Allergic rhinitis: What’s best for your patient?

Due to lack of data, probiotics should not be recommended.²⁷ A pediatric review article noted that probiotics may alter cytokine production in patients with seasonal AR and may be more helpful in AR than in asthma, although more research was needed.¹⁵ Another review showed that probiotics may reduce AR symptoms and medication use.³⁵

CASE Since the nasal steroid you prescribed for your patient did not provide adequate relief, you opt to add cetirizine 10 mg to his NS regimen. This step relieved his symptoms within 2 to 3 days. Had his symptoms persisted, the patient would have been a candidate for a one-week course of oral decongestant, such as pseudoephedrine 120 mg orally every 12 hours, as needed; and then for allergen testing, specifically for pollens corresponding to the seasonality of his AR. Appropriate follow-up would be to monitor the patient until his symptoms resolved or became manageable.