies cause the rhinitis. The therapeutic options available for the treatment of aller- gic rhinitis are effective in managing symptoms and are generally safe and well-tolerated. Second-generation oral antihistamines and intranasal corticosteroids are the mainstay of treatment for the disorder. Allergen immu- notherapy as well as other medications such as deconge- stants and oral corticosteroids may be useful in select cases. Key take-home messages Allergic rhinitis is linked strongly with asthma and conjunctivitis. Allergen skin testing is the best diagnostic test to confirm allergic rhinitis. Intranasal corticosteroids are the mainstay of treat- ment for most patients that present to physicians with allergic rhinitis. Allergen immunotherapy is an effective immune- modulating treatment that should be recommended if pharmacologic therapy for allergic rhinitis is not effec- tive or is not tolerated. Acknowledgements This article has been published as part of Allergy, Asthma & Clinical Immunology Volume 7 Supplement 1, 2011: Practical guide for allergy and immunology in Canada. The full contents of the supplement are available online at http://www.aacijournal.com/supplements/7/S1 Author details 1Sir Mortimer B. Davis Jewish General Hospital, Division of Allergy & Clinical Immunology, Montreal Quebec, Canada. 2University of Western Ontario, London, Ontario, Canada. 3McMaster University, Hamilton, Ontario, Canada. Competing interests Dr. Peter Small has received consulting fees or honoraria from GlaxoSmithKline, Graceway Pharmaceuticals, King Pharma, Merck Frosst, Novartis, and Nycomed. Dr. Harold Kim is the past president of the Canadian Network for Respiratory Care and co-chief editor of Allergy, Asthma and Clinical Immunology. He has received consulting fees and honoraria for continuing education from AstraZeneca, GlaxoSmithKline, Graceway Pharmaceuticals, King Pharma, Merck Frosst, Novartis, and Nycomed. Published: 10 November 2011 References 1. Small P, Frenkiel S, Becker A, Boisvert P, Bouchard J MD, Carr S, Cockcroft D, Denburg J, Desrosiers M, Gall R, Hamid Q, Hébert J, Javer A, Keith P, Kim H, Lavigne F, Lemièr C, Massoud E, Payton K, Schellenberg B, Sussman G, Tannenbaum D, Watson W, Witterick I, Wright E, The Canadian Rhinitis Working Group: Rhinitis: A practical and comprehensive approach to assessment and therapy. J Otolaryngol 2007, 36(Suppl 1):S5-S27.