# Allergic rhinitis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ARIA Guidelines 2020 · Egyptian National Drug Formulary - Respiratory Medicines 2026 (fexofenadine monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026 (chlorpheniramine maleate monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026 (xylometazoline monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026 (montelukast monograph) - Verified date: 2026-08 ## Verified against - ARIA Guidelines 2020 - Egyptian National Drug Formulary - Respiratory Medicines 2026 (fexofenadine monograph) - Egyptian National Drug Formulary - Respiratory Medicines 2026 (chlorpheniramine maleate monograph) - Egyptian National Drug Formulary - Respiratory Medicines 2026 (xylometazoline monograph) - Egyptian National Drug Formulary - Respiratory Medicines 2026 (montelukast monograph) ## Treatment metadata - Cetirizine — 10 mg — oral.solid - Loratadine — 10 mg — oral.solid - Fluticasone propionate — 0.05 mg — nasal - Mometasone furoate — 0.05 mg — nasal - Fexofenadine — 120 mg — oral.solid - Chlorpheniramine maleate — 4 mg — oral.solid - Xylometazoline — 0.1 mg — nasal - Montelukast — 10 mg — oral.solid ## Complete treatment card ```text ALLERGIC RHINITIS Sources: ARIA Guidelines 2020 · Egyptian National Drug Formulary - Respiratory Medicines 2026 (fexofenadine monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026 (chlorpheniramine maleate monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026 (xylometazoline monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026 (montelukast monograph) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Seasonal disease brings sneezing, a runny nose, and watery eyes [runny nose · sneezing] - The chronic form more often brings postnasal drip and a stuffy, blocked nose [blocked nose] - Common triggers include pollen, pet dander, carpet or upholstery, mold, humidity, perfume, and cigarette smoke - A family history of the condition, or a personal history of asthma, is often present SIGNS - what you find (4) - Mouth breathing, frequent sniffling or throat-clearing, a crease across the nose, and dark circles under the eyes can be seen [mouth breathing] - Looking inside the nose typically shows swollen mucosa with thin clear secretions - The inferior turbinates can look bluish, and the mucosal surface can appear cobblestoned - Pressing over the sinuses can be tender in patients with chronic symptoms TESTS (5) - Improvement with a trial of nasal steroid spray supports the diagnosis - Blood testing for allergen-specific IgE, or skin testing, gives a formal diagnosis - Skin testing is somewhat more sensitive than blood testing and costs less - Uncontrolled asthma, unstable heart disease, pregnancy, and beta-blocker use rule out skin allergy testing - Imaging is not routinely needed and is mainly used to exclude sinus disease instead IF NOT THIS - what else fits (9) - Vasomotor rhinitis, triggered by temperature or odor changes rather than allergy, is a key mimic - Viral or bacterial infection is the likelier cause of rhinitis in children - Clear discharge that does not respond to treatment raises concern for a cerebrospinal fluid leak - Eosinophils in nasal tissue without true allergic sensitization defines NARES - Occupational or household chemical exposure can cause a chemical rhinitis - Certain drugs - NSAIDs, ACE inhibitors, decongestant sprays, cocaine - can cause a drug- induced rhinitis - Vasculitic conditions such as