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
- Oral antihistamines
- Lifestyle
- 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