Figure 1

Algorithm for the treatment of nonallergic VMR. Once a patient is categorized as VMR, the predominant symptom complex determines initial treatments based on symptom severity. Initial treatments for mildly affected patients use single entities, but patients with more severe disease who have failed monotherapy should be tried on combination therapies. Most patients will ultimately respond to the use of combinations of nasal sprays plus an oral medication. Once under control, stepping the therapy down to the lowest effective dose of mediations is suggested.