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Philippine Guidelines for Allergic Rhinitis

The document provides guidelines for allergic rhinitis from the Philippine Society of Allergy, Asthma and Immunology. It defines allergic rhinitis as an IgE-mediated response causing symptoms like sneezing, congestion and rhinorrhea. Risk factors include family history and high socioeconomic status. Treatment involves environmental control measures, pharmacotherapy including oral antihistamines, intranasal corticosteroids and immunotherapy. Evaluation includes patient history, physical exam, allergy testing and assessment of quality of life.
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0% found this document useful (0 votes)
73 views9 pages

Philippine Guidelines for Allergic Rhinitis

The document provides guidelines for allergic rhinitis from the Philippine Society of Allergy, Asthma and Immunology. It defines allergic rhinitis as an IgE-mediated response causing symptoms like sneezing, congestion and rhinorrhea. Risk factors include family history and high socioeconomic status. Treatment involves environmental control measures, pharmacotherapy including oral antihistamines, intranasal corticosteroids and immunotherapy. Evaluation includes patient history, physical exam, allergy testing and assessment of quality of life.
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Guidelines for

Allergic Rhinitis
(2011)

Philippine Society of Allergy, Asthma


and Immunology, Inc.
Room 305 Medical Arts Building
Dr. Fe del Mundo Medical Center Foundation Philippines, Inc.
11 Banawe Avenue corner Cardiz Street, Quezon City
Telephone/Fax No.: 712-9432

Allergic Rhinitis

Philippine Society of Allergy, Asthma and Immunology, Inc.


Room 305 Medical Arts Building
Dr. Fe del Mundo Medical Center Foundation Philippines, Inc.
11 Banawe Avenue corner Cardiz Street, Quezon City
Telephone/Fax: 712-9432

PSAAI Board of Directors


President
President-Elect
Secretary
Treasurer
Public Relations Officer
Directors

Linda Lim-Varona, MD
Agnes G. Andaya, MD
Jovilia M. Abong, MD
Nenita L. Alberto, MD
Marysia Stella T. Recto, MD
Ma. Carmela Agustin-Kasala, MD
Hilda Diana A. Alava, MD
Lara Theresa A. Aleta, MD
Mary Anne R. Castor, MD
Ma. Stella G. Paspe, MD
Beatrice Vicente-Pascual, MD

Task Force for Allergic Rhinitis


The Collation of Summary Statements on Allergic Rhinitis (2011) is an adaptation from the
Diagnosis and Management of Rhinitis: An Updated Practice Parameter developed by the Joint
Task Force on Practice Parameters, representing the American Academy of Allergy Asthma
and Immunology: the American College of Allergy Asthma and Immunology. It also includes a
portion of the published data from the ISAAC study.
The Collation of Summary Statements on Allergic Rhinitis (2011) is a consensus of the Allergic
Rhinitis Task Force of the Philippine Society Allergy, Asthma and Immunology after taking
into consideration the published evidence and clinical practice applicability in the Philippine
setting.
Head
Members

Alejandro P. Ortigas, MD
Ma. Zoila G. Carandang, MD
Shirley L. Kwong, MD
Agnes G. Andaya, MD
Manuel F. Ferreria, MD
Arlene Grace S. Sandejas, MD
Hiyasmin M. Lim, MD
Olivia Geronimo-De Jesus, MD
Rosa C. Ong, MD
Gina Marie E. Ponio, MD

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21

Allergic Rhinitis
Collation of Summary Statements:

