**3. Nasal lavage**

68 Otolaryngology

drugs.

Side effects Comments

Excellent tolerance. Effective on rhinitis

Minor local side effects. Intraocular cromones

Effective on smell. Effect observed after 12 hours but maximal effect after a few days

and asthma. Effective on all symptoms of rhinitis and on ocular symptoms.

are very effective. Intranasal cromones are less effective and their effect is short

Effective on allergic and non-allergic patients with rhinorrhea.

Use oral decongestants with caution in patient with heart disease. Oral H1-antihistamine-

Act more rapidly and more effectively than oral decongestants. Limit duration of treatment to minor 10 days to avoid rhinitis medicamentosa.

When possible, intranasal

glucocorticosteroids should replace oral or intramuscular drugs. However a short course of oral glucocorticosteroids may be needed of moderate /severe symptoms.

decongestant combination products may be more effective than either product alone but side effects are combined.

lasting.

consider the combination of intranasal and inhaled

Minor local side effects. Almost no systemic anticholinergic activity.

Dry mucous membranes. Urinary retention. Exacerbation of glaucoma or thyrotoxicosis.

Same side affects as oral decongestants but less

Rhinitis medicamentosa is a rebound phenomenon occurring with prolonged use (over 10 days)

Systemic side effects common in particular for intramuscular drugs. Depot injections may cause local tissue atrophy.

intense.

Hypertension. Palpitations. Restlessness. Agitation. Tremor. Insomnia. Headache.

Drugs Generic names Mechanism of

propionate Fluticasone furoate Metasone furoate Triamcinolone acetonide

Montelukast Pranlukast Zafirlukast

Cromoglycate Nedocromil NAAGA

Ephedrine Phenylephrine Phenylpropan olamine Pseudoephedri

Oxymethazoli

Xylomethazoli

Dexamethason

Hydrocortison

Methylprednis olone Prednisolone Prednisone Triamcinolone

ne Oral H1 antihistamine decongestants combinations

ne

ne Others

e

e

Leukotriene antagonists

Local cromones (intranasal, intraocular)

Intranasal anticholinergics

decongestants

Intranasal decongestants

Oral/intramusc

glucocorticoster

ular

oids

Oral

action

Blockage of CystLT receptor.

Mechanism of action poorly known.

block almost exclusively rhinorrhea

drugs.

of nasal congestion.

drugs.

nasal inflammation. Reduce nasal hyperreactivity.

Sympathomimetic

Relieve symptoms

Sympathomimetic

Relieve symptoms of nasal congestion

Potently reduce

Table 1. Therapeutic groups in the "ARIA-pharmaceutical market" (Bousquet et al, 2008).

Ipratropium Anticholinergic

Nasal lavage is a non-pharmacological treatment of rhinitis. Most authors agree that this is a well-tolerated, effective and inexpensive treatment.
