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How is acute rhinoconjunctivitis treated?
Last reviewed: 06.07.2025
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Treatment of allergic rhinitis and conjunctivitis involves the use of antiallergic agents of various groups. The main drugs used to treat allergic rhinitis are antihistamines. Their therapeutic effect is associated with the blockade of histamine receptors on the cellular structures of various tissues. Almost all first-generation antihistamines [chloropyramine (suprastin), clemastine (tavegil), diphenhydramine (diphenhydramine), promethazine (pipolfen), mebhydrolin (diazolin), quifenadine hydrochloride (fenkarol)] have a significant antihistamine activity. After parenteral administration or oral administration, the therapeutic effect of antihistamines appears within 15-30 minutes and reaches its maximum within an hour. It should be emphasized that an important place in the therapy of allergic rhinitis belongs to new generation antihistamines, such as loratadine, cetirizine, ebastine (kestin), desloratadine (erius), levocetirizine.
Local treatment of allergic rhinoconjunctivitis
Currently, topical antihistamines such as levocabastine and azelastine are used locally (in the form of eye drops and nasal spray).
Among the agents that stabilize mast cell membranes, eye drops and intranasal forms of cromoglicic acid (cromoglyn, cromoghexal, lecrolyn) can be distinguished. In acute conjunctivitis, instillation of eye drops gives a quick effect. They can be used as monotherapy or in combination with each other. It is necessary to use topical antihistamines (azelastine). Cromoglicic acid (cromoghexal, lomuzole, optikrom) has a pronounced preventive effect in allergic lesions. The drugs significantly reduce itching, photophobia, lacrimation, hyperemia and prevent papillary growths of the mucous membrane of the eyelids.
Local therapy should begin with washing the eyelids and conjunctiva. To provide anti-edematous and antipruritic action, 10 drops of 0.1% epinephrine (adrenaline) solution and 0.05 g of tetracaine (dicaine) are added to 10 ml of this mixture. Effective may be the introduction of 0.05% naphazoline (naphthyzine) solution into the conjunctival sac, 1-2 drops 2-3 times a day, 0.25-0.5% phenylephrine (mesaton) solution, 1-2 drops 2-3 times a day for several days. In case of pronounced symptoms of allergic eye damage and in cases of low efficiency of therapy with antihistamines and sympathomimetic agents, topical glucocorticoid drugs are indicated. In case of conjunctival lesions, suspensions of cortisol (adreson) or hydrocortisone, solutions of prednisolone, dexamethasone (dexazone) are instilled into the eye slit, hydrocortisone ointment and eye medicated films with dexamethasone are applied.
In the treatment of allergic rhinitis, vasoconstrictors (decongestants) are also used: phenylephrine, xylometazoline (otrivin, galazolin). Their use is symptomatic, limited to 10 days due to the effect of tachyphylaxis and the possibility of developing drug-induced rhinitis; combinations with antihistamines are used, for example, vibrocil.
In severe allergic rhinitis, treatment is mainly carried out with topical corticosteroids [mometasone (nasonex), fluticasone (flixonase), beclometasone (aldecin)]. With regular and long-term use, they suppress various stages of allergic inflammation. Reaching high concentrations in the nasal epithelium, they suppress nasal congestion, rhinorrhea, sneezing, itching.
When an infection joins allergic conjunctivitis, there is a need for local administration of antibiotics. Recently, sofradex drops have been widely used, which include gramicidin C, dexamethasone, and framycetin.
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