Definition of allergic rhinitis


1. Allergic rhinitis is a classic example of Type I
hypersensitivity, IgE mediated response. It may
be characterized by early-phase and late phase
responses. Each type of response is characterized
by sneezing, congestion, rhinorrhea (anterior and
posterior) and itching, but congestion predominates
in the late phase. C
Burden and epidemiology of allergic rhinitis
2. Published data on allergic rhinitis in the Philippines
is limited to ISAAC study. In the US it affects 30-60
million people annually, including 10%-30% of adults
and as many as 40 percent of children. C
3. Risk factors for allergic rhinitis include (1) family
history of atopy, (2) serum IgE >100 IU/mL before
age 6 years, (3) higher socioeconomic class, and (4)
presence of a positive allergy skin prick test (SPT). C
4. The influence of early childhood exposure to infect
ions, animals and secondary tobacco smoke on
the development on the development of atopy and
allergic rhinitis is still not clear. C
5. Aeroallergen sensitization may occur within the first
2 years of life. C
6. The cost of treating allergic rhinitis and indirect cost
related to loss of workplace productivity resulting
from disease are substantial. It is also a significant
cause of lost of work and school days. C
Pathogenesis
7. The symptoms of allergic rhinitis result from a complex
allergen-driven mucosal inflammation caused by
interplay between resident and infiltrating cells
and a number of vasoactive and proinflammatory
mediators, including cytokines. Sensory nerve
activation, plasma leakage, and congestion of
venous sinusoids also contribute. C
Seasonal and perennial allergic rhinitis
8. Seasonal allergic rhinitis is caused by an IgE-media
ted reaction to seasonal allergens. Symptoms may
occur only during specific seasons. The length of
seasonal exposure to these allergens is dependent
on geographic location and climatic conditions. C
9. Perennial allergic rhinitis is caused by an IgE-media
ted reaction to perennial environmental aeroallergens. Symptoms may occur with or without seasonal
exacerbations. Perennial environmental aeroallergens include dust mites, molds, animal allergens,
or certain occupational allergens, as well as pollen
in areas where pollen is prevalent perennially. C
10. Episodic allergic rhinitis denotes allergic nasal
symptoms elicited by sporadic exposures to inhalant
aeroallergens. D
Severity
11. The severity of allergic rhinitis ranges from mild and
intermittent to seriously debilitating, or mild, mode
rate- severe. D
12. Although there is no generally accepted method of
grading the severity of allergic rhinitis, the clinician
may want to consider a graphic rating scale. D
Associated allergic conjunctivitis
13. Allergic rhinitis is often accompanied by symptoms

22

of allergic conjunctivitis. C
14. Many treatments used for allergic rhinitis can
benefit associated symptoms of allergic conjunctivitis, and a variety of topical ophthalmic agents is
useful for specific treatment of associated ocular
symptoms. A
15. Intranasal steroids, oral antihistamines, and intranasal antihistamines have similar effectiveness in
relieving eye symptoms associated with rhinitis. A
Differential diagnosis of allergic rhinitis
16. Non-allergic rhinitis is characterized by periodic or
perennial symptoms of rhinitis that are not a result
of IgE-dependent events. Examples are infectious
rhinitis, vasomotor rhinitis, non-allergic rhinitis with
eosinophilia syndrome (NARES), food & druginduced rhinitis, occupational rhinitis, hormonal
rhinitis, atrophic rhinitis, nasal polyps, anatomic
abnormalities, cerebrospinal fluid rhinorrhea and
ciliary dysfunction. C
Evaluation and diagnostic studies
History
17. An effective evaluation of the patient with allergic
rhinitis often includes the following: a determination
of the pattern, chronicity and seasonality of nasal
and related symptoms (or lack thereof); response
to medications; presence of coexisting conditions;
occupational exposure; and a detailed environmental
history and identification of precipitating factors. D
18. Evaluation of allergic rhinitis therapy should include
assessment of quality of life (QOL). C
Physical Examination
19. A physical examination of all organ systems
potentially affected by allergies with emphasis on
the upper respiratory tract should pe performed
in patients with a history of allergic rhinitis. The
nasal examination supports but does not definitely
establish the diagnosis of allergic rhinitis. D
Testing for specific IgE antibody
Skin testing
20. Determination of specific IgE, preferably by skin
testing, is indicated to provide evidence of an aller
gic basis for the patients symptoms, or to assess
the sensitivity to a specific allergen for avoidance
measures and/or allergen immunotherapy. B
21. Skin tests are the preferred tests for the diagnosis of
IgE- mediated sensitivity. The number of skin tests
and the allergens selected for skin testing should be
determined on the basis of the patients age, history,
environment, and living situation, such as area of the
country, occupation and activities. D
In vitro assays for specific IgE
22. The precise sensitivity of specific IgE immunoassays
compared with skin prick/puncture tests is approximately 70% to 75%. Immunoassays have similar
sensitivity to skin tests in identifying those patients
with nasal symptoms elicited after natural or controlled allergen challenge tests. C
23. The interpretation of IgE is best done by an allergyimmunology specialist. It may be confounded by
variables such as potency of allergens bound to
solid support systems, cross-reactive proteins and

