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TREATMENT OF RHINITIS

Avoid
Sedating antihistamines
Depot corticosteroids
Chronic use of decongestants or
RHINITIS
Check for asthma and treat
systemically bioavailable intra- Nasal congestion, rhinorrhoea, itching, sneezing
nasal steroids (INS) (e.g.
dexamethasone, betamethasone)

- New polyps - History suggestive of


Thick, - Nasal crusting, Systemically unwell
(gelatinous, insensitive) allergy (itching, sneezing, No obvious
green bleeding (tired, sleep apnoea,
- Unilateral symptoms conjunctivitis) cause
secretions - nasal deformity rash, malaise, etc.
and signs - Positive SPT or RAST

INFECTIVE ALLERGIC
ENT REFERRAL OTHER
RHINITIS/SINUSITIS RHINITIS

allergen and irritant avoidance, where Consider


Nasal appropriate, consider douching non-allergic
Orbital
douching autonomic (vaso-
cellulitis
+/- INS* motor)
Mild
Moderate hormonal
intermittent
severe/persistent; drug induced
+ antibiotics affects QoL (decongestant
if severe overuse, aspirin/
pain/fever NSAID sensitivity,
Non- Regular INS*
sedating anti- non systemically nasal polyps, anti-
histamines biovailable hypertensive)
If chronic/recurrent
consider allergy or
Poor response*
immune deficiency Treat the underlying
cause; course of INS*
Combine above, i.e. non-sedating anti- (non-bioavailable) could
histamines AND regular non-bioavailable INS* be tried

Poor response* No improvement*


URGENT ENT
REFERRAL REFER TO ALLERGY CLINIC

*Check nasal inhalation technique and compliance With kind permission from BSACI; http://www.bsaci.org

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