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Wise et al.

Page 100

• Harm: Side effects include insomnia, loss of appetite, irritability, palpitations, and increased blood pressure. Risk of toxicity in young children. • Cost: Low. • Benefits-Harm Assessment: Balance of benefit and harm for pseudoephedrine. Harm likely outweighs benefit for phenylephrine. • Value Judgments: Patient’s other comorbidities and age should be considered before use. • Policy Level: Option for pseudoephedrine. Recommendation against for phenylephrine. • Intervention: Pseudoephedrine as an oral decongestant can be effective in reducing symptom of nasal congestion in patients with AR; used for short-term symptom relief. Side effects, comorbidities, and age of patient should be considered before use. IX.B.3.b. Intranasal decongestants.: Topical decongestants, such as xylometazoline and oxymetazoline, are alpha-adrenergic stimulators delivered directly to nasal mucosal tissue that result in vasoconstriction and reduction of mucosal thickness. In an 18-day study, Barnes et al. 1330 found that nasal xylometazoline was a stronger decongestant than nasal corticosteroids (Table IX.B.3.b). Topical decongestants relieve the symptom of nasal congestion, however they have no effect on other symptoms of AR, such as sneezing, rhinorrhea, or nasal itching. Rhinitis medicamentosa (RM), a condition thought to result from prolonged usage of topical decongestants, involves an increase in symptomatic nasal congestion, thereby precluding a recommendation for chronic use of this medication. Studies to identify the duration of topical decongestant use that leads to rhinitis medicamentosa have shown variable results. Some studies show prolonged use up to 8 weeks does not produce any symptoms of rebound nasal congestion, 83,1331 while others note development of RM within 3 days of use. 72 Known adverse effects of topical decongestants include nasal burning, stinging, dryness, epistaxis, and mucosal ulceration. While topical decongestants are effective at reducing nasal congestion, short-term use of the medication, 3 days or less, is recommended to avoid the potential for rebound nasal congestion and effects on mucociliary activity. (See section III.C.2. Definitions, classifications, and differential diagnosis – Allergic rhinitis differential diagnosis – Rhinitis medicamentosa (RM) for additional information on this topic.) • Aggregate Grade of Evidence: B (Level 1b: 3 studies; Level 2b: 1 study; Table IX.B.3.b). • Benefit: Reduction of nasal congestion with topical decongestants. • Harm: Side effects include nasal burning, stinging, dryness, and mucosal ulceration. Potential for rebound congestion when used long term. • Cost: Low.

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Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.

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