First-generation antihistamines, including brompheniramine, chlorpheniramine, clemastine, and diphenhydramine (Benadryl), may cause sedation, fatigue, and impaired mental status.
For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see https://org/afp/recommendations/Symptoms of allergic rhinitis are classified based on the temporal pattern (seasonal, perennial, or episodic), frequency, and severity.
Frequency can be divided into intermittent or persistent (more than four days per week and more than four weeks per year, respectively).
Evidence does not support the use of mite-proof impermeable mattresses and pillow covers, breastfeeding, air filtration systems, or delayed exposure to solid foods in infancy or to pets in childhood.
Allergic rhinitis is an immunoglobulin E–mediated disease that occurs after exposure to indoor or outdoor allergens, such as dust mites, insects, animal dander, molds, and pollen.
Because their onset of action is typically within 15 to 30 minutes and they are considered safe for children older than two years, second-generation antihistamines are useful for many patients with mild symptoms requiring as-needed treatment.214Compared with oral antihistamines, intranasal antihistamines have the advantage of delivering a higher concentration of medication to a targeted area, resulting in fewer adverse effects and an onset of action within 15 minutes.2 Intranasal antihistamines FDA-approved for the treatment of allergic rhinitis are azelastine (Astelin; for patients five years and older) and olopatadine (Patanol; for patients six years and older).
They have been shown to be similar or superior to oral antihistamines in treating symptoms of conjunctivitis and rhinitis, and may improve congestion.31 Adverse effects include a bitter aftertaste, headache, nasal irritation, epistaxis, and sedation.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.
For information about the SORT evidence rating system, go to https://org/afpsort Other interventions that do not have documented effectiveness in the prevention of allergic rhinitis include breastfeeding, delayed exposure to solid foods in infancy or to pets in childhood, and the use of air filtration systems.
For information about the SORT evidence rating system, go to https://org/afpsort Source: For more information on the Choosing Wisely Campaign, see