Allergic Rhinitis

Casebank History
1

Who you are:
You are in FY2 GP

Who the patient is:
36 year old man has presented some concerns

What you must do:
Talk to the patient and address the concern

Patient information

  • He has been sneezing for 6 weeks.
  • 6 weeks ago you bought a cat.
  • symptoms worse when at home.
  • Whenever you go out, symptoms get better.
  • Allergic to penicillin and you get rashes when you take penicillin

Approach

  • GRIPS
  • History of sneezing
  • DD’s
    • Flu
    • Allergic rhinitis
  • Sinusitis
  • PMFATOSA: Family Hx Asthma
  • ICE
  • Effects of symptoms
  • Summarize

Typical symptoms of allergic rhinitis

  • Sneezing
  • Nasal itching
  • Nasal discharge
  • Nasal congestion
  • Symptoms develop within a minute exposure
  • There may be associated symptoms such as bilateral eye itchiness redness and tearing
  • Personal or family history of atopy (asthma eczema
    allergic rhinitis)
  • Symptoms occur following exposure
  • Causative allergen could be tree pollens : intermittent or chronic symptoms occurs seasonal e.g during spring or summer or autumn
  • House dust mites
  • Animal danger

Examination

  • Ear, nose and throat examination
  • Eye examination
  • Examination findings: Redness of nasal mucosa

Management

  • Advice to use nasal irrigation with saline using spray or pump, can buy (over the counter)
  • Advice to avoid triggers e.g avoid pets (give away or sell the pets)
  • Offer intranasal antihistamine e.g. azelastine
  • To come for review in 2 to 4 weeks if symptoms persist
  • Offer a leaflet