granulomatosis with polyangiitis or sarcoidosis can present similarly - Nasal polyps or a nasopharyngeal tumor should be on the differential too - In a young child with nasal polyps, cystic fibrosis should be excluded with a sweat chloride test Source StatPearls "Allergic Rhinitis" - disease-level clinical article Status traced to the source above Rx: Antihistamine | Nasal steroid | Nasal decongestant | Add-on ANTIHISTAMINE - choose one 1. CETIRIZINE [1st line] Adult 10 mg once daily - as-needed Peds 1 to 2 years: 2.5 mg once daily 2 to 6 years: 5 mg once daily Over 6 years: 10 mg once daily (2.5 mg daily (1-2 yrs), 5 mg daily (2-6 yrs), 10 mg daily over 6 yrs) Choice Alternatives. All three are second-generation antihistamines with equivalent effect in allergic rhinitis; cetirizine is the most widely stocked and the cheapest to start. Source ARIA Guidelines 2020 Why Second-generation antihistamine that blocks the histamine driving sneezing, itching, and rhinorrhea, with little sedation; a standard first-line oral option for allergic rhinitis. Caution Cetirizine is a second-gen H1 blocker; the sedation risk is low but mild drowsiness is possible. Avoid alcohol. A dose reduction is required in renal impairment. Egyptian National Drug Formulary - Respiratory 2026, cetirizine monograph, renal dosage table: eGFR 30-49 mL/min 5 mg once daily; eGFR <30 not requiring dialysis 5 mg once every 2 days. Egypt EPIRIZINE 10 MG 10 TABS. EIPICO 15.50 EGP (1.55/unit) CETRITIN 10MG 20 TAB. EL NILE. 42.00 EGP (2.10/unit) TOMAZINE 10MG 30 F.C. TABS. ALFACURE PHAR... 63.00 EGP (2.10/unit) CETRAK 10 MG 20 TABS. PHARCO 68.00 EGP (3.40/unit) HISTAZINE-1 10 MG 20 TABS. AMRIYA 68.00 EGP (3.40/unit) ZYRTEC 10 MG 20 TAB. GLAXO SMITHKLINE 100.00 EGP (5.00/unit) CETRICHEW 10MG 20 CHEWABLE F.C. TABS. AL ROWAD PHARMACEUTICAL INDUSTRIAL... 15.00 EGP HISTA CHEW 10 MG 20 CHEWABLE TAB. ARAB CAPS > ADVOCURE 15.00 EGP LERGFREE 5MG/5ML SYRUP 120ML DEBEIKY 9.00 EGP -> ? strength differs, ? different route - not oral solid EPIRIZINE 5MG/ML SYRUP 60 ML EIPICO 19.00 EGP -> ? strength differs, ? different route - not oral solid 2. LORATADINE [1st line] Adult 10 mg once daily - as-needed Peds 2 to 5 years: 5 mg once daily 6 years and over: 10 mg once daily (5 mg daily (2-5 yrs), 10 mg daily over 6 yrs) Source ARIA Guidelines 2020 Why Non-sedating second-generation antihistamine, an alternative first-line oral option to cetirizine for allergic rhinitis symptoms. Caution Caution in severe hepatic impairment. Egyptian National Drug Formulary - Respiratory 2026, loratadine monograph, Hepatic impairment: "Severe liver impairment - Adults and children weighing more than 30 kg: Initial: 10 mg every other day. Children weighing 30 kg or less: 5 mg every other day is recommended." Take on empty stomach or with meals. Loratadine is a non-sedating antihistamine. Egypt HISTALONG 10 MG 20 TAB. JEDCO INT. CO... 17.00 EGP (0.85/unit) UNILORATADINE 10 MG 20 TABS. UNIPHARMA CO.... 17.00 EGP (0.85/unit) SEDCLARIT 10MG 20 TAB. SEDICO 19.50 EGP (0.97/unit) LORATADINE 10MG 10 TAB. MISR 25.50 EGP (2.55/unit) ONY 10 MG 20 TABS. UNIPHARMA 51.00 EGP (2.55/unit) ALLERGETONE 10 MG 20 TABS. MARCYRL PHARM... 66.00 EGP (3.30/unit) CLARITINE 10MG 20 TAB. SEDICO > BAYE... 110.00 EGP (5.50/unit) ALLERGIRAZ 10MG 30 DISINTEGRATING TABS. JEDCO INT. CO. FOR PHARMACEUTICA... 