10 mg tab 10 mg po daily Age ≥15 yrs bid, twice a day; tid, three times a day; po, by mouth Goals of Treatment Emergency management of allergic rhinitis includes acute symptomatic relief symptoms both nasal (obstruction, secretions) and ophthalmic (irritation, pruritus, tearing) Outpatient primary care and/or allergy follow-up is warranted in most cases Clinical Considerations Clinical Recognition The classic symptoms of allergic rhinitis include nasal congestion, paroxysmal sneezing, and ocular pruritus Other complaints include noisy breathing, snoring, repeated throat clearing or cough, itching of the palate and throat, “popping” of the ears, and ocular complaints such as redness, itching, and tearing The physical examination is variable but may reveal the “gaping” look of a mouth breather, dark discoloration of skin on the infraorbital ridge caused by venous congestion (allergic shiners), and a transverse external nasal wrinkle secondary to chronic rubbing of the nose (allergic salute) There may be cobblestoning in the posterior oropharynx and palpebral conjunctiva, rhinorrhea (clear, mucoid, or opaque), and edematous nasal mucosal which may appear pale or violaceous Management Although there is a paucity of high-quality evidence regarding the pharmacologic management of children with allergic rhinitis, the mainstay of therapy includes identifying and avoiding environmental allergens, symptomatic treatment (oral antihistamines, nasal steroids, and decongestants), and immunotherapy Recognizing that long-term therapy must be individualized, emergency providers should limit interventions to those that provide safe and rapid symptomatic relief, while emphasizing the importance of establishing outpatient follow-up with primary care providers and/or allergists Special attention should be made to ensure patients with concomitant asthma are appropriately managed as data from adult studies suggest that effectively treating allergic rhinitis reduces health care utilization related to bronchospasm Topical corticosteroids are considered first-line therapy for chronic allergic rhinitis but may require as long as weeks to achieve maximal relief Rapid relief can generally be achieved by using second-generation (nonsedating)