Allergic Rhinitis/Conjunctivitis (perennial/non-seasonal)
Key Messages
Scope
Diagnosis and management of perennial (non-seasonal) allergic
rhinitis/conjunctivitis. For seasonal allergic rhinitis see separate guidelines.
Assessment
Signs and Symptoms
Bilateral nasal itching, congestion and rhinorrhoea, sneezing, or bilateral
conjunctivitis.
Ask about triggers (eg pets) if symptoms intermittent all year round (perennial).
Differential diagnosis
- Seasonal rhinitis (symptoms only in pollen season spring/summer)
- Infective rhinosinusitis
- Non-allergic (eg hormonal, drug-induced, vasomotor) rhinitis
For diagnostic algorithm see
http://www.bsaci.org/Guidelines/Algorithm-RhinitisPCGL.pdf
Red Flags
Unilateral symptoms, polyps, persistent blood stained discharge or persistent
purulent discharge – consider referral to ENT.
Investigations
Send blood for specific IgE to suspect aero-allergen (most commonly house dust
mite and pets if exposed).
Management
1. Allergen avoidance where possible (eg house dust mite reduction measures
or pet avoidance).
2. Mild symptoms should be treated with oral non-sedating antihistamines at
doses up to twice BNF maximum dosing (cetirizine 10mg, loratadine 10mg, or
fexofenadine 180mg up to twice daily).
3. Moderate-severe symptoms should be treated with intranasal corticosteroid
(eg Beconase, two sprays into each nostril twice daily; consider alternative, eg
Nasonex or Avamys) in addition to non-sedating antihistamines. Consistent
daily use of intranasal use is vital, given maximal effect may not be apparent
for at least two weeks.
Version: 3
Date last edited: 10/06/15
Locality: Devon wide
Amendments by: Kevin Bishop
a. Training in appropriate nasal spray technique essential. Guidance is
given at
http://www.nationalasthma.org.au/uploads/publication/intranasalcorticosteroid-spray-technique.pdf
4. Systemic corticosteroids (in addition to intranasal corticosteroid) at doses of
15-20mg for a maximum of 5 days as a one-off course can be used for severe
symptoms uncontrolled on conventional therapy, to control symptoms during
important periods (eg exams or other major events).
5. Topical cromoglicate and nedocromil eyedrops are useful to manage allergic
conjunctivitis.
Consider a concomitant diagnosis of asthma and manage according to guidelines
Avoid sedating antihistamines, depot corticosteroids, and chronic use of
decongestants.
Treatment failure should prompt a review of the diagnosis, compliance with therapy
(regular therapy is more effective than “as required” treatment), and intranasal
corticosteroid technique.
For more information see
http://www.guidelines.co.uk/eye_ear_nose_throat_bsaci_rhinitis
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2007.02888.x/pdf
Referral
Referral Criteria
i)






Perennial symptoms that are severe and resistant to treatment (when
combination treatment at maximum doses has been attempted for at least
3 months).
Referral Instructions
Red Flags – refer to ENT
Refer via DRSS for NEW Devon CCG patients
Choose and Book Selection
Specialty: ENT
Clinic type: Not otherwise specified
Service: DRSS- Western – ENT -NEW Devon CCG - 99p
Refer to Peninsula Immunology and Allergy Service
Refer via DRSS for NEW Devon CCG patients
Choose and Book Selection
Specialty: Allergy
Clinic type: Allergy
Service: DRSS- Western –Allergy & Immunology - CCG - 99p
Version: 3
Date last edited: 10/06/15
Locality: Devon wide
Amendments by: Kevin Bishop
Referral forms
DRSS Referral form
Supporting Information
http://www.guidelines.co.uk/eye_ear_nose_throat_bsaci_rhinitis
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2007.02888.x/pdf
Evidence
Pathway Group
This guideline has been signed off by the Western Locality on behalf of NEW Devon
CCG.
Publication date: June 2015
Review date: May 2017
Version: 3
Date last edited: 10/06/15
Locality: Devon wide
Amendments by: Kevin Bishop