Allergic Rhinitis ( (Advise the person not to increase beyond the…
Advise the person not to increase beyond the prescribed dose as there is no evidence of additional benefit, and do not switch to an alternative preparation, as they all have comparable efficacy.
Nasal drops may be preferred if there is severe nasal obstruction.
Advise the person that the onset of action is 6–8 hours after the first dose, but the maximal effect may not be seen until after two weeks.
Options include intranasal mometasone furoate, fluticasone furoate, or fluticasone propionate. See the CKS topic on Corticosteroids - topical (skin), nose, and eyes for more prescribing information including different preparations and advice on intranasal spray and drop technique.
Prescribe a regular intranasal corticosteroid to be used during periods of allergen exposure.
If the person has moderate-to-severe persistent symptoms, or initial drug treatment is ineffective:
Oral antihistamine options include loratadine or cetirizine, which may be available over-the-counter. See the section on Oral antihistamines in Prescribing information for more information.
Advise that intranasal antihistamines (azelastine) have a faster onset of action and are more effective than oral preparations. See the section on Intranasal antihistamines in Prescribing information for more information on intranasal antihistamines and intranasal spray and drop technique.
Advise on the 'as-needed' use of an intranasal antihistamine first-line, or a second-generation, non-sedating oral antihistamine, depending on the person's age and personal preference.
f the person has mild-to-moderate intermittent, or mild persistent symptoms:
Advise the person to consider the use of nasal irrigation with saline
Note: people may be allergic to one or more allergens.
Occupational history should include the nature of the job; duration of employment before symptoms developed; agents exposed to at work; and whether symptoms improve when the person is away from work such as weekends and holidays.
Housing conditions, pets, and occupation, to identify possible causative triggers and allergens.
The severity of symptoms and impact on the person's quality of life, including sleep, concentration, mood, behaviour, and fatigue; impact on leisure activities, school, and work.
The type, frequency, persistence, and location of symptoms (indoors or outdoors).
Occupational — intermittent or chronic symptoms tend to improve when the person is away from work, such as weekends and holidays.
Animal dander — symptoms follow exposure to animal dander, and may be all year-round or occasional, depending on exposure.
House dust mites — symptoms are worse on waking and are present all year-round, but may peak in autumn and spring.
Weed pollens — intermittent or chronic symptoms may occur from early spring to early autumn.
Grass pollens — intermittent or chronic symptoms occur from late spring to early summer.
Tree pollens — intermittent or chronic symptoms occur from early to late spring.
A personal or family history of atopy (asthma, eczema, or allergic rhinitis).
Associated eye symptoms such as bilateral itching, redness, and tearing
Additional symptoms such as postnasal drip, itching of the palate, and cough; and features suggestive of chronic nasal congestion, such as snoring, mouth breathing, and halitosis.
Classic symptoms of sneezing, nasal itching, nasal discharge (rhinorrhoea), and nasal congestion — bilateral symptoms typically develop within minutes following allergen exposure.
IgE-mediated inflammatory disorder of the nose which occurs when the nasal mucosa becomes exposed and sensitized to allergens, to produce typical symptoms of sneezing, nasal itching, discharge (rhinorrhoea), and congestion.