INTRODUCTION:

Patients often experience long waits to see their primary care providers, lose time at work for appointments, or turn to the emergency room, which may not be appropriate for all types of illnesses [1]. Convenient care clinics have become increasingly available across the country, providing access to health care for many patients. According to the 2015 Benchmarking Survey Headlines Summary by the Urgent Care Association of America, there were 14,000 urgent care visits in 2014 [2]. Given the prevalence of allergic rhinitis and the accessibility of convenient care clinics, providers will likely treat this disease frequently. Luckily for patients, many of the drug therapies for allergic rhinitis are now available OTC, making them readily available and cost-effective. Clinicians in convenient care settings often have pharmacists just a few feet away who can assist with product selection, patient counseling, and follow-up.

Epidemiology:

Affecting 19.1 million adults and 6.1 million children in 2014, allergic rhinitis is extremely prevalent in the United States [3]. It is the most common chronic condition affecting children in the United States, and one of the most common chronic diseases affecting adults [4]. Allergic rhinitis was one of the most popular reasons for office visits in 2010-more than 11,000 visits to primary care providers resulted in a diagnosis of allergic rhinitis [5].

Allergic rhinitis can result in a loss in productivity at school and work, as well as in overall quality of life (QoL). It is estimated that as much as $5 billion is spent on direct expenditures in health care due to this condition, and as much as $4 billion is lost because of reduced productivity each year [4].

Pathophysiology:

Allergic rhinitis occurs as a result of an IgE-mediated inflammatory response to aeroallergens. When exposure occurs, this leads to inflammation of the inner lining of the nose. Patients experience one or more of the following symptoms: rhinorrhea (anterior and posterior), nasal congestion, nasal itching, and sneezing. Children with allergic rhinitis present with cough and malaise or fatigue [4,6].

Examples of allergens that contribute to allergic rhinitis include pollen from trees, grasses or weeds, mold spores, dust mites, animal dander, and cockroaches [4,7]. Environmental irritants include tobacco smoke, volatile organic compounds from bacteria or fungi, formaldehyde, chlorine, and perfume.

Allergic rhinitis can be further categorized as seasonal or perennial; it can also be classified as episodic, intermittent or persistent [4,5]. The FDA utilizes the classification as seasonal or perennial when approving new drugs to treat it; however, this is based on geographic and climatic factors, so its usefulness will differ from patient to patient. For example, pollen exposure is seasonal in some areas and perennial in others; mold can also be seasonal or perennial. In addition, perennial allergic rhinitis can be worsened by seasonal allergen exposure [5].

Episodic allergic rhinitis happens when exposure to an allergen occurs outside of the patient’s normal environment, such as being exposed to animal dander at a friend’s house. Patients with intermittent allergic rhinitis experience symptoms less than 4 days per week or less than 4 weeks per year. Persistent allergic rhinitis occurs more than 4 days per week and more than 4 weeks per year [4].

Classifying patients based on frequency helps guide treatment selection; however, there are still drawbacks to using these categories. For example, depending on allergen and frequency of exposure, a patient could have symptoms 3 days per week, classifying them as intermittent, but the symptoms occur every week of the year, which would make them persistent. A thorough history of symptoms is imperative for the provider to decide which category best suits a patient’s allergic rhinitis.

Severity of allergic rhinitis is a classification that can also help with determining appropriate drug therapy. Patients with mild allergic rhinitis may complain of symptoms, but might not feel they interfere with their daily lives. Patients with more severe allergic rhinitis may experience worsening of coexisting asthma, trouble sleeping, and difficulty with performance at work or with daily activities, including leisure and exercise [4-6].

