Dawaa Reference

Clinical reference

Allergic rhinitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 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 against5 documents
  • 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 date2026-08

Presentation reference

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

SourceStatPearls "Allergic Rhinitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Antihistamine | Nasal steroid | Nasal decongestant | Add-on

ANTIHISTAMINE - choose one

1

CETIRIZINE

Antihistamine

1st line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily - as-needed

Paediatric dose

(2.5 mg daily (1-2 yrs), 5 mg daily (2-6 yrs), 10 mg daily over 6 yrs)

Dose by age
1 to 2 years:2.5 mg once daily
2 to 6 years:5 mg once daily
Over 6 years:10 mg once daily
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.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
EPIRIZINE 10 MG 10 TABS.EIPICO15.50 EGP (1.55/unit)
CETRITIN 10MG 20 TAB.EL NILE.42.00 EGP (2.10/unit)
TOMAZINE 10MG 30 F.C. TABS.ALFACURE PHARMACEUTICALS63.00 EGP (2.10/unit)
CETRAK 10 MG 20 TABS.PHARCO68.00 EGP (3.40/unit)
HISTAZINE-1 10 MG 20 TABS.AMRIYA68.00 EGP (3.40/unit)
ZYRTEC 10 MG 20 TAB.GLAXO SMITHKLINE100.00 EGP (5.00/unit)
CETRICHEW 10MG 20 CHEWABLE F.C. TABS.AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.15.00 EGP
HISTA CHEW 10 MG 20 CHEWABLE TAB.ARAB CAPS > ADVOCURE15.00 EGP
LERGFREE 5MG/5ML SYRUP 120ML? strength differs? different route - not oral solidDEBEIKY9.00 EGP
EPIRIZINE 5MG/ML SYRUP 60 ML? strength differs? different route - not oral solidEIPICO19.00 EGP
2

LORATADINE

Antihistamine

1st line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily - as-needed

Paediatric dose

(5 mg daily (2-5 yrs), 10 mg daily over 6 yrs)

Dose by age
2 to 5 years:5 mg once daily
6 years and over:10 mg once daily
Dose source

ARIA Guidelines 2020

Why

Non-sedating second-generation antihistamine, an alternative first-line oral option to cetirizine for allergic rhinitis symptoms.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
HISTALONG 10 MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS17.00 EGP (0.85/unit)
UNILORATADINE 10 MG 20 TABS.UNIPHARMA CO. > UNIPHARMA17.00 EGP (0.85/unit)
SEDCLARIT 10MG 20 TAB.SEDICO19.50 EGP (0.97/unit)
LORATADINE 10MG 10 TAB.MISR25.50 EGP (2.55/unit)
ONY 10 MG 20 TABS.UNIPHARMA51.00 EGP (2.55/unit)
ALLERGETONE 10 MG 20 TABS.MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) > SPLENDID PHARMA66.00 EGP (3.30/unit)
CLARITINE 10MG 20 TAB.SEDICO > BAYER HEALTHCARE110.00 EGP (5.50/unit)
ALLERGIRAZ 10MG 30 DISINTEGRATING TABS.JEDCO INT. CO. FOR PHARMACEUTICALS > ELRAZY PHARMACEUTICALS-EGYPT31.50 EGP
LORANO 5MG/5ML SYRUP 60ML? strength differs? different route - not oral solidMINA PHARM5.00 EGP
UNILORATADINE 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solidUNIPHARMA CO. > UNIPHARMA9.00 EGP
3

FEXOFENADINE

Antihistamine

1st line

Strength120 mg

Formoral.solid

Adult dose and duration

120-180 mg once daily for seasonal allergic rhinitis, or 60 mg twice daily - as-needed

Paediatric 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.)

Dose by age
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
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEXOFENADINE-CID 120MG 20 F.C. TABS.CID12.00 EGP (0.60/unit)
FEXODINE 120MG 10 CAP.MEMPHIS8.00 EGP (0.80/unit)
SANZALERA 120 MG 14 F.C. TAB.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > TABUK PHARMA13.50 EGP (0.96/unit)
ALLERGYNA 120MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > REXCEL15.00 EGP (1.50/unit)
ALLERFEN 120 MG 30 F.C. TABS.AMOUN96.00 EGP (3.20/unit)
FASTEL 120 MG 20 F.C.TABS.EUROPEAN EGYPTIAN PHARM. IND.66.00 EGP (3.30/unit)
TELFAST 120MG 20 F.C. TABS.SANOFI116.00 EGP (5.80/unit)
ORGOFEXADINE 120MG 10 FILM COATED TABS.ORGANOPHARMA > ORGANO5.50 EGP
ALERTAM 30MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidMUP8.50 EGP
FEXODINE 30MG/5ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidMEMPHIS10.00 EGP
4

CHLORPHENIRAMINE MALEATE

Antihistamine

2nd line

Strength4 mg

Formoral.solid

Adult dose and duration

4 mg every 4-6 hours, maximum 24 mg in 24 hours - as-needed

Paediatric dose

(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.)