31.50 EGP LORANO 5MG/5ML SYRUP 60ML MINA PHARM 5.00 EGP -> ? strength differs, ? different route - not oral solid UNILORATADINE 5MG/5ML SYRUP 100 ML UNIPHARMA CO. > UNIPHARMA 9.00 EGP -> ? strength differs, ? different route - not oral solid 3. FEXOFENADINE [1st line] Adult 120-180 mg once daily for seasonal allergic rhinitis, or 60 mg twice daily - as-needed Peds 2 to under 12 years: 30 mg (5 mL of the 30 mg/5 mL suspension) twice daily as required 12 years and over: Use the adult dose (Children 2-11 years: 30 mg (5 mL of the 30 mg/5 mL suspension) twice daily as required. From 12 years use the adult dose. Not established under 2 years for seasonal allergic rhinitis.) Source Egyptian National Drug Formulary - Respiratory Medicines 2026 (fexofenadine monograph) Why The Egyptian formulary licenses fexofenadine for allergic rhinitis from 2 years. It is the second-generation antihistamine with the least sedation of the three, which matters for a driver or a student, and it is a common Egyptian prescription. Caution Least sedating of the three oral antihistamines here. Reduce to 60 mg every 12 to 24 hours if eGFR is 10-50, and 60 mg every 24 hours below 10. Take the tablet with water, not with fruit juice, which reduces absorption. Allegra Allergy (fexofenadine hydrochloride) tablets, US OTC Drug Facts label (DailyMed SetID 81c1dcbb-28b3-4ad5-9f3d-9ccc16ddd173) says "do not take with fruit juices" and directs that the tablet be taken "with water". Antacids containing aluminium or magnesium reduce absorption; separate by 2 hours. Egypt FEXOFENADINE-CID 120MG 20 F.C. TABS. CID 12.00 EGP (0.60/unit) FEXODINE 120MG 10 CAP. MEMPHIS 8.00 EGP (0.80/unit) SANZALERA 120 MG 14 F.C. TAB. FUTURE PHARMA... 13.50 EGP (0.96/unit) ALLERGYNA 120MG 10 F.C. TAB. GLOBAL NAPI P... 15.00 EGP (1.50/unit) ALLERFEN 120 MG 30 F.C. TABS. AMOUN 96.00 EGP (3.20/unit) FASTEL 120 MG 20 F.C.TABS. EUROPEAN EGYP... 66.00 EGP (3.30/unit) TELFAST 120MG 20 F.C. TABS. SANOFI 116.00 EGP (5.80/unit) ORGOFEXADINE 120MG 10 FILM COATED TABS. ORGANOPHARMA > ORGANO 5.50 EGP ALERTAM 30MG/5ML ORAL SUSP. 100ML MUP 8.50 EGP -> ? strength differs, ? different route - not oral solid FEXODINE 30MG/5ML ORAL SUSP. 100 ML MEMPHIS 10.00 EGP -> ? strength differs, ? different route - not oral solid 4. CHLORPHENIRAMINE MALEATE [2nd line] Adult 4 mg every 4-6 hours, maximum 24 mg in 24 hours - as-needed Peds 2 to under 6 years: 1 mg every 4-6 hours, maximum 6 mg/day 6 to under 12 years: 2 mg every 4-6 hours, maximum 12 mg/day 12 years and over: 4 mg every 4-6 hours, maximum 24 mg/day (2-6 years: 1 mg every 4-6 hours, maximum 6 mg/day. 6 to under 12 years: 2 mg every 4-6 hours, maximum 12 mg/day. 12 years and over: 4 mg every 4-6 hours, maximum 24 mg/day. Not recommended under 2 years.) Source Egyptian National Drug Formulary - Respiratory Medicines 2026 (chlorpheniramine maleate monograph) Why It is on the Egyptian EML 2025 under antiallergics and the Egyptian formulary names allergic/vasomotor rhinitis and hay fever as indications. It is cheap and everywhere in Egypt, and a patient who is already taking it needs to be able to find it - even though the sedation makes it second choice to the three above. Caution Sedation and somnolence are very common - over 10 percent. A second-generation antihistamine is the better first choice; keep this for the night dose or where cost decides. Contraindicated in acute asthma, in coma or pre-coma, in known brain damage or epilepsy, and within 14 days of an MAOI. In the elderly the anticholinergic effects bite harder - the formulary suggests capping at 12 mg in 24 hours. Anticholinergic load: dry mouth, blurred vision, urinary retention. Caution in prostatism and glaucoma. Egypt CHLORPHENIRAMINE 4 MG 20 TAB. B.P.93 HI-PHARM > PYRAMIDS TRA... 1.00 EGP (0.05/unit) CHLORANTINE-M 4MG 20 TAB. MISR 1.40 EGP (0.07/unit) PIRAFENE 4MG 20 TAB. MEMPHIS 2.45 EGP (0.12/unit) ANALLERGE 4 MG 60 TAB. KAHIRA 30.00 EGP (0.50/unit) PIRAFENE 2MG/5ML SYRUP 120ML MEMPHIS 10.00 EGP -> ? strength differs, ? different route - not oral solid ANALLERGE 2MG/5ML SYRUP 100ML KAHIRA 24.00 EGP -> ? strength differs, ? different route - not oral solid NASAL STEROID - choose one 5. FLUTICASONE PROPIONATE [1st line] Adult 2 sprays (100 mcg) into each nostril once daily - long-term Peds 4 to 11 years: 1 spray into each nostril once daily (1 spray into each nostril once daily in children 4-11 years) Source ARIA Guidelines 2020 Why Intranasal corticosteroid that damps the local mucosal inflammation driving nasal congestion, sneezing, and rhinorrhea; first-line for moderate-to-severe allergic rhinitis, though full benefit takes a few days of regular use to appear. Caution First-line for moderate-severe symptoms; takes days for full benefit. Point nozzle slightly outward away from nasal septum. Local nasal irritation and minor nosebleeds are common. Egypt RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSE ARAB DRUG COMPANY (ADCO) 32.00 EGP FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSE EVA PHARMA 76.00 EGP FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSE GLAXO SMITHKLINE 133.00 EGP FLIXOTIDE DISKUS 50MCG/DOSE ACCUHALER GLAXO SMITHKLINE 36.00 EGP FLIXOTIDE EVOHALER 50MCG/ACTUATION INHALER GLAXO SMITHKLINE 111.00 EGP 6. MOMETASONE FUROATE [1st line] Adult 2 sprays (100 mcg) into each nostril once daily - long-term Peds 2 to 11 years: 1 spray into each nostril once daily (1 spray into each nostril once daily in children 2-11 years) Choice Alternatives. Mometasone for the same reason as in sinusitis - lower systemic bioavailability - and keeping one intranasal steroid across both conditions avoids two habits. Source ARIA Guidelines 2020 Why Intranasal corticosteroid with high topical potency and minimal systemic absorption, an alternative to fluticasone for moderate-to-severe allergic rhinitis. Caution Direct away from septum. Discontinue if persistent nasal septum ulceration occurs. Mometasone furoate has high topical potency with minimal systemic bioavailability. Egypt SNIFFACAN 50MCG/G NASAL SPRAY 15 ML SIGMA TEC 25.20 EGP TABUNEX 50MCG/G NASAL SPRAY 120 DOSES TABUK PHARMACEUTICAL MANUFACTURING... 28.80 EGP NORHINOSE 50MCG/DOSE NASAL SPRAY 120 DOSES EUROPEAN EGYPTIAN PHARM. IND.... 90.00 EGP NASAL DECONGESTANT - give alongside 7. XYLOMETAZOLINE [add-on - not a substitute] Adult 1 spray (0.1%) into each nostril every 8 hours, maximum 3 sprays per nostril per day - no more than 7 consecutive days Peds 6 to 11 years: 1 to 2 drops of the 0.05% formulation in each nostril, once or twice daily - maximum twice per nostril per day. The 0.1% is contraindicated under 12 years. (Children 6-11 years: 1-2 drops of the 0.05% formulation in each nostril once or twice daily, maximum twice per nostril per day. The 0.1% formulation is contraindicated under 12 years and the 0.05% under 6 years.) Source Egyptian National Drug Formulary - Respiratory Medicines 2026 (xylometazoline monograph) Why The Egyptian formulary's indication for xylometazoline names perennial and allergic rhinitis (including hay fever) directly. Blockage is the symptom an