Complications:

Since their pathophysiology is similar, certain atopic disorders, such as asthma and eczema, are commonly associated with allergic rhinitis. More than half of patients with asthma have allergic rhinitis, and up to 40% of patients with allergic rhinitis also have asthma. In patients with allergy-induced asthma, allergic rhinitis is also extremely likely to be present. Children with eczema are also likely to develop this chronic condition [4]. About 80% of patients with allergic rhinitis also have allergic conjunctivitis [8]. Although some drugs used to treat allergic rhinitis can also alleviate the symptoms of conjunctivitis, some patients may need additional drug therapy. Due to the inflammatory nature of allergic rhinitis that can cause nasal blockage, as well as mucociliary clearance that is weakened, sinusitis may be more common, though a causal relationship has not been defined [4,5].

Diagnosis:

Many patients present to a provider with a primary complaint of rhinitis [5]. Although history helps the providers differentiate between allergic rhinitis and non-allergic causes of the symptoms. When gathering information from the patient, it is important to determine the severity, pattern, timing, and triggers of the patient’s symptoms [4,6]. Family history, coexisting conditions, occupational exposure, and details about the patient’s environment can help solidify an allergic cause of the rhinitis [6]. Determining a patient’s current medications and what other medications the patient has used for symptoms will help guide treatment. Finally, it is important to ascertain other respiratory symptoms the patient is experiencing, as well as how their symptoms are affecting their sleep and productivity at work or school.

Patients with allergic rhinitis usually have several findings in common upon physical examination. Rhinorrhea-which is described as clear, nasal turbinate mucosa with pale pink or bluish swelling and post-nasal drip-is present resulting in persistent throat clearing. Patients may also have watery eyes and conjunctivitis. Additionally, the “allergic shiner” is common-dark and puffy lower eyelids from venous pooling in the blood vessels-especially in children with allergic rhinitis. Patients with chronic allergic rhinitis often rub their noses frequently in the “allergic salute,” leading to an “allergic crease” across the bridge of the nose. When congestion leads to frequent mouth breathing, patients may also exhibit an “adenoid facies.” Findings on physical exam of a patient presenting with rhinitis should also rule out other non-allergic causes of rhinitis, such as foreign body presence, cerebral spinal fluid leak, nasal polyps, tumors, and infection [4,5].

In the convenient care setting, an initial diagnosis of allergic rhinitis can be made without further allergy testing [5,6]. In order to improve QoL in patients with severe symptoms or symptoms that are affecting their work or school performance, it is important to begin both non-pharmacologic and pharmacologic therapy when history and physical findings point to allergic rhinitis.

Approach to treatment:

Once it has been determined that a patient has allergic rhinitis, treatment should be selected based on symptoms and severity, as described above. When congestion is the primary complaint, intranasal corticosteroids or oral decongestants should be considered. For patients with sneezing, nasal itching, and rhinorrhea, oral or intranasal antihistamines are first-line therapies [6].

Patients with mild symptoms can begin with oral antihistamines, which are primarily available without a prescription, are well tolerated, and are inexpensive [7, 8]. Patients with moderate to severe symptoms can start with intranasal corticosteroids, intranasal antihistamines, or a combination. For patients who begin therapy and still have poor symptom control, adding additional medication, starting immunotherapy, and utilizing environmental control may be necessary.

Management:

Nonpharmacologic Management:

Reduction in environmental aeroallergen exposure can improve allergen counts for patients who identify certain allergens as triggers for their allergic rhinitis [7]. Patient preference plays a large role in choosing low-cost, beneficial controls.

For patients with triggers from allergens such as animal dander, removing a pet from the home may reduce exposure, but might be difficult for the patient to do [6]. Study results have demonstrated a reduction in symptoms when pets are removed from homes, when acaricides are used to kill dust mites, or when a Combination of environmental controls are used. Other study results have not demonstrated a reduction in symptoms when frequent washing of pets, use of impermeable bed covers, and air filtration alone as environmental controls are attempted; however, some study results have shown bathing dogs and cats weekly or biweekly can help with allergen counts in the home [6].

Additional study results have shown that confining a cat to a noncarpeted room of a home equipped with a high-efficiency particulate air (HEPA) filtration system can reduce aeroallergens by 90%. Having a HEPA filtration system in the home, as well as a vacuum equipped with a HEPA filter, maintaining a low humidity level, having no carpeting, washing clothing in hot water, using pillow and mattress protectors, and using acaricides to kill dust mites are all methods that reduce allergen exposure and can improve symptoms in some patients [4,6].

Nasal irrigation with saline solution has become a widely used complementary treatment for allergic rhinitis. Though it is not entirely clear how nasal irrigation improves symptoms, it is thought that the irrigation removes mucus, crusts, debris, and allergens; it also removes inflammatory mediators, and improves ciliary function and mucociliary clearance. A meta-analysis in 2012 demonstrated that nasal irrigation or nasal sprays with isotonic saline showed symptom and QoL improvement with use, and could be recommended to patients as adjunct treatment for allergic rhinitis [9].

Pharmacological Management:

Intranasal Corticosteroids:

Intranasal corticosteroids are able to obtain high drug concentrations in the nasal mucosa after administration, and are considered to be the most efficacious for treating allergic rhinitis [10]. They are effective in relieving symptoms such as sneezing, nasal itching, rhinorrhea, congestion, and ocular conjunctivitis [11]. Intranasal corticosteroids work to reduce the inflammatory response to allergens by inhibiting T-cell activation, reducing inflammatory cytokines, and reducing the levels of mast cells, eosinophils, and basophils in the nasal mucosa [12]. This class of drugs includes budesonide, beclomethasone, ciclesonide, fluticasone, flunisolide, triamcinolone, and mometasone, some of which are available as both prescription and non-prescription [12]. Some of the intranasal corticosteroids are approved for use in children as young as 2 years old. Although they are easy to use and have a low risk of adverse effects (AEs), they can take up to 2 weeks to take full effect [11].

AEs of these drugs are due to local irritation of the mucosa. Patients may complain of dryness, burning, stinging, blood in nasal secretions, and epistaxis. Preference of one product over another may be due to its formulation that affects smell, after taste, and subsequent secretions from the nose and down the throat. Preparations that are nonaqueous and use hydrofluoroalkane aerosol may eliminate these concerns [13].

Intranasal corticosteroids can be used in combination with other medications for allergic rhinitis, but they have been shown to be superior to antihistamines in managing nasal symptoms, and are more effective than leukotriene receptor antagonists in managing all allergic rhinitis symptoms. When intranasal corticosteroids are used for seasonal allergic rhinitis, the patient should begin using the chosen medication several days before pollen season begins. When severe congestion is present, adding intranasal oxymetazoline for no more than 3 days can be effective for patients currently using an intranasal corticosteroids.

Oral Corticosteriods:

Oral corticosteriods, such as prednisone and methylprednisolone, are available by prescription only and are used to treat severe nasal symptoms or polyposis. The main mechanism by which oral glucocorticoids relieve allergic rhinitis symptoms is through their anti-inflammatory effects [14].

The use of oral corticosteroids as therapy for chronic rhinitis is limited due to the potential AEs such as peptic ulceration and potential adrenal suppression. Oral therapy treatment over a course of 5-7 days may be appropriate for those experiencing severe nasal congestion with insufficient relief from other agents [14]. Due to the potential for long-term AEs with corticosteroids, parenteral administration is discouraged and is contraindicated for recurrent use [15].

Oral Antihistamines:

Oral antihistamines are widely available and recommended for treating allergic rhinitis [14,15]. Oral antihistamines are effective in children and adults in reducing the occurrence of symptoms like rhinorrhea, sneezing, itching, nasal blockage, and ocular symptoms [16]. Antihistamines block histamine at the H₁ receptor, resulting in an anti- inflammatory effect. First-generation antihistamines, such as diphenhydramine, chlorpheniramine, and hydroxyzine, cross the blood-brain barrier; very commonly, they cause significant sedation and mucosal dryness, which limit their use. Second-generation antihistamines, such as fexofenadine, cetirizine, loratadine, levocetirizine, and desloratadine, are more selective for the H₁ receptors, which cause infrequent sedation [17-21].

