Allergic Rhinitis

Question 1

What are the 3 types of allergic rhinitis?

Answer 1

1. Seasonal
2. Perennial - symptoms occur throughout the year.
3. Occupational

Question 2

What are the features of allergic rhinitis?

Answer 2

• Sneezing
• Bilateral nasal obstruction
• Clear nasal discharge
• Post-nasal drip
• Nasal pruritus

Question 3

What is the management of allergic rhinitis?

Answer 3

1. Allergen avoidance
2. First line - Oral or intranasal antihistamines
   
   • ​Oral - Cetirizine, fexofenadine or loratadine.
   • Intranasal - (Azelastine BD-QDS)
3. Intranasal corticosteroids:
   
   • Once Daily Preparations- triamicinolone, fluticasone, mometasone or budesonide
   • More than once daily - beclometasone, betametasone.
   • Nasal fluticasone drops if nasal polyps/ blockage is present.
4. Course of oral corticosteroids are occasionally needed
5. There may be a role for short courses of topical nasal decongestants (e.g. oxymetazoline). They should not be used for prolonged periods as increasing doses are required to achieve the same effect (tachyphylaxis) and rebound hypertrophy of the nasal mucosa may occur upon withdrawal

Question 4

What nasal spray technique should be advised?

Answer 4

• Gently blow the nose to try and clear it.
• Shake the bottle well.
• Close off one nostril and put the nozzle in the other, directing it away from the midline. Tilt head forward slightly and keep the bottle upright.
• Squeeze a fine mist into the nose while breathing in slowly. Do not sniff hard.
• Breathe out through the mouth.
• Take a second spray in the same nostril then repeat this procedure for the other nostril.

Question 5

At how many weeks does NICE recommend for you to review a patient that has been prescribed an oral/intranasal corticosteroid?

Answer 5

2-4 weeks

Question 6

What are the adverse effects of intranasal steroids?

Answer 6

They are rare

• Localized symptoms.
• If high dose can lead to growth retardation