Dose by age
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
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
CHLORPHENIRAMINE 4 MG 20 TAB. B.P.93HI-PHARM > PYRAMIDS TRADING1.00 EGP (0.05/unit)
CHLORANTINE-M 4MG 20 TAB.MISR1.40 EGP (0.07/unit)
PIRAFENE 4MG 20 TAB.MEMPHIS2.45 EGP (0.12/unit)
ANALLERGE 4 MG 60 TAB.KAHIRA30.00 EGP (0.50/unit)
PIRAFENE 2MG/5ML SYRUP 120ML? strength differs? different route - not oral solidMEMPHIS10.00 EGP
ANALLERGE 2MG/5ML SYRUP 100ML? strength differs? different route - not oral solidKAHIRA24.00 EGP

NASAL STEROID - choose one

5

FLUTICASONE PROPIONATE

Nasal steroid

1st line

Strength0.05 mg

Formnasal

Adult dose and duration

2 sprays (100 mcg) into each nostril once daily - long-term

Paediatric dose

(1 spray into each nostril once daily in children 4-11 years)

Dose by age
4 to 11 years:1 spray into each nostril once daily
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSEARAB DRUG COMPANY (ADCO)32.00 EGP
FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSEEVA PHARMA76.00 EGP
FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSEGLAXO SMITHKLINE133.00 EGP
FLIXOTIDE DISKUS 50MCG/DOSE ACCUHALERGLAXO SMITHKLINE36.00 EGP
FLIXOTIDE EVOHALER 50MCG/ACTUATION INHALERGLAXO SMITHKLINE111.00 EGP
6

MOMETASONE FUROATE

Nasal steroid

1st line

Strength0.05 mg

Formnasal

Adult dose and duration

2 sprays (100 mcg) into each nostril once daily - long-term

Paediatric dose

(1 spray into each nostril once daily in children 2-11 years)

Dose by age
2 to 11 years:1 spray into each nostril once daily
Choice

Alternatives. Mometasone for the same reason as in sinusitis - lower systemic bioavailability - and keeping one intranasal steroid across both conditions avoids two habits.

Dose 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.

Cautions
  • Direct away from septum.
  • Discontinue if persistent nasal septum ulceration occurs.
  • Mometasone furoate has high topical potency with minimal systemic bioavailability.
Egyptian brands
Egyptian brandManufacturerIndicative price
SNIFFACAN 50MCG/G NASAL SPRAY 15 MLSIGMA TEC25.20 EGP
TABUNEX 50MCG/G NASAL SPRAY 120 DOSESTABUK PHARMACEUTICAL MANUFACTURING COMPANY > AL ANSAR FOR MARKETING28.80 EGP
NORHINOSE 50MCG/DOSE NASAL SPRAY 120 DOSESEUROPEAN EGYPTIAN PHARM. IND. > AMRIYA90.00 EGP

NASAL DECONGESTANT - give alongside

7

XYLOMETAZOLINE

Nasal decongestant

add-on - not a substitute

Strength0.1 mg

Formnasal

Adult dose and duration

1 spray (0.1%) into each nostril every 8 hours, maximum 3 sprays per nostril per day - no more than 7 consecutive days

Paediatric dose

(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.)

Dose by age
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.
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
OTRIVIN 0.1% ADULT NASAL SPRAY 10 ML? strength differsNOVARTIS > GLAXO SMITHKLINE32.00 EGP
BALKIS 0.1% ADULT NASAL DROPS 10 ML? strength differsEIPICO > DOLORGIT3.75 EGP
RHINEX 0.1% ADULT NASAL DROPS 10 ML? strength differsCID18.00 EGP
OTRIVIN 0.1% ADULT NASAL DROPS 15 ML? strength differsGLAXO SMITHKLINE24.00 EGP
BALKIS 0.05% INFANTILE NASAL DROPS 10 ML? strength differsEIPICO > DOLORGIT3.50 EGP
NASOSTOP 0.05% PAED NASAL DROPS 15 ML? strength differsHI-PHARM18.00 EGP
RHINEX 0.05% INFANTILE NASAL DROPS 10 ML? strength differsCID18.00 EGP
OTRIVIN 0.05% PEDIATRIC NASAL DROPS 15 ML? strength differsGLAXO SMITHKLINE24.00 EGP

ADD-ON - give alongside

8

MONTELUKAST

Add-on

add-on - not a substitute

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily in the evening - review at 2-4 weeks and stop if there is no response

Paediatric dose

(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.)

Dose by age
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
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
PIRONTAGONIST 10MG 20 F.C. TABS.EGPI > ADVANCE PHARMA60.00 EGP (3.00/unit)
ASMALAIR 10MG 10 TAB.HI-PHARM40.00 EGP (4.00/unit)
MONTEKAL 10MG 10 TAB.EUROPEAN EGYPTIAN PHARM. IND.40.00 EGP (4.00/unit)
INLETAIR 10 MG 10 F.C.TAB.ORGANOPHARMA47.00 EGP (4.70/unit)
MONTELOSAB 10 MG 14 F.C. TABS.P&C > VERCURE82.00 EGP (5.86/unit)
LELIPEL 10 MG 20 F.C. TABS.EGPI > GLOBE INTERNATIONAL PHARMACEUTICALS120.00 EGP (6.00/unit)
OPIKAST 10 MG 14 SCORED F.C. TABS.EL-OBOUR22.20 EGP
STATUKAST 10 MG 10 SCORED F.C. TABS.ADWIA41.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.