Allergic Rhinitis
Ear, Nose and Throat Conditions
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ICD-10 Code: J30.0-4
DESCRIPTION
- Inflammation of the mucous membranes of the nose and paranasal sinuses in response to an allergen e.g. pollen, house dust, grasses and animal hair
- Allergic rhinitis is characterised by recurrent episodes of:
- Blocked stuffy nose
- Watery nasal discharge
- Frequent sneezing, often accompanied by nasal itching and irritation
- Conjunctival itching and watering
- Oedematous pale nasal mucosa
- Mouth breathing
- Snoring at night
- Exclude other causes, such as infections, vasomotor rhinitis, overuse of decongestant drops, side effects of antihypertensives and antidepressants
GENERAL MEASURES
- Avoid allergens and irritants
MEDICINE TREATMENT
Adults and children >6 years of age
- Corticosteroid, e.g.:
- Fluticasone, aqueous nasal solution, 1 spray of 100 mcg in each nostril 12 hourly
- Aim the nozzle laterally and upwards (aim for the eye) and not to the back of the throat
- Do not sniff vigorously
- Review 3 monthly
Note:
- Fluticasone and budesonide interacts with protease inhibitors.
- Refer all patients on protease inhibitors requiring corticosteroids for further management
For short term symptomatic use:
Children
- Chlorphenamine, oral, 0.1 mg/kg/dose 6–8 hourly. See: dosing table
Adults
- Chlorphenamine, oral, 4 mg, 6–8 hourly
For relief of nocturnal nasal blockage:
- Topical nasal decongestant e.g.:
- Oxymetazoline 0.05%, intranasal, administered at night for a maximum of 5 days
Long-term antihistamines should only be used after an adequate trial of intranasal corticosteroids and should be added to steroid therapy, if necessary.
For long-term use in adults and school going children:
Children: 2–6 years of age
- Cetirizine, oral, 5 mg once daily. See dosing table
Children >6 years of age and adults
- Cetirizine, oral, 10 mg daily
CAUTION
Do not give an antihistamine to children <2 years of age
REFERRAL
- Chronic persistent symptoms
- Severe symptoms
- Patients on protease inhibitors, requiring nasal corticosteroids
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition