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Allergic Rhinoconjunctivitis
Diagnosis/Definition:
The presence of ocular itching, tearing, or redness and/or the presence of nasal itching, persistent rhinorrhea, nasal obstruction, or sneezing. There may be an identifiable season of the year or a particular exposure which will elicit symptoms. Symptoms should exceed 6 weeks or be present in a particular season at least 2 years in a row.
Initial Diagnosis and Management
- History should include identification of at least one of the symptoms indicated above, should be of sufficient duration or have recurred often enough to exclude transitory processes such as viral or irritant rhinitis.
- Examination should indicate the presence of inflammation or edema of nasal mucosa and/or conjunctivae.
- Mild or intermittent symptoms should be managed with a trial of a non-sedating antihistamine (Fexofenadine, Cefatrizine, or Loratadine—Loratadine is preferred due to the tremendous difference in price) with or without an oral decongestant.
- Persistent or more severe symptoms should be managed with daily use of a nasal corticosteroid spray, such as fluticasone, combined with as needed oral antihistamine use. A more sedating antihistamine (hydroxyzine, diphenhydramine, or chlorpheniramine) can be added at bedtime. Nasal cromolyn may be an effective alternative for some patients, although is less effective than corticosteroids.
- In patients with perennial rhinitis, the diagnosis of chronic sinusitis should be considered.
Ongoing Management and Objectives:
Patients should be symptom-free or have minimal symptoms with good functional capacity and lack of side effects from medications.
Indications for Specialty Care Referral
Refer to Allergy/Immunology Clinic after failure to get adequate relief of symptoms with regular use of medications after one month of continuous treatment with combined nasal corticosteroid spray and oral antihistamine use.
Inability to tolerate medications.
Complications of allergy such as asthma or sinusitis.
Administrative reasons such as flying status or personal reliability program.
Patient moving into the area already on immunotherapy.
Criteria for Return to Primary Care
Immunotherapy not required.
Completion of immunotherapy.
