Transcript Allergic Rhinitis

Primary Care
Management of Rhinitis
Dr Julian Smith, MBBS MRCGP PGDipENT
GPwSI Ear Nose & Throat
St Albans & Harpenden ENT Community Services
Clinical Diagnosis
Rhinitis definition
 Nasal discharge
 Blockage/congestion
 Sneeze/itching
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2 or more symptoms
for > 1 hour on
most days
 History
 Examination
 Investigations
Allergic
Non-Allergic
Rhinitis
Rhinitis
Management in Primary Care
Pathway
Pre referral management
RHINITIS
Start with a trial of INS e.g. Fluticasone or
Mometasone, for a minimum of 6 weeks,
which must be taken regularly.
If allergy test positive: topical antihistamines
e.g. Azelastine.
Pre referral management
CHRONIC SINUSITIS
With a classical history, intensive medical
treatment should be attempted before referral
with INS to both nostrils for up to 6 weeks if
severe in combination with Co-amoxiclav or
Doxycycline for the first two weeks of the
course.
If no response after 6 weeks of good
compliance with treatment, refer
Top Tips
Individual patients vary in their response to treatments, therefore try
different treatment(s) if the first fails
Steroid sprays less likely to work with nasal blockage, so try drops instead
Avoid chronic use of decongestants (rhinitis medicamentosa)
ENT referral for
unilateral symptoms
nasal perforations/ulceration
new onset unilateral polyps
crusting high in nasal cavity
recurrent infections
periorbital cellulitis (emergency)
Instruct patient on correct technique using sprays/drops
Technique
More Top Tips
Postnasal space tumour; beware if recent onset nasal symptoms, especially
blockage, bleeding or pain
Is the patient Chinese?
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Does the patient have adult glue ear?
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Does the patient have recent headache?
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Is there a neck lump?
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Unilateral polyps require urgent histology, but if referring urgently,
beware confusion with a large turbinate! Patients can feel a turbinate
being touched with, e.g. a long probe, but polyps are asensate.