Rhinitis – QuickDoc.

UNILATERAL SYMPTOMS, BLEEDING, ATYPICAL REFER ENT

Non allergic
- More likely if [first time] [no atopic disease] [adult onset]
- Causes – [polyps] [nasal injuries or septal deviation] [foreign body’s] [vasculitis] [systemic disease – thyroid] [Sinister – Weight loss, blood stained discharge, fever…]
- Consider investigating [as below] for allergic causes and excluding above disease
  - If -ve IgE, allergy effectively excluded
- Treatment
  - Nasal steroid spray or intranasal ipratropium [for watery rhiorrhoea]
Allergic
- Seasonal [intermittent]
  - Trigger
    - Usually grass [late spring – early summer] [May, June, July]
    - Tree pollens [birch, alder hazel] [Spring]
      [March, April, May]
    - Rarely moulds [Autumn] [September, October, November]
  - Management
    - Regular antihistamines
      - Non-sedating antihistamine [loratadine, cetirizine, fexofenadine, desloratadine]
      - Add sedating antihistamines [chlorphenamine, hydroxyzine, promethazine]
    - Regular nasal spray
      - Congestion – Steroid spray 1st line [betamethasone, fluticasone] [Use as directed – Will NOT provide immediate relief – maximum effect is only seen after 1-2 months of daily use.]
      - Itch & sneezing (not nasal congestion) – Nasal antihistamines, acts fast [azelastine] [Use as directed – Will NOT provide immediate relief – maximum effect is only seen after 3 weeks of daily use.]
      - Watery rhinorrhoea – [Ipratropium bromide – Rinatec]
    - Eye drops
    - Severe symptoms – Steroid [prednisolone 20mg OD 5d]
    - IM Steroid injections not advisable
- Perennial [Persistent]
  - Trigger
    - Almost always house dust mite
  - Management
    - As per seasonal rhinitis
    - House dust mite reduction measures are probably effective – ONLY if combined with above therapy.
Referral [consideration of desensitisation]
- Conventional management failure and compliant with Rx.

Links

Patient.co.uk on persistent rhinitis

NHS.uk on allergic rhinitis