Allergic Rhinitis
glycol-epitopes, specific IgG antibodies in the test
serum and high total IgE. D
Special diagnostic techniques
24. In selected cases, special techniques may be
useful in evaluating patients presenting with allergic
rhinitis symptoms and its associated diseases:
fiberoptic nasal endoscopy and/or rhinomanometry,
nasal smears for eosinophils, saccharin test for
mucociliary clearance, nasal biopsy, measurement
of total IgE and IgG subclasses, B-2-transferrin,
sweat test, sinus computed tomography (CT),
evaluation for obstructive sleep apnea, pulmonary
function tests. B
25. There is no evidence that the following procedures
have diagnostic validity for allergic rhinitis: cytotoxic
tests, provocation-neutralization, electrodermal
testing, applied kinesiology, iridology and hair
analysis. B
Management of Allergic Rhinitis
(See Table 1 in Appendix for Sample Action Plan)
Environmental control measures play a significant role
in controlling allergic rhinitis.
26. The most common allergic triggers for rhinitis include
pollens, fungi, dust mites, furry animals, and insect
emanations. B
27. The types of pollen responsible for rhinitis symptoms
vary widely with locale, climate, and introduced
plantings. B
28. Highly pollen-allergic individuals should limit
exposure to the outdoors. Ideally, pollen counts
should be available in the locale. B
29. Fungi are ubiquitous organisms, many of which
produce clinically important allergens. B
30. Reduction of indoor fungal exposure involves
removal of moisture sources, replacement of
contamination materials, and the use of dilute bleach
solutions on nonporous surfaces. D
31. Clinically effective dust mite avoidance requires a
combination of dust mite covers for bedding, high
efficiency particulate air (HEPA) vacuuming of
carpeting, and the use of acaricides. B
32. Avoidance is the most effective way to manage
animal sensitivity. D
33. Cockroaches are a significant cause of nasal
allergy. C
34. The best preventive measure for allergic rhinitis is
avoidance. B
Pharmacologic therapy
Oral antihistamines
35. Second-generation antihistamines are generally
preferred over first-generation antihistamines for
the treatment of allergic rhinitis. First-generation
antihistamines have significant potential to cause
sedation, performance impairment, and anticholi
nergic effects. Although occasionally advantageous
(e.g., sleep induction when taken at bedtime or a
reduction in rhinorrhea), these properties are usually
undesirable and are potentially dangerous. Secondgeneration antihistamines have less or no tendency
to cause these effects. B
36. Before prescribing or recommending a first-gene
ration antihistamine, the physician should ensure
that the patient understands both the potential for
adverse effects and the availability of alternative

