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Allergic Rhinitis

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Before you start a diagnosis, please read all of the information below. If you think you need urgent help then please call NHS 111, or 999 in an emergency.

Allergic rhinitis is swelling and inflammation of the lining of the nose caused by an allergy. It is a common problem affecting 1 in 5 people in the UK. Typical symptoms include sneezing, runny nose, and nasal stuffiness. An allergy is where an environmental trigger causes a reaction in the body's immune system. Common environmental triggers include irritants such as dust, house dust mites, mould, pollen, animals, grass, and trees. Other allergic symptoms include itching, skin rashes, and watery eyes.

Trigger factors for chronic rhinitis include airborne irritants and low humidity (dry air).

Risk factors include atopy (history of asthma or eczema), family history, pollution, reduced exposure to infections and exposure to cigarette smoke.

We treat simple allergies to pets, dust mite and also hay fever and can prescribe prescription only treatments including Avamys (nasal steroid spray) and Fexofenadine (anti-histamine tablet). Nasal steroids reduce the inflammation of the lining of the nose and help ease nasal symptoms. Antihistamines help to prevent the allergic reaction.

Please see the Common Treatments section below for further information.

 


Common Symptoms

  • A runny nose
  • Sneezing
  • Watery and/or itchy eyes
  • A blocked nose
  • A mild headache
Common Treatments

Possible treatments we prescribe if clinically appropriate:

  • Fexofenadine 120mg once a day: 30-day course (£1.53*)
  • Avamys Nasal Spray (120 