antihistamine does least for, and this is what gets added when the nose will not open - it is already on the Egyptian EML under nasal decongestants. Caution Not more than 7 consecutive days - beyond that it causes rebound congestion and can atrophy the nasal mucosa. This is the single most important thing to say to the patient. Tell the patient to see you again if symptoms last beyond 3 days. Contraindicated in closed-angle glaucoma, rhinitis sicca, phaeochromocytoma and prostatic hypertrophy, and within 2 weeks of an MAOI. Caution in cardiovascular disease, diabetes and thyroid disorders. Should not be used in pregnancy - no adequate data, and it is a vasoconstrictor. Egypt OTRIVIN 0.1% ADULT NASAL SPRAY 10 ML NOVARTIS > GLAXO SMITHKLINE 32.00 EGP -> ? strength differs BALKIS 0.1% ADULT NASAL DROPS 10 ML EIPICO > DOLORGIT 3.75 EGP -> ? strength differs RHINEX 0.1% ADULT NASAL DROPS 10 ML CID 18.00 EGP -> ? strength differs OTRIVIN 0.1% ADULT NASAL DROPS 15 ML GLAXO SMITHKLINE 24.00 EGP -> ? strength differs BALKIS 0.05% INFANTILE NASAL DROPS 10 ML EIPICO > DOLORGIT 3.50 EGP -> ? strength differs NASOSTOP 0.05% PAED NASAL DROPS 15 ML HI-PHARM 18.00 EGP -> ? strength differs RHINEX 0.05% INFANTILE NASAL DROPS 10 ML CID 18.00 EGP -> ? strength differs OTRIVIN 0.05% PEDIATRIC NASAL DROPS 15 ML GLAXO SMITHKLINE 24.00 EGP -> ? strength differs ADD-ON - give alongside 8. MONTELUKAST [add-on - not a substitute] Adult 10 mg once daily in the evening - review at 2-4 weeks and stop if there is no response Peds 2 to 5 years: One 4 mg chewable tablet or one 4 mg granule sachet daily 6 to 14 years: One 5 mg chewable tablet daily (6-14 years: one 5 mg chewable tablet daily. 2-5 years: one 4 mg chewable tablet or one 4 mg granule sachet daily. Perennial allergic rhinitis is licensed from 6 months, seasonal from 2 years. A child with both asthma and allergic rhinitis takes one dose only, in the evening.) Source Egyptian National Drug Formulary - Respiratory Medicines 2026 (montelukast monograph) Why The Egyptian formulary licenses montelukast for seasonal and perennial allergic rhinitis but tells you to reserve it for patients with an inadequate response or intolerance to alternative therapies, because of the neuropsychiatric risk. That is exactly a 'consider' - it belongs on the screen with the reservation attached, particularly for the patient who also has asthma. Caution Second line by the formulary's own wording - reserve it for inadequate response to or intolerance of an antihistamine and a nasal steroid. Neuropsychiatric reactions: agitation, sleep disturbance, depression, suicidal thinking. Warn the patient and the parent explicitly and tell them to stop and come back. Review at 2-4 weeks and discontinue if there is no clinical response - do not let it become a repeat prescription by default. It is not a rescue drug for an acute asthma attack; a patient with asthma still needs a short-acting beta agonist. Egypt PIRONTAGONIST 10MG 20 F.C. TABS. EGPI > ADVANC... 60.00 EGP (3.00/unit) ASMALAIR 10MG 10 TAB. HI-PHARM 40.00 EGP (4.00/unit) MONTEKAL 10MG 10 TAB. EUROPEAN EGYP... 40.00 EGP (4.00/unit) INLETAIR 10 MG 10 F.C.TAB. ORGANOPHARMA 47.00 EGP (4.70/unit) MONTELOSAB 10 MG 14 F.C. TABS. P&C > VERCURE 82.00 EGP (5.86/unit) LELIPEL 10 MG 20 F.C. TABS. EGPI > GLOBE ... 120.00 EGP (6.00/unit) OPIKAST 10 MG 14 SCORED F.C. TABS. EL-OBOUR 22.20 EGP STATUKAST 10 MG 10 SCORED F.C. TABS. ADWIA 41.50 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)