Consultation with an allergist-immunologistmay be indicated in other situations when there is agreement between the patient and the referring physician that such an approach is in the patient's best interests. On the other hand, if the patient does not meet any of the criteria above and responds adequately to avoidance of documented triggers and the usual medication for the treatment of rhinitis, referral to an allergist-immunologist may not be necessary. Therapeutic Trial Initial treatment of non-severe rhinitis may include single agent or combination pharmacologic therapy and avoidance measures. Oral antihistamines are generally effective in reducing rhinorrhea, sneez-ing and itching associated with allergic rhinitis, but have little objective effect on nasal congestion. These agents may reduce symptoms of allergic conjunctivitis which are often associated with allergic rhinitis.
Antihistamines have a limited role in treating nonallergic rhinitis syndromes.
Consequently, second generation antihistamines that are associated with less risk or no risk for these side effects should usually be considered before sedating antihistamines, and are even mandated in segments of the transportation industry. However, the use of first generation antihistamines in smaller children may be desirable because of the benefit of mild sedation in children agitated from the discomfort of rhinitis. Intranasal antihistamines may be useful alternatives to oral antihistamines but may cause sedation in some patients and may be perceived to have a bitter taste. Oral decongestants, such as pseudoephedrine or phenylpropanolamine, help reduce symptoms of nasal congestion in both allergic and non-allergic rhinitis, and are rational agents for use in combination with antihistamines. However, they can cause insomnia, loss of appetite or excessive nervousness and occasionally an increase in blood pressure.