Allergic Rhinitis

Data gathering

  • Red flags
  • Others – sneezing, itching, runny nose, seasonal, year-long, asthma, eczema, impact
  • Examine

 

Clinical management

  • Investigations
    • Skin prick tests – more reliable than food alergen testing
  • Explanation
  • Treatment
    • Lifestyle
      • allergen avoidance (see below)
      • Nasal douching – NeilMed
    • Medications
      • Oral antihistamines
        • First line: Cetirizine
        • Second line: Fexofenadine 120mg OD
      • Intranasal steroids (for 2-3 months)
      • oral Prednisolone 30mg OD (non-EC coated) for 5-10 days
  • Follow-up / Safety-net
    • Check nasal-spray technique
    • Consider
    • Refer to ENT
      • resistant to treatment
      • Samter’s triad (sensitivity to aspirin/NSAIDs, nasal polyps, asthma)

 

Notes

  • If grass pollen (symptoms late spring/early summer) – avoid grassy, open spaces particularly early morning and evening, keep windows shut
  • If house dust mites – burdensome strategies but consider in confirmed allergy
  • Nasal spray technique
    • Shake bottle
    • Look down
    • Use right hand for left nostril
    • Aim towards outside wall of nostril (not midline)
    • Do not sniff hard