allergic rhinitis

Question 1

what are the symptoms of allergic rhinitis?

Answer 1

• Nose symptoms: o Sneezing
o Nasal itching
o Nasal blockage
o Watery nasal discharge
• Eye symptoms:
o Red, itchy and watery eyes
• Cough
• Dyspnoea

Question 2

what are the red flags for allergic rhinitis?

Answer 2

• Wheezing
• Difficulty breathing
• Painful ear
• Allergic rhinitis complicated by a severe secondary infection
o For example, purulent conjunctivitis, which is a bacterial infection that presents with morning crusting and difficulty opening the eyelids

Question 3

what is the lifestyle advice for allergic rhinitis?

Answer 3

Avoidance of allergens by patients is a good concept to follow, but this is not always possible or fully effective. Patients can be advised to take note of pollen counts to help them decide if they would like to partake in outdoor activities. Wearing sunglasses and a hat when outside can help symptoms and closing windows whilst indoors may also be helpful.
• Avoid drying clothes outside if allergies to outdoor triggers e.g. pollen

Question 4

what are the drug treatment options for allergic rhinits?

Answer 4

oral antihistamines
intranasal corticosteroids
oral decongestants

Question 5

examples of oral antihistamines?

Answer 5

Chlorphenamine, Promethazine, Loratadine, Cetirizine, Acrivastine

Question 6

which are the sedating oral antihistamines?

Answer 6

Chlorphenamine and Promethazine are sedating antihistamines and all the others are
non-sedating. Patients who purchase Chlorphenamine or Promethazine must be informed
of their sedative nature and the need to avoid driving or use of machinery afterwards.

Question 7

what are examples of intranasal corticosteroids?

Answer 7

Beclometasone, Budesonide, Fluticasone, Triamcinolone

Question 8

when should intranasal corticoteroids be used?

Answer 8

▪ First-line where rhinitis is the main symptom, as they are more effective than oral antihistamines in reducing nasal symptoms. They can also help eye symptoms
▪ Slow onset of action of around 12 hours, maximum efficacy is normally achieved after a few days
▪ Treatment should begin 2-3 weeks before hay fever season begins and then continued throughout the season. Used for a maximum of three months

Question 9

when is sodium cromoglicate used?

Answer 9

x▪ Commonly a first-line choice for children
▪ A mast cell stabiliser available as eye drops and nasal spray
▪ Eye drops are effective for eye symptoms
▪ Intranasal spray is less effective than antihistamines or corticosteroids ▪ Discard eye drops 28 days after opening

Question 10

when would you use oral decongestants?

Answer 10

▪ Can be used for short-term relief of nasal congestion
▪ Are also helpful to use in conjunction with nasal corticosteroids as the decongestant will
increase passage of the corticosteroid to the nasal mucosa

Question 11

what are the OTC guidelines for oral decongestants?

Answer 11

o OTC oral decongestant sales are limited at 720mg, which is equivalent to 12 tablets/capsules of 60mg or 24 tablets/capsules of 30mg of pseudoephedrine or ephedrine
o The sale should be carried out by a pharmacist and there is a limit of selling one pack per customer