Complications
Appropriate therapy with oral or ophthalmic antihistamines or ophthalmic cromolyn may be required to achieve a successful and comprehensive therapeutic outcome.
Poorly controlled AR may result in the development of lower respiratory tract symptoms or loss of asthma control in certain individuals. If this occurs, the physician will need to address both airways equally to gain adequate disease control.
Symptoms such as itching and swelling triggered by certain fruits or vegetables in patients with allergic rhinitis are usually confined to the oropharynx and will generally resolve without treatment. However, a nonsedating antihistamine may be appropriate for troublesome symptoms. Anaphylaxis is rare but an epinephrine (adrenaline) autoinjector is recommended for patients who are at increased risk of severe reactions. Patient education about avoidance of the responsible foods is recommended.[111]
Use of first-generation antihistamines may result in both drowsiness and a global reduction or impairment in intellectual and motor performance, such as learning a new task or driving an automobile. This can also occur with some second-generation antihistamines (e.g., cetirizine and levocetirizine), but is less common than with first-generation agents.
Paradoxical hyperactivity with use of sedating antihistamines has been reported, particularly in children.[83]
Include nasal burning, stinging, dryness, and less commonly, mucosal ulceration.
Can occur when intranasal decongestants are used for longer than 3 to 5 days.
Adverse effects of oral decongestants include central nervous stimulation such as insomnia, which may occur in up to one third of people; nervousness; anxiety; tremors; tachycardia; palpitations; and increases in BP.
Leukotriene receptor antagonists (e.g., montelukast) are associated with an increased risk of neuropsychiatric events (e.g., agitation, depression, sleeping problems, and suicidal thoughts and actions). The risk of neuropsychiatric events may outweigh the benefits, particularly for patients with symptoms that are mild and treatable with alternative agents.
Leukotriene receptor antagonists should be reserved for those who have failed or are intolerant of other agents.[3][70]
There is considerable epidemiologic evidence to support an association between sinus disease and AR. Studies have noted that 40% to 67% of patients with unilateral chronic sinusitis and up to 80% with chronic bilateral sinusitis have AR.
There is considerable epidemiologic evidence to support an association between sinus disease and AR. Studies have noted that 25% to 30% of patients with acute sinusitis have AR.
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