Allergic rhinitis (hay fever)

Question 1

What is allergic rhinitis?

Answer 1

Hay fever

occurs after an inflammation response releasing histamine due to allergens being deposited on the nasal mucosa.

Question 2

In allergic rhinitis, list some common allergens

When is allergic rhinitis worse?

Answer 2

Grass pollen, tree pollen, fungal mold spores

Worse when pollen count is high. Peak at May-July, but symptoms may start in April, when tree pollen appears

Question 3

Define perennial allergic rhinitis

Answer 3

year-round symptoms due to house dust mite, animal dander and feathers

Question 4

Time scale for intermittent allergic rhinitis

Answer 4

<4 days/7 or <4 weeks

Question 5

Time scale for persistent allergic rhinitis

Answer 5

> 4 days/7 and >4 weeks

Question 6

Describe mild allergic rhinitis effect on life

Answer 6

normal sleep, normal daily activities including sports, leisure, work/school, symptoms not troublesome

Question 7

Describe moderate allergic rhinitis effect on life

Answer 7

abnormal sleep
impairment of daily activities including sports, leisure.
Problems at work/school
Troublesome symptoms

Question 8

Treatment timescale of allergic rhinitis

Answer 8

with treatment should resolve within 5 days

Question 9

Symptoms of allergic rhinitis

Answer 9

• Rhinorrhoea
• nasal congestion
• nasal itching
• irritation of roof of mouth
• itchy and watery eyes, tear duct congestion
• sneezing

Question 10

Define rhinorrhoea in hay fever

Answer 10

runny nose, thin discharge, clear, watery, but can change to thick, purulent suggesting infection, but no need for antibiotics - treat hay fever as normal

Question 11

Cause of nasal congestion in hay fever and signs it is severe
Examples of secondary inflammation

Answer 11

Nasal congestion is due to inflammatory response causing vasodilatation of nasal blood vessels.
Severe=headaches and earache.
Secondary inflammation= otitis media, sinusitis

Question 12

what causes the eye symptoms in hay fever?

Answer 12

direct inflammation in the eye due to pollen

Question 13

Describe the pattern of sneezing in allergic rhinitis

Answer 13

sneezing is more severe in the morning and evening when pollen rises and settles
Gets better with rain.
If the cause is fungal mould spores, however, then it is worse in damp weather, present in September

Question 14

referral criteria for allergic rhinitis

Answer 14

• failed medication
• wheezing/shortness of breath (asthma - sometimes only during summer=seasonal asthma)
• tightness of chest
• painful ear
• painful sinuses
• painful conjunctivitis
• failed medication

Question 15

Lifestyle advice for hay fever/allergic rhinitis

Answer 15

sleep with windows closed
avoid being outside when pollen count is high (mid morning/early evening)
get someone else to cut the lawn/grass
avoid stroking animals
drive the car with windows and vents closed
Vacuum regularly

Question 16

List drugs that treat allergic rhinitis

Answer 16

Antihistamines:

• cetirizine
• chlorphenamine
• loratidine

Steroid:
-beclomethasone

Mast cell stabiliser:
-sodium cromoglicate

Question 17

Benadryl one day relief
active ingredient
symptoms

Answer 17

cetirizine

Hay fever, sneezing, rhinorrhoea

Question 18

Benadryl one day relief
directions side effects
patient populations

Answer 18

one daily
Headache, malaise (discomfort)
Only suitable for >12 years
Fine to use in pregnancy and breastfeeding

Question 19

Piriton allergy tablets
active ingredient
symptoms

Answer 19

Chlorphenamine

Hay fever, urticaria (allergic rash), chickenpox itch, insect bites, food allergies

Question 20

Piriton allergy tablets

side effects

Answer 20

drowsiness 
dry mouth
blurred vision
constipation 
urinary retention 
sedating effect aids sleep

Question 21

Piriton allergy tablets

patient populations

Answer 21

> 6yrs only

suitable in pregnancy and breastfeeding

Question 22

Clarityn rapide allergy tablets
active ingredient
symptoms

Answer 22

Loratidine

Symptomatic treatment of allergic rhinitis and chronic urticaria (allergy rash)

Question 23

Clarityn rapide allergy tablets

patient populations

Answer 23

> 2years only

Not suitable for breastfeeding or in pregnancy

Question 24

Beconase Hay fever nasal spray
active ingredient
symptoms

Answer 24

Beclomethasone

reduces inflammation

Question 25

Beconase hay fever nasal spray
side effects
Warnings
counselling

Answer 25

Rare: dryness and irritation of nose and throat, nosebleeds
NOT to be used in glaucoma
Only for use in >18 years for up to 3 months
Not suitable in pregnancy or breastfeeding
Counselling:
Takes several days to see effect
regular use needed

Question 26

Murine hay fever relief eye drops
active ingredient
symptoms

Answer 26

sodium cromoglicate
red, itchy, watery eyes
Both seasonal and perennial allergic conjunctivitis

Question 27

Murine hay fever relief eye drops
warnings, side effects
patient populations
counselling

Answer 27

May feel mild transient burning/stinging sensation after administration
>6yrs only
Suitable in pregnancy and breastfeeding
Can use mast cell stabiliser for prophylaxis. In recurrent season allergies, use 4 weeks before the start of allergy season
remove contact lenses before applying?