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Allergic rhinitis - Coggle Diagram
Allergic rhinitis
Management
Moderate-to-severe persistent symptoms or initial drug treatment is ineffective - prescribe regular intranasal corticosteroid.
Advise the person to be reviewed after 2–4 weeks if symptoms persist after initial treatment, as management may need to be stepped up.
In mild-moderate intermittent or mild persistent - as needed intranasal antihistamine first line or 2nd line non-sedating oral antihistamine. Consider use of intranasal chromone such as sodium cromoglicate to be used 'as needed' if antihistamine are contraindicated or not tolerated.
In treatment failure - consider compliance with self-management strategies, compliance with initial drug treatment or correct technique or alternative diagnosis. Consider stepping up treatment.
Provide advice on allergen avoidance techniques if there is a specific identified causative allergen.
If the person has severe, uncontrolled symptoms that are significantly affecting quality of life, consider prescribing a short course of oral corticosteroids to provide rapid symptom relief
Advise the person to consider the use of nasal irrigation with saline to rinse the nasal cavity using a spray, pump, or squirt bottle, which can be bought over-the-counter.
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Consider arranging referral for specialist assessment and management to an allergy or ear, nose, and throat (ENT) specialist if: there are red flag symptoms, predominant nasal obstruction and/or structural abnormality, persistent symptoms despite optimal management or diagnosis is uncertain.
If drug treatment provides adequate symptom control, advise the person to continue treatment until they are no longer likely to be exposed to the suspected allergen.
Assessment
Housing conditions, pets and occupation to identify any triggers
Symptoms suggesting associated conditions such as allergic conjunctivitis, asthma, eczema, and sinusitis, and manage accordingly.
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Any drugs that may cause or aggravate symptoms, previous treatments and their effectiveness
Type of symptoms, frequency, persistence and location.
Examine for signs of nasal intonation of the voice, darkened eye shadows, horizontal nasal crease, deviated or perforated nasal septum, depressed or widened nasal bridge, purulent nasal discharge or eye involvement.
When to suspect
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Symptoms occurring following exposure to a known trigger such as tree pollen, grass pollen, weed pollen, house dust mites, animal dander or occupational.
Associated eye symptoms of bilateral itching, redness or tearing.
Additional symptoms such as postnatal drop, itching of the palate, cough, snoring, mouth breathing and halitosis.
Classic symptoms: sneezing, nasal itching, nasal discharge, nasal congestion - bilateral symptoms typically develop within minutes following allergen exposure.
Differential diagnosis
Non-allergic rhinitis such as autonomic or irritant rhinitis, drugs, endocrine, food or drink, non-allergic rhinitis with eosinophilia syndrome, systemic or structural.
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Definition: Allergic rhinitis is an IgE-mediated inflammatory disorder of the nose which occurs when the nasal mucosa becomes exposed and sensitized to allergens. This triggers the release of histamine and other inflammatory mediators. Allergic rhinitis may be classified according to timing, frequency and persistence of symptoms. Causes can be genetic or environmental.