Treatment

Second-Generation Antihistamines

Drug

Adult dose

Cetirizine (Zyrtec) Fexofenadine (Allegra) Loratadine (Claritin) Astemizole (Hismanal)

10 mg once daily 60 mg twice daily 10 mg once daily 10 mg once daily

A. Serious cardiac side effects have been reported with use of astemizole (Hismanal). Caution must be taken when coadministering astemizole with macrolides, antifungals, antidepressants or cimetidine because they may interfere with its metabolism.

B. Azelastine nasal spray (Astelin) is an intranasal, topical antihistamine, which may cause somnolence; 2 sprays in each nostril bid.

C. Intranasal steroids may be useful in relieving itching, rhinorrhea and congestion--and are more effective than antihistamines. Intranasal steroids require five to seven days for symptom improvement. The most common side effects are headache and local irritation. Occasionally, patients develop intranasal candidiasis.

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