antihistamines with a lower likelihood of adverse


effects. D
37. There are important differences among the secondgeneration antihistamines in regard to their sedative
properties: fexofenadine, loratadine, and desloratadine do not cause sedation at recommended doses;
loratadine and desloratadine may cause sedation at
doses exceeding the recommended dose; cetirizine
and intranasal azelastine may cause sedation at
recommended doses. A
38. Among the newer, nonsedating antihistamines,
no single agent have been conclusively found to
achieve superior overall response rates. C
Intranasal antihistamines
39. Intranasal antihistamines may be considered for use
as first-line treatment for allergic rhinitis. A
40. Intranasal antihistamines are efficacious and equal
to or superior to oral second-generation antihistamines for treatment of seasonal allergic rhinitis. A
41. Because systemic absorption occurs, currently available intranasal antihistamines have been associated
with sedation and can inhibit skin test reactions. A
42. Intranasal antihistamines have been associated
with a clinically significant effect on nasal congest
ion. A
43. Intranasal antihistamines are generally less effect
ive than intranasal corticosteroids for treatment of
allergic rhinitis. A
Oral and topical decongestants
44. Oral decongestants, such as pseudoephedrine and
phenylephrine, are a-adrenergic agonists that can
reduce nasal congestion but can result in side effects
such as insomnia, irritability, and palpitations. A
45. Oral and topical decongestant agents should be
used with caution in older adults and young children,
and in patients of any age who have a history of
cardiac arrhythmia, angina pectoris, cerebrovascular
disease, hypertension, bladder neck obstruction,
glaucoma, or hyperthyroidism. C
46. Topical decongestants can be considered for shortterm and possibly for intermittent or episodic therapy
of nasal congestion, but are inappropriate for regular
daily use because of the risk for the development of
rhinitis medicamentosa, which may occur within the
third and fourth day. C
Over-the-counter cough and cold medications for
young children
47. The efficacy of cold and cough medications for symptomatic treatment of upper respiratory tract infections
has not been established for children younger than
6 years. Because of the potential toxicity of these
medications, the use of these over-the-counter
(OTC) drugs generally should be avoided in all
children below 6 years of age. A
INTRANASAL CORTICOSTEROIDS
48. Intranasal corticosteroids are the most effective
medication class for controlling symptoms of allergic
rhinitis. A
49. In most studies, intranasal corticosteroids have been
shown to be more effective than the combined use
of an antihistamine and leukotriene (LT) antagonist
in the treatment of seasonal allergic rhinitis. A
50. Intranasal corticosteroids may provide significant
relief of symptoms of seasonal allergic rhinitis

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23

Allergic Rhinitis
when used not only on a regular basis but also on
as needed basis. B However as needed use may
not be as effective as continuous use of intranasal
corticosteroids.
51. When comparing the available intranasal corticosteroids, the overall clinical response does not appear
to vary significantly between products irrespective
of the differences in topical potency, lipid solubility
and binding affinity. C
52. Intranasal corticosteroids when given in recommended doses are not generally associated with
clinically significant systemic side effects. A
53. Although local side effects are typically minimal with
the use of intranasal corticosteroids, nasal irritation
and bleeding may occur. Nasal septal defect is rarely
reported. B
Oral Corticosteroids
54. A short course (5-7 days) of oral corticosteroids
may be appropriate for the treatment of very
severe or intractable nasal symptoms or to treat
nasal polyposis. However single administration of
parenteral corticosteroids is discouraged and recurrent administration of parenteral corticosteroids is
contraindicated because of potential for long term
corticosteroid side effects. D
Intranasal cromolyn
55. Intranasal cromolyn sodium is effective in some
patients for prevention and treatment of allergic
rhinitis and is associated with minimal side effects. It
is less effective in most patients than corticosteroids
and has not been adequately studied in comparison
with LT antagonists and antihistamines. A
Intranasal anticholinergics
56. Intranasal anticholinergics may effectively reduce
rhinorrhea but have no effect on other nasal symptoms. Although side effects are minimal, dryness of
the nasal membranes may occur. A
57. The concomitant use of ipratropium bromide nasal
spray and an intranasal corticosteroid is more
effective than administration of either drug alone in
the treatment of rhinorrhea without any increased
incidence of adverse effect. A
Oral and LT agents
58. Oral anti LT agents alone or in combination with
antihistamines have proven to be useful in the treatment of allergic rhinitis. A
Omalimuzab
59. Omalimuzab has demonstrated efficacy in AR;
however, it has US Food and Drug Administration
(FDA) approval for use only in allergic rhinitis. A
Nasal saline
60. There is evidence that topical saline is beneficial in
the treatment of the symptoms of chronic rhinorrhea
and rhinosinusitis when used as a sole modality or
for adjunctive treatment. A
Allergen immunotherapy
61. Allergen immunotherapy is effective for the treatment
of allergic rhinitis. A
62. Allergen immunotherapy should be considered for
patients with allergic rhinitis who have demonstrable
evidence of specific IgE antibodies to clinically rele

