Allergic rhinitis

J30.0-4

DESCRIPTION

Inflammation of the mucous membranes of the nose and paranasal sinuses in response to an allergen e.g. pollen, house dust, grasses, and animal hair.

Allergic rhinitis is characterised by recurrent episodes of:

  • blocked stuffy nose - watery nasal discharge
  • frequent sneezing, often accompanied by nasal itching and irritation
  • conjunctival itching and watering
  • oedematous pale nasal mucosa
  • mouth breathing
  • snoring at night

Exclude other causes, such as infections, vasomotor rhinitis, overuse of decongestant drops, and side effects of antihypertensives and antidepressants.

GENERAL MEASURES

Avoid allergens and irritants.

MEDICINE TREATMENT

Adults and children > 6 years of age

  • Corticosteroid, e.g.:
    LoEIII [1]
  • Fluticasone, 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.

LoEI [2]

Note: Fluticasone and budesonide interacts with protease inhibitors. Refer all patients on protease inhibitors requiring corticosteroids for further management.

LoEIII [3]

For short term symptomatic use:

Children

  • Chlorphenamine, oral, 0.1 mg/kg/dose 6–8 hourly. See paediatric dosing tool.

Adults

  • Chlorphenamine, oral, 4 mg, 6–8 hourly.

For relief of nocturnal nasal blockage:

Topical nasal decongestant e.g.:

  • Oxymetazoline 0.05%, intranasal, administered at night for a maximum of 5 days.

Long-term antihistamines should only be used after an adequate trial of intranasal corticosteroids and should be added to steroid therapy, if necessary.

For long-term use in adults and school going children:

Children: 2–6 years of age

  • Cetirizine, oral, 5 mg once daily. See paediatric dosing tool.

Children > 6 years of age and adults

  • Non-sedating antihistamine, oral.
  • Cetirizine, oral, 10 mg once daily.

LoE:I[4]

CAUTION

Do not give an antihistamine to children < 2 years of age.

REFERRAL

  • Chronic persistent symptoms.
  • Severe symptoms.
  • Patients on protease inhibitors, requiring nasal corticosteroids.