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6–12 months or even for life). Spraying the nasal septum and sniffing the spray straight back into the throat should be avoided.Figure 3: Method of application for nasal sprays and nasal drops(a) Correct procedure for the application of nasal sprays. those allergic to pollens) it has been demonstrated that if therapy with topical nasal corticosteroids is begun a week or two before symptoms are expected, symptoms have delayed onset and reduced severitySimilarly, both antihistamines and nasal corticosteroids, particularly the latter, are more effective if used on a daily basis, rather than being stopped and startedA simple way to keep track of patients’ symptoms is for them to use the MACVIA-ARIA visual analogue scale, via a mobile phone appBSACI guidelines suggest that in more severe disease nasal corticosteroids and antihistamines may be used togetherThe BSACI guidelines provide direction to help healthcare professionals direct therapy for allergic rhinitisFigure 4: A simple algorithm for the treatment of allergic rhinitisThe progression of treatment goes from left to right as severity increases.For patients with intermittent allergic rhinitis caused by seasonal allergens, as the season wanes and pollen levels in the atmosphere reduce, treatment can be gradually reduced, if the symptoms are completely controlled, and stopped once the season is over.Patients with persistent allergic rhinitis, such as those allergic to perennial allergens (e.g.

(2) Allergen interacts with IgE, shown in red, to activate the mast cell. Therefore, it is important to explain to the patient that the dose of nasal steroids is in microgram quantities and for most of the common molecules there is minimal systemic bioavailability (i.e. However, if in doubt, looking for theThis section assesses the drugs only briefly – further information and the British Society for Allergy & Clinical Immunology (BSACI) guidelines for the management of allergic and non-allergic rhinitisThe treatment of ocular symptoms of allergic rhinitis is summarised in Box 1.Oral antihistamines are the first-line treatment used by most patients, doctors and pharmacists for all allergic rhinitis.When selecting the most appropriate antihistamine to manage allergic rhinitis, healthcare professionals should be aware of the significant detrimental effect of first generation antihistamines (FGAH) on cognitive processes in all patient groupsStudies in children have demonstrated that FGAHs exacerbate the detrimental effect of allergic rhinitis on learning abilityIn adults the detrimental effects of allergic rhinitis on quality of life and productivity at work are exacerbated by FGAHs, even at the lowest doses recommended by manufacturersTherefore, the British and European Guidelines for both allergic rhinitis and urticaria specify that only second generation antihistamines should be used for symptom relief, because they penetrate less well into the brain than FGAHs and have negligible anticholinergic effectsIntranasal antihistamines are more effective at reducing nasal symptoms than oral antihistamines, but do not treat extra-nasal symptomsAlthough antihistamines demonstrate efficacy, for the control of symptoms like sneezing, itching and rhinorrhoea or eye streaming, they are considerably less effective than intranasal corticosteroids that have a much stronger anti-inflammatory effect and are more effective in treating nasal obstructionIntranasal steroids are the most effective treatment for reducing nasal inflammation and improving conjunctival symptomsWhen bought OTC or even when prescribed by a medical practitioner, nasal steroids are often wrongly used or not used at all, because of fears of “steroids”. Special consideration should be given to badly affected young people who face years of summertime examinations or adults whose functioning is disturbed (e.g. Note that house dust mite levels are highest in the winter when doors and windows are closed in centrally heated homes.Patients may be allergic to trees, plants and fungi that use the wind to disperse their pollen or sporesWhile high amounts of pollen and fungal spores are released during warmer days compared to colder ones, house dust mite allergens are present all year round. To measure your antibodies to specific allergens, your provider may take a blood sample and send it to a lab for testing.

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