24

vant allergens, and its use depends on the degree


to which symptoms can be reduced by avoidance
and medication, the amount and type of medication required to control symptoms, and the adverse
effects of the medications. A
63. Allergen immunotherapy may prevent the development of new allergen sensitization ad reduce the risk
for the future development of asthma in patients with
allergic rhinitis. B
Surgery
64. Although there is no surgical treatment for allergic
rhinitis, surgery may be indicated in the management
of comorbid conditions, such as nasal obstruct
ion from severe nasal septal deviation or inferior
turbinate hypertrophy, adenoidal hypertrophy, or
refractory sinusitis and complications thereof. C
Management decisions
65. Management and monitoring of Allergic rhinitis
should be individualize and based on the spectrum,
duration and severity of symptoms; physical
examination findings; comorbidities; age of the
patient; and patient preferences using both step-up
and step-down approaches. C
66. Effective allergic rhinitis management requires the
development of a physician/patient/family partnership, avoidance of environmental triggers, and the
appropriate use of prescribed therapeutic interventions. C
Education of patient and caretakers
67. Education is a key element in promoting adherence
and optimizing treatment outcomes in allergic rhinitis. D
Major comorbid conditions
68. Patients with allergic rhinitis are at increased risk for
the development of asthma. A
69. Treatment of allergic rhinitis may improve asthma
control in patients with co-existing allergic rhinitis
and asthma. B
70. The cause-and-effect relationship of allergic rhinitis
with recurrent otitis media and otitis media with effu
sion (OME) is not yet clearly established. C
Special Considerations
Pregnancy
71. When selecting medications for treating rhinitis in
pregnancy, the clinician might consider the FDA
risk categories that are largely based on animal
data and limited human studies. However, it is also
beneficial to review human cohort and case-control
studies as well as birth registry data before reaching a decision. C
72. The most critical time for concern about potential
congenital malformation because of medication use
is the first trimester, when organogenesis is occurring. D
73. A sufficient amount of human observational data
has now been accumulated to demonstrate safety
for second-generation as well as first-generation
antihistamines. C
74. Oral decongestants should be avoided during the
first trimester. Topical decongestants when used on
a short term basis may have a better safety profile
than oral agents for first trimester use. C

Allergic Rhinitis
75. Sodium cromolyn is a safe treatment for allergic
rhinitis during pregnancy. C
76. Montelukast is a safe treatment for allergic rhinitis
during pregnancy. C
77. Intranasal steroids may be used in the treatment of
nasal symptoms during pregnancy because of their
safety and efficacy profile. C
78. Immunotherapy for allergic rhinitis may be continued
during pregnancy but without dose escalation. C
Elderly Patients
79. Rhinitis in the elderly may be caused by types of
rhinitis common in other age groups but may also
be influenced by age related physiologic changes
such as cholinergic hyperactivity, anatomic changes
and medications taken for other medical conditions.
C
Athletes
80. Athletic performance can be affected by rhinorrhea
and chronic or rebound nasal congestion. Rhinitis
medication for the competitive athlete must be an
International Olympic Committee (IOC) approved
product and should be one that does not adversely
affect performance. C
Consultation with an Allergist
81. Allergist care improves patient outcomes; however,
consultation/referral services are often underused.
C
82. Consultation with an allergist should be considered
for patients with rhinitis who have inadequately
controlled symptoms, a reduced QOL and/or abi
lity to function, adverse reactions to medications,
a desire to identify the allergens to which they are
sensitized and to receive advice on environmental
control, or co-morbid conditions such as asthma and
recurrent sinusitis, or when allergen immunotherapy
is a consideration. C
Referral Guidelines
1. Patients with allergic rhinitis with prolonged and severe
disease with:
a. Co-morbid conditions
i. Asthma
ii. Recurrent sinusitis
iii. Nasal Polyps
iv. Conjunctivitis
b. Symptoms interfere with
i. QOL (quality of life)
ii. Ability to function
c. Medications are
i. Ineffective

ii. Associated with adverse reactions

iii. Unacceptable for chronic use by patient choice,
such as cost or concern with long term side
effects
2. Patients with allergic rhinitis, children and possibly
adults, being considered for allergen immunotherapy
as a means of preventing the progression of allergic
disease.

