It should not be used to do screening without a clinical suspicion because of its high rate of false positives. In vitro tests for allergen-specific IgE are indicated for those patients with contact dermatitis or a questionable false skin test. A high serum IgE level can also provide some information but, in general, it is not sought because it is very non-specific. The first step in managing a patient with allergic rhinitis is to educate them about the importance of avoiding allergen contact. Even the best medical therapies are ineffective in the face of a high allergen load.
Antihistamines are very effective in acute episodes.
Generally, the non-sedative antihistamines are preferred to sedative ones. However, if for financial reasons the non-sedative antihistamines are not an option the patient should be instructed to take their antihistamines before bed. For patients with moderate disease, sodium cromoglycate may be taken prophylactically. However, this might not be popular with patients because it requires them to take medications four times a day. When antihistamines and decongestants are insufficient or patients require daily medications, topical steroids should be considered.