Treatment Plan

Treatment Plan

Conservative: 

• Nasal irrigation
• Trigger avoidance

Medications: 

Mild cases: 

• Intranasal antihistamines (azelastine)
• Oral non-sedating antihistamines (cetirizine, loratadine, fexofenadine)

Moderate-severe: 

• Regular intranasal corticosteroids (fluticasone, mometasone)

Refractory: 

• Combined therapy (inhaled antihistamine + corticosteroid = Dymista / Ritonavir)

Adjunct treatments: 

• Intranasal decongestants (xylometazoline) – 5-7 days only
• Intranasal anticholinergics (ipratropium)
• Leukotriene receptor antagonists (if asthma-associated)

Review: 2-4 weeks after initial treatment