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Allergic Rhinitis
Appendix:
Fig 1: Sample Action Plan for the Management of AR

Table 1: Definition of levels of evidence as denoted by capital letters (U.S. Preventive Services Task Force*)

Level A

Level B

Level C

Level D

Level I

Good scientific evidence suggests that the benefits of the clinical service substantially outweigh
the potential risks. Clinicians should discuss the service with eligible patients.
At least fair scientific evidence suggests that the benefits of the clinical service outweigh the potential
risks. Clinicians should discuss the service with eligible patients.
At least fair scientific evidence suggests that there are benefits provided by the clinical service,
but the balance between benefits and risks are too close for making general recommendations.
Clinicians need not offer it unless there are individual considerations.
At least fair scientific evidence suggests that the risks of the clinical service outweigh potential
benefits. Clinicians should not routinely offer the service to asymptomatic patients.
Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance
cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the
clinical service.

*Adopted from [Link]

26

Allergic Rhinitis
Index of Drugs Mentioned in the Guideline
This index is not part of the guideline. It lists the products and/or their therapeutic classes as mentioned in the guideline. For
the doctor's convenience, brands available in the PPD references are listed under each of the classes. For drug information,
refer to the PPD references (PPD, PPD Pocket Version, PPD Text, PPD Tabs, and [Link]).

Anti-leukotrienes
Montelukast sodium
Bronast
Geokast
Glenmont-CT
Kastair/Kastair EZ Tab
Kastorion
Leukast
Lukas
Montair
Montecad-4/Montecad-5
Montel 10
Montemax
Montiget
Moscalair
Primeair
RiteMED Montelukast
Singulair
Zykast
Zafirlukast
Accolate
Anticholinergics
Ipratropium bromide
Atrovent
Ipratec
Ipratropium bromide/Fenoterol
Berodual
Ipratropium bromide/Salbutamol
Aura Plus
Combivent
Duavent
Duavent Metered Dose Inhaler
Multivent
Pulmodual
Tiotropium
Spiriva

Antihistamines
Acrivastine
Azelastine HCl
Azela Nasal Spray
Azelone
Azep
Cetirizine
Aforvir/Aforvir Syrup
Aletor
Allerkid
Allermed
Alnix/Alnix Plus
Antrazine
Avec
Benadryl One
Cetirizine Sandoz
Prixlae
Rhinitrin
RiteMED Cetirizine Dihydrochloride
Sitizine
Texzine
Virlix
Welcet
Zericin
Zetrix
Zinex
Zyriz

Zyrrigin
Zyrtec
Chlorphenamine maleate
Chlorphenoxamine HCl
Clemastine fumarate
Marsthine
Clemastine hydrogen fumarate
Tavegyl
Tavist
Desloratadine
Aerius
Dimethindene maleate
Diphenhydramine HCl
Benadryl
Rabaphen
Soniphen
Diphenhyrdramine/
Phenylpropanolamine
Disodium cromoglycate/
Benzalkonium Cl
Vividrin Nasal Spray
Ebastine
Aleva
Ebastine/Betamethasone
Co-Aleva
Fexofenadine
Neofex
Sensitin
Telfast
Hydroxyzine diHCl
Iterax
Levocetirizine diHCl
Glencet
Lerizine-5
Lisinex
Sensitrin
Tecovel
Xyzal
Zestra
Levocetirizine diHCl/
Montelukast
Zykast
Loratadine
Allerta
Claritin
L. Meyerf Loratadine
Loradaze
Lorange
Lorano
Loratyne
Lorfast
Lorid
Prevahist
UHP Loratadine
Zantih
Zylohist
Loratadine/
Bethamethasone
Claricort
Loratadine/Phenylephrine
Loraped
Mebhydrolin napadisylate
Mequitazine
Primalan
Olopatadine HCl
Patanol

