There are useful guidelines for management of rhinitis, and nasal spray technique, on the BSACI website at www.bsaci.org
A detailed history is vital for diagnosis and identifying the likely allergen
e.g. house dust mite, pollens, animals, fungi.
Younger children – no tests usually needed, history gives an obvious source a lot of the time eg the dog, pollen, house dust mite in carpets / furnishings
If older patient – Specific IgE based on history eg house dust mite and other common aeroallergens can be helpful but if there is a clear trigger tests again not required
- Nasal saline douching eg. Sterimar in older patients
- Nasal steroids - there is good safety data for long term use in children for fluticasone (from age 4), mometasone (from age 6) and budesonide (from age 12)
- Antihistamines - for optimal results give continuously or prophylactically e.g. prior to exposure to known allergen as opposed to ‘as required’. Desloratidine licensed from age 1; cetirizine (SAR) and loratidine from age 2; fexofenadine (SAR) and cetirizine from age 6; fexofenadine from age 12.
Different antihistamines can be trialled and some children need ‘double dosing’ – can be discussed by e-mail
- Leukotriene receptor antagonists may have a role, particularly if child has concomitant asthma
Refer to Consultant Allergy clinic / discuss:-
Patients with resistant allergic rhinitis of uncertain cause, very troublesome symptoms with poor quality of life, already on optimal treatment as per BSACI guidelines and already seen ENT team
NB – referrals are not accepted for allergen testing only, if above criteria not met
Guideline updated by Simon Bedwani, Consultant Paediatrician, Royal Cornwall Hospital, November 2018.
Review Date 14/08/2019
Next Review Date 14/08/2020
GP Sifter Dr Rebecca Harling
Version No. 1.1