GuidelinesEML (Adult Hospital STG)
Rhinitis, Allergic, Persistent
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
ICD-10 Code: J30.1-4
DESCRIPTION
- Allergic rhinitis is an allergic inflammation of the nasal airways.
- Signs and symptoms include rhinorrhea, itching, sneezing, nasal congestion and obstruction, conjunctival swelling and erythema, puffy eyes, swollen nasal turbinates, and middle ear effusion.
GENERAL MEASURES
- Avoid allergens and irritants.
- Provide education on the correct technique of administering topical medicines.
- Incorrect technique is a common cause of treatment failure.
MEDICINE TREATMENT
- Corticosteroid, topical, nasal spray, e.g.:
- Fluticasone topical, aqueous nasal spray, 1 spray of 100 mcg in each nostril daily.
- Aim the nozzle laterally and upwards (aim for the eye) and not to the back of the throat.
- Do not sniff vigorously.
- Fluticasone topical, aqueous nasal spray, 1 spray of 100 mcg in each nostril daily.
Patients on protease inhibitors:
- Beclomethasone, 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.
If symptoms persist despite an adequate trial of topical corticosteroids administered with the correct technique:
ADD
- Non-sedating antihistamine, oral e.g.:
- Cetirizine, oral, 10 mg daily.
For relief of nasal blockage:
- Oxymetazoline 0.05%, intranasal, administered 8 hourly for a maximum of 5 days.
Note
Rebound nasal congestion occurs with prolonged use (>5 days) of topical nasal decongestants.
Failure of the above:
ADD
- Corticosteroids (intermediate-acting) e.g.:
- Prednisone, oral, 30 mg daily for 5 days whilst continuing the topical steroid.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition