Which agent is a nonsedating antihistamine
Preventive and nonpharmacologic approaches should be tried before beginning medication in children.Approved for use in patients six years and older, nasal anticholinergics such as ipratropium (Atrovent) often reduce rhinorrhea without the undesirable side effects of sedation and fatigue sometimes associated with oral antihistamine use.26 However, anticholinergics have no effect on the other symptoms of vasomotor rhinitis.There was no evidence of growth retardation or hypothalamic-pituitary-adrenal axis suppression.11 Although short-term use studies purporting safety are quoted in the literature, budesonide (Rhinocort), beclomethasone (Beclovent), and triamcinolone acetonide (Kenalog) are not recommended for children younger than six years because of continued concern over possible long-term growth suppression by these older agents.1217 Cromolyn sodium (Intal) can be used to manage symptoms of sneezing and congestion in children older than two years.6As in adults, traditional oral antihistamines and newer less-sedating antihistamines have no established beneficial effects on vasomotor rhinitis in children.Prolonged use of topical nasal decongestants can cause irritation and rhinitis medicamentosa without proven benefit.
The minimum level of diagnostic testing needed to differentiate between the two types of rhinitis also has not been established. Specific approaches to the management of rhinitis in children, athletes, pregnant women, and older adults are discussed.
Vasomotor rhinitis affects millions of Americans and results in significant symptomatology.
Characterized by a combination of symptoms that includes nasal obstruction and rhinorrhea, vasomotor rhinitis is a diagnosis of exclusion reached after taking a careful history, performing a physical examination, and, in select cases, testing the patient with known allergens.
The vasomotor nasal effects of emotion and sexual arousal also may be caused by autonomic stimulation.
In one small study,4 researchers concluded that autonomic system dysfunction is significant in patients with vasomotor rhinitis (No specific test is available to diagnose vaso-motor rhinitis.A stepwise pharmacologic approach may then be employed, choosing the initial intervention based on the patient’s predominant symptoms.