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Allergic rhinitis

  • Can be seasonal (hayfever or seasonal allergic rhinitis), throughout the year (perennial rhinitis) or linked to an allergen at work (occupational).


Epidemiology of rhinitis

  • Very common – prevalence up to 20%
  • Adults more commonly have perennial rhinitis and children more commonly have seasonal rhinitis.


Aetiology of rhinitis

  • Seasonal rhinitis
    • Common allergens are pollens from trees (spring), grass (late spring/early summer), weeds (spring to autumn)
  • Perennial rhinitis
    • House-dust mite, domestic pets
  • Sensitivity to substances like smoke, perfumes can aggravate rhinitis
  • Vasomotor rhinitis (perennial symptoms, but without the eosinophilic granulocytosis seen in nasal secretions – unlike perennial or seasonal allergic disease).
    • Thought to be due to autonomic system imbalance
  • Rhinitis often co-exists with asthma
    • May have personal or family history of atopy


Symptoms of rhinitis

  • Sneezing
  • Nasal discharge/Nasal blockage
    • Ask about discharge colour – usually clear in allergic rhinitis.
  • Itching/red eyes
  • Seasonal attacks of asthma
  • Ask about timing of symptoms and irritant exposure.
  • Think about classifications
    • Mild: Normal sleep/activities/work/school
    • Moderate-severe: These all affected
    • Intermittent
      • <4 days/week and <4 weeks/year.
    • Persistent
      •  >4 days/week and 4 weeks/year.


Treatment of rhinitis

  • All patients
    • Allergen avoidance
      • Skin prick testing/RAST is helpful to find what allergens are implicated.
      • Removal of pets, enclosure of industrial processes, avoid being outside in later afternoon (pollen count highest), keep bedroom window shut etc.
    •  Nasal douching with saline
  • Mild intermittent:
    • Oral route preferred or age 2-5 or conjunctivitis a problem use oral antihistamines e.g. cetirizine or loratidine (non-sedating) else use spray e.g. azelastine.
  • Mild persistent:
    • Use nasal steroid spray e.g. Flixonase, Avamys. Consider also oral/topical anthihistamine.
  • Moderate-severe intermittent:
    • Use nasal steroid drops e.g. Flixonase nasules.
    • Consider mast cell stabiliser e.g. sodium cromoglycate spray
  • Moderate-severe persistent
    • A short course of oral steroids can be helpful followed by above treatment (e.g. 40mg prednisolone 7 days in adults).
    • Montelukast can also be used especially if asthmatic.
  • If struggling, refer to medical rhinologist/ENT.


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