Oral antihistamine (cetirizine, loratadine, fexofenadine)

Oral decongestant (pseudoephedrine)

Unrelated mechanism of two drugs provides synergy. Controls sneezing, itching, and nasal congestion.

Improved control of nasal congestion vs. antihistamine alone.

Combination is more effective for reducing symptoms in SAR than either drug alone.

Oral decongestant side effects: Systemic hypertension, urinary retention (additional adverse effects noted in pregnant women and young children). Drug-drug interactions for oral antihistamines are prevalent, especially in elderly.

Typically considered an option for acute AR exacerbations, but not recommended as daily maintenance therapy.

Oral antihistamine (cetirizine, loratadine, fexofenadine)

INCS (fluticasone propionate, mometasone furoate)

Addition of INCS when a patient is already taking an oral antihistamine provides symptom improvement, especially for nasal congestion.

Most studies show no benefit of adding an oral antihistamine to INCS, compared to an effective INCS alone.

Although this combination is often used clinically, based on current evidence, if a patient is already on an effective INCS, adding an oral antihistamine provides no additional benefit.

The key medication in this combination is an effective INCS.