For allergic rhinitis, second- generation antihistamines are preferred over the first-generation antihistamines. These drugs have a rapid onset and are administered once daily. When used continuously, they do not have a diminished effect, but instead, this is how their maximum benefit is achieved. However, some patients with intermittent symptoms of allergic rhinitis can use oral antihistamines as needed and still experience symptom relief. The majority of oral antihistamines are available over the counter. All of the second-generation oral antihistamines are approved for use in children as young as 2 years old. Despite the selectivity of the second-generation antihistamines, cetirizine and levocetirizine have been reported to potentially cause sedation at recommended doses compared to the others [22]. Other AEs include dry mouth, urinary retention, and headache [23].

Oral antihistamines are not more effective in treating congestion than intranasal corticosteroids, and they have not shown additional benefit when added to an intranasal corticosteroid. However, they likely provide sufficient relief for many patients with allergic rhinitis. Adding an oral decongestant, such as pseudoephedrine, to an oral antihistamine has been shown to significantly manage allergic rhinitis more effectively than either class alone. Patients will likely experience an increase in AEs, including insomnia, headache, dry mouth, and nervousness.

Intranasal Antihistamines:

There are 2 prescription intranasal antihistamines available in the United States that are approved for seasonal allergic rhinitis: azelastine and olopatadine [24]. They have been shown to be effective in treating congestion, rhinorrhea, sneezing, and nasal itching. Study results have demonstrated that intranasal antihistamines are as good as or better than oral antihistamines in treating nasal symptoms [25]. Intranasal antihistamines block histamine at the H₁receptor. Since intranasal antihistamines are delivered to the site of action directly, some of the systemic AEs of antihistamines are avoided, so they are a good choice for patients who cannot tolerate oral antihistamines. Intranasal antihistamines are also an option for patients that fail oral antihistamines. Intranasal antihistamines are more effective at treating congestion than oral antihistamines, and they have a faster onset [26,27]. These medications are approved for use in children as young as 6 years old [28].

AEs of intranasal antihistamines include epistaxis, headache, and somnolence. Bitter taste can also occur, and its incidence is more than 10 times higher than with intranasal corticosteroids.

Intranasal antihistamines have utility in treating patients with episodic symptoms or as a prophylactic treatment prior to a particular allergen exposure because of their rapid onset and targeted delivery. The combination of an intranasal antihistamine with an intranasal corticosteroid in the drug combination azelastine/fluticasone propionate has been shown to provide better symptom relief than either drug alone, and it has a rapid onset of action of 30 minutes [29]. This combination nasal spray has also been shown to be significantly more effective in children ages 6 to 12 than fluticasone alone in relieving symptoms of allergic rhinitis [30].

Decongestants:

Decongestants, such as pseudoephedrine and oxymetazoline, are available in oral and/or intranasal forms. They specifically treat sinus and nasal congestion by acting on adrenergic receptors to constrict dilated blood vessels within the nasal mucosa, resulting in decreased inflammation [31, 32].

Due to the potential systemic AEs, including insomnia and headache, patients with certain health conditions, such as diabetes, heart conditions, hypertension, glaucoma, and prostate or thyroid issues, should use these medications with close monitoring [33,34]. Rhinitis medicamentosa, also known as rebound congestion, has been associated with intranasal decongestant use because of various hypothesized reasons, such as preservative agents and duration of therapy.

Nasal decongestants should be used for no more than 3 to 5 days [35]. Caution should also be used with oral combination products containing antihistamines and decongestants with potential for additional AEs [4]. Multiple randomized placebo-controlled trials have studied this combination to control allergic rhinitis symptoms, and results found the combination to work better than either oral antihistamine or oral decongestant therapy alone. However, patient comorbidities and preferences should always be considered [36].

