Who you are:
You are in FY2 GPWho the patient is:
36 year old man has presented some concernsWhat 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