Promethazine HCl

Corticosteroids
Betamethasone/
Chlorpheniramine maleate
Betamethasone/
Dexchlorphenamine maleate
Celestamine
Dexamethasone
Decilone
Oradexon
Fluticasone furoate
Avamys
Fluticasone propionate
Flixotide
Flixotide Aqueous Nasal Spray
Nasoflo
Fluticasone propionate/
Salmeterol xinafoate
Salmeflo
Seretide
Prednisolone/
Chlorphenamine maleate
Decongestants
Brompheniramine maleate/
Phenylephrine HCl
Dimetapp
Profaril
Remedril
Sidrocine Plus
Snizee
Brompheniramine maleate/
Phenylpropanolamine
Congestapp
Nasatapp
Pediatapp Syrup/Oral Drops
Solvamin
Camphor/Menthol/Eucalyptol
Chlorphenamine maleate/
Dextromethorphan/Guaifenesin/
Phenylpropanolamine HCl
Myracof-AF
Chlorphenamine maleate/
Dextromethorphan/Guaifenesin/
Phenylpropanolamine HCl/
Paracetamol
Dynatussin
Myracof-T
Chlorphenamine maleate/
Guaifenesin/Phenylpropanolamine
Chlorphenamine maleate/
Paracetamol/Phenylephrine
Coldezent
Coldzep
Decolgen
Chlorpheniramine maleate/
Phenylephrine HCl
Bronchofen
Chlorphenamine maleate/
Phenylpropanolamine HCl
Nasathera CPM
Neozep Syrup (Oral Drops)
Noxifen
Chlorphenamine maleate/
Phenylpropanolamine HCl/

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27

Allergic Rhinitis
Paracetamol
Cynosal
Nagelin
Norcolds
Chlorphenamine maleate/
Phenylpropanolamine HCl/
Paracetamol
Bioflu
Nafarin-A
Sinutab Extra Strength
Diphenhydramine HCl/
Phenylpropanolamine HCl
Guaifenesin/Chlorphenamine
maleate
Guaifenesin/Chlorphenamine
maleate/Phenylpropanolamine
Langex
Neovent
Guaifenesin/Chlorphenamine
maleate/Sodium citrate/
Phenylpropanolamine/
Oxeladine citrate/
Sodium citrate
Altussan
Guaifenesin/Oxeladine citrate/
Phenylpropanolamine/
Chlorpheniramine maleate
Altussan (capsule)
Guaifenesin/Chlorphenamine
maleate/Sodium citrate/
Ammonium chloride
Guaifenesin/
Dextromethorphan
Paracetamol/Phenylpropanolamine/Chlorphenamine
maleate
Colvan
Guaifenesin/Dextromethorphan
Paracetamol/Phenyl propanolamine/
Sodium citrate
Dynatussin (syrup)
Loratadine/
Pseudoephedrine sulfate
Phenylephrine/Dextromethorphan/
Paracetamol
Tuseran Forte (Reformulated)
Phenylephrine HCl/Paracetamol
Decolgen No-Drowse
Non-Drowsy Neozep
Phenylpropanolamine
Nasathera P
Phenylpropanolamine HCl/
Chlorphenamine maleate
Nasathera CPM
Neozep Syrup (Oral Drops)
Noxifen
Phenylpropanolamine/
Paracetamol
Nasathera/Nasathera Syrup
Phenylpropanolamine/
Paracetamol/
Dextromethorphan
Decolsin Reformulated
Phenylpropanolamine/
Paracetamol/
Guaifenesin/
Dextromethorphan/
Chlorphenamine maleate
Phenylpropanolamine/
Paracetamol/Phenyltoloxamine
Phenylpropanolamine/
Brompheniramine maleate
Congestapp
Nasatapp
Pediatapp Syrup/Oral Drops

28

Phenylephrine/Brompheniramine
maleate
Dimetapp
Profaril
Remedril
Sidrocine Plus
Snizee
Sodium Chloride
Muconase
Salinase
Snif

Nasal Preparations
Azelastine
Azep
Azelone
Azela Nasal Spray
Budesonide
Budecort Aqueous Nasal Spray
Disodium cromoglycate/
Benzalkonium chloride
Vividrin Nasal Spray
Ciclesonide
Omnaris
Fluticasone furoate
Avamys
Fluticasone propionate
Flixotide Aqueous Nasal Spray
Nasoflo
Fusafungine
Mometasone furoate
monohydrate
Nasonex AQ Nasal Spray
Oxymetazoline HCl
Drixine Nasal Spray/Ped Drops
Sodium Chloride
Muconase
Salinase
Snif
Triamcinolone
Actonaze
Ultra filtrated and desalinised natural
sea-water
Physiomer
Xylometazoline HCl
Otrivin
Xylonas
Mucokinetics/Expectorants
Bromhexine/Chlorphenamine maleate
Mucosform

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