Intranasal Cromolyn:

Intranasal cromolyn, which prevents and treats symptoms like nasal congestion and sneezing, is a mast cell stabilizer that inhibits the influx of calcium into mast cells; this prevents mediator release of the allergic response and inflammation.

Though it is generally well tolerated with minimal AEs (ie, sneezing and nasal irritation) and drug interactions, intranasal cromolyn is not considered first-line therapy for allergic rhinitis because it may not be as effective as corticosteroids, and it requires regular use of the medication for it to be most effective [37,38].

Since the efficacy of cromolyn depends on the drug’s ability to cover the entire nasal lining, counseling on administration technique is important. Since it will take 4 to 7 days for initial treatment efficacy, patients should be counseled to start therapy prior to when their symptoms occur. Additionally, it requires 2 weeks or more of continued therapy for maximum effects in those with severe or perennial cases; therefore, physician assistants and nurse practitioners may consider recommending antihistamines or decongestants during the initial phase of therapy to provide relief [39]. There is a possibility for dose decrease as cromolyn begins to work, but each patient should be assessed individually [39, 40].

Leukotriene Receptor Antagonists:

Montelukast is a leukotriene receptor antagonist (LTRA) that helps control various allergic rhinitis symptoms such as sneezing, itching, nasal congestion, and rhinorrhea. LTRAs inhibit the cysteinyl leukotriene receptor, which is one type of inflammatory mediator released from mast cells in an allergic response [22].

Overall, montelukast is well tolerated with common AEs (incidence ≥5% and greater than placebo), such as upper respiratory infection, fever, and headache [6, 22]. When compared to intranasal steroids and antihistamines, montelukast may not be as effective in treating allergic rhinitis symptoms [32]. Routine use of combination oral antihistamines and LTRAs is not recommended because of the conflicting evidence as to whether combination treatment is superior to either treatment monotherapy. The American Academy of Otolaryngology-Head and Neck Surgery treatment guidelines advise that LTRAs, such as montelukast, should be considered after antihistamines and nasal steroids are used and may provide additional benefit in patients who have comorbid allergic rhinitis with asthma [34].

Intranasal Anticholinergics:

Ipratropium, an intranasal anticholinergic, is only effective for the symptomatic relief of excessive rhinorrhea associated with allergic rhinitis. It has antisecretory properties, and inhibits seromucous gland secretions when applied locally to the nasal mucosa [24, 30].Ipratropium is available in 0.03% and 0.06% nasal spray; the 0.06% form is also recommended for treatment of rhinorrhea associated with the common cold [24].

Ipratropium is associated with mild AEs, such as headache and dryness of the nasal mucosa [24]. It can be used alone or concomitantly with other medications, such as intranasal corticosteroids. This combination is more effective than administration of either drug alone in the treatment of rhinorrhea without an increase in adverse events [6]. Important management points include educating patients on how to appropriately administer the nasal spray, as well as assessing compliance with medication, as it needs to be administered 2 to 4 times daily [24].

Allergen Immunotherapy:

Allergen immunotherapy is recommended for patients with moderate or severe persistent allergic rhinitis whose symptom control is not adequate with optimal pharmacotherapy, whether with or without environmental controls [30-33]. It should be reserved for patients with clearly documented symptoms of allergic rhinitis related to defined allergen exposure and confirmed by the presence of relevant allergen-specific IgE antibodies [33]. It can also be recommended to patients for whom allergen avoidance is not possible or those who develop allergic reactions to stinging insect venom [29]. There is no specific upper or lower age limit recommended to initiate allergen immunotherapy; instead, prescribers should appropriately assess indications, comorbid conditions, and whether patients will remain adherent to allergen immunotherapy. The appropriate use of allergen immunotherapy incorporates several key decision points [33].

