Allergic_Rhinitis_Management:

Question 1

What should be done first in managing allergic rhinitis?

Answer 1

Try to identify the most likely causative allergen.

Question 2

What conditions should be assessed for in a patient with allergic rhinitis?

Answer 2

Assess for atopy, including asthma, allergic conjunctivitis, and eczema.

Question 3

What are signs of chronic nasal congestion?

Answer 3

Signs of chronic nasal congestion include mouth breathing, cough, and halitosis.

Question 4

What should be examined in the nose of a patient with allergic rhinitis?

Answer 4

Examine the nose for nasal polyps, deviated nasal septum, mucosal swelling, or a depressed or widened nasal bridge.

Question 5

What allergens are sublingual immunotherapy available for?

Answer 5

Sublingual immunotherapy is available for house dust mite allergen, mixed grass pollens, timothy grass pollen, and short ragweed pollen.

Question 6

Who is sublingual immunotherapy reserved for?

Answer 6

Sublingual immunotherapy is reserved for patients resistant to other medications.

Question 7

What is the first step in managing mild-moderate intermittent or mild persistent allergic rhinitis?

Answer 7

The first step in managing mild-moderate intermittent or mild persistent allergic rhinitis is allergen avoidance and considering nasal irrigation with saline.

Question 8

What should be done if intranasal antihistamines are contraindicated or not tolerated?

Answer 8

If intranasal antihistamines are contraindicated or not tolerated, use intranasal chromone, such as sodium cromoglycate.

Question 9

What additional treatment is recommended for persistent moderate to severe, uncontrolled allergic rhinitis?

Answer 9

For persistent moderate to severe, uncontrolled allergic rhinitis, continue as per treatment for less severe and add regular intranasal corticosteroid during allergen exposure.

Question 10

What should be considered if severe, uncontrolled symptoms significantly affect quality of life?

Answer 10

Consider a short course of oral corticosteroids (e.g. prednisolone) for 3-7 days if severe, uncontrolled symptoms significantly affect quality of life.

Question 11

What should be done if nasal congestion is a problem in allergic rhinitis?

Answer 11

If nasal congestion is a problem, add intranasal decongestants, such as ephedrine or xylometazoline for up to 5-7 days.

Question 12

What should be given for persistent watery rhinorrhoea in allergic rhinitis?

Answer 12

For persistent watery rhinorrhoea, give intranasal anticholinergic, such as ipratropium bromide.

Question 13

What additional treatment should be considered if symptoms of asthma are present in allergic rhinitis?

Answer 13

If symptoms of asthma are present, consider a leukotriene receptor antagonist.

Question 14

How do intranasal antihistamines compare to oral antihistamines?

Answer 14

Intranasal antihistamines have a faster onset of action and are more effective than oral antihistamines.

Question 15

When should a review be conducted after initiating treatment for allergic rhinitis?

Answer 15

Review in 2-4 weeks after initiating treatment to consider step-up treatment if symptoms persist.

Question 16

What should be advised if adequate symptom control with drug treatment is achieved in allergic rhinitis?

Answer 16

Advise the patient to continue treatment until they are no longer exposed to the suspected allergen if adequate symptom control is achieved.

Question 17

summarise allergic rhinitis management

Answer 17