Rhinitis, allergic, persistent

J30.1-4

DESCRIPTION

Allergic rhinitis is an allergic inflammation of the nasal airways. Signs and symptoms include rhinorrhoea, itching, sneezing, nasal congestion and obstruction, conjunctival swelling and erythema, puffy eyes, swollen nasal turbinates, and middle ear effusion.

GENERAL MEASURES

Avoid allergens and irritants.

Provide education on the correct technique of administering topical medicines.

Incorrect technique is a common cause of treatment failure.

MEDICINE TREATMENT

  • Corticosteroid, topical, nasal spray e.g.:
  • Fluticasone topical, aqueous nasal solution, 1 spray of 100 mcg in each nostril daily.
    • Aim the nozzle laterally and upwards (aim for the eye) and not to the back of the throat.
    • Do not sniff vigorously.

LoEI [4]

Patients on protease inhibitors:

  • Beclomethasone, aqueous nasal solution, 1 spray of 100 mcg in each nostril 12 hourly.
    • Aim the nozzle laterally and upwards (aim for the eye) and not to the back of the throat.
    • Do not sniff vigorously.
    • Review 3 monthly.

LoEIII [5]

If symptoms persist despite an adequate trial of topical corticosteroids and with the correct technique :

ADD

  • Non-sedating antihistamine, oral e.g.:
  • Cetirizine, oral, 10 mg daily.

LoEI [6]

For relief of nasal blockage:

  • Oxymetazoline 0.05%, intranasal, administered 8 hourly for a maximum of 5 days.

Note: Rebound nasal congestion occurs with prolonged use (>5 days) of topical nasal decongestants.

LoEIII [7]

Failure of the above:

ADD

  • Corticosteroids (intermediate-acting) e.g.:
    • Prednisone, oral, 30 mg daily for 5 days whilst continuing the topical steroid.