Mechanism of Action:

Immunotherapy is the only treatment that can modify the natural history of the disease by targeting the underlying immunologic mechanisms to down-regulate allergic response due to specific allergens, and that can offer long-term disease remission [29]. Immunotherapy, which can be administered subcutaneously or sublingually, is considered cost-effective in the long term due to cost savings over time, possibly improving or preventing other comorbidities such as asthma [29]. The proposed mechanism of action is likely the result of altered T-cell cytokine production (a shift from T-helper type 1 to T-helper type 2), resulting in a reduction of Il-4, IL-5, and IL-13 cytokines production, which may help reduce upper and lower airway inflammation. Allergen immunotherapy is a slow, gradual process of at least several years of injecting increasing, small, controlled concentrations of antigens that had resulted in the allergic symptoms inducing allergen tolerance when natural exposure occurs. This process is continued until a maintenance dose is achieved [29, 33].

Administration:

Subcutaneous immunotherapy is given with multiple allergens in single or multiple injections. It is injected either once or twice weekly to monthly intervals. Once a maintenance dose is found, monthly injections are adequate. The Preventive Allergy Treatment (PAT) study found that long-term clinical effects and potential of prevention of asthma development in children with allergic rhinoconjunctivitis lasted up to 7 years after treatment with specific immunotherapy [34]. As long as immunotherapy offers a benefit after 1 year of maintenance therapy, allergen immunotherapy should be continued. Allergen immunotherapy treatment should be individualized, and, depending on patient’s response, it may continue beyond 3 years [35].

Adverse Effects:

Some local reactions, such as redness and swelling at the injection site, may occur for 1 to 3 days, and there is a potential risk of severe systemic allergic reactions, including anaphylaxis, especially with subcutaneous immunotherapy. Because of this risk, it should be administered to the patient in a treatment site where anaphylactic consequences can be managed appropriately by a trained provider. Patients should be monitored at treatment site for 30 minutes after administration and have an action plan discussed with their provider in the case of an immediate or delayed systemic reaction occurs. Although immunotherapy can be given for asthma, it can only be given when the asthma is well controlled [32, 33].

Sublingual Immunotherapy:

Another form of allergy immunotherapy approved in the United States is sublingual immunotherapy (SLIT), which is a fixed dose of allergen in a liquid or tablet form placed under the tongue and must be taken on a daily basis for 12 to 16 weeks prior to the anticipated start of the allergy season. The FDA approved 3 SLIT products with 2 directed at different kinds of grass pollen, Oralair and Grastek, and 1 for short ragweed, Ragwitek [35-38]. SLIT may induce minor AEs, such as local irritation in the mouth and under the tongue, which decrease after the first few doses [36-38].

Although subcutaneous immunotherapy has not been compared with SLIT in large head-to-head trials, indirect comparisons suggest that subcutaneous immunotherapy is more effective for symptom relief. However, SLIT may have an advantage over subcutaneous immunotherapy in that it has fewer reports of anaphylactic reactions [39], but it also requires daily treatment, which causes therapy adherence to be lower compared to subcutaneous immunotherapy [40].

Considerations:

To improve outcomes, clinicians should consider when a referral to an allergist/immunologist is warranted. Although an initial treatment may be successful, patient follow-up needs to be maintained to assess whether symptoms are controlled on current therapy and if new medication AEs develop. Certain patient factors that warrant a referral to an allergist or immunologist include patients with prolonged severe rhinitis history who may have comorbid conditions or complications, such as asthma and recurrent sinusitis, who have symptoms that interfere with quality of life and function, and who take medications that are ineffective, causing AEs, or that are not to be used long term [40].

Collaborative care:

Successful allergic rhinitis treatment requires considering a combination of factors, such as allergen avoidance, patient education, pharmacotherapy, and immunotherapy in some patients [41].These factors should be discussed by physician assistants, nurse practitioners, and pharmacists to help patients achieve optimal management of chronic disease states, such as allergic rhinitis [41]. Although there is no cure, patients can effectively manage their allergic rhinitis symptoms by incorporating pharmacologic therapy and developing a long-term management plan, which may include a thorough understanding of appropriate self-care and self-medication and when to follow up with a health care provider when allergic rhinitis symptoms are no longer managed optimally on the current regimen [42]. This plan should be assessed continuously, accounting for changes in environmental factors and QoL with health care professionals, including physician assistants, nurse practitioners, and pharmacists, working collaboratively.

The role of the pharmacists is evolving, and they are being incorporated into the health care team-based model to improve health outcomes and assist with reducing the cost of treating chronic conditions [43]. Allergic rhinitis is a chronic condition that can be managed appropriately in an outpatient setting. However, patients are self-managing their conditions apart from a designed care plan [42]. One online survey study investigated how patients diagnosed with allergic rhinitis manage their condition and the types of interactions they have with their physicians and community pharmacists. The study results showed that a significant portion of these patients are self-managing their conditions without a designated care plan. In addition, those who were using prescription medications to treat allergic rhinitis did not have appropriate follow-ups with their physicians since it was first prescribed. Patients seeking assistance are those with higher income and education and those who tend to speak more frequently to their pharmacists than any other health care providers about their OTC and prescription medications [42]. Therefore, pharmacists and clinicians are in a unique position to serve as an accessible health resource to assist patients with effectively managing their allergic rhinitis and ensuring that patients are following an appropriate care plan.

Many times, patients may have poor perception about their disease control and will not seek appropriate follow-up to address their symptoms [44]. However, optimal allergic rhinitis treatment requires regular follow-up appointments, whether it is with their physician assistant, nurse practitioner, or pharmacist. The management of allergic rhinitis often begins at the pharmacy, where patients can purchase OTC products for management of allergic rhinitis symptoms. Pharmacists can serve as medical liaisons and advisors to assist patients with recognition of complications, counsel on appropriate medication use to increase therapeutic success, and improve patient compliance to medications [45].

Like treatment of any chronic conditions, patient management and monitoring of allergic rhinitis symptoms should be individualized for each patient. Managing a chronic medical condition such as allergic rhinitis is a complex process that requires collaborative effort from both the patient and health care providers such as physician assistants, nurse practitioners, and pharmacists. The physician assistants and nurse practitioners prescribe and recommend appropriate allergic rhinitis treatments, accounting for a patient’s symptoms, comorbidities, physical examination, age, and preferences [33]. However, these factors will change over time, and a continuous provider–patient partnership will help patients adhere to treatment. Pharmacists can strengthen this partnership and maintain continuous communications between the providers and patients in management of their allergic rhinitis symptoms.

CONCLUSION:

Allergic rhinitis is a common chronic illness that affects both adults and children in the United States. If not managed appropriately, it can cause a loss in productivity at school and work, as well as overall QoL. Allergic rhinitis can be effectively self-managed on an outpatient basis by incorporating pharmacologic therapy and developing a long-term management plan. This long-term management plan will be assessed continuously, accounting for changes in environmental factors and QoL with clinicians, such as physician assistants, nurse practitioners, and pharmacists, working collaboratively. In many cases, treatment of allergic rhinitis will start at the pharmacy where OTC treatments are readily accessible. Clinicians and pharmacists can educate patients on the importance of adherence to therapy, assess symptom relief on current therapy, and help develop a plan with patient preferences in mind. Pharmacists can help manage patients’ symptoms between follow-up visits with their clinician and refer patients back for follow-up if necessary. Incorporating pharmacists, nurse practitioners, and physician assistants to assist patients with their management of allergic rhinitis will maximize patient outcomes, and foster a collaborative working relationship among health care providers.

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Received on 10.01.2021 Modified on 18.01.2021

Res. J. Pharmacology and Pharmacodynamics.2021; 13(1):9-16.

DOI: 10.5958/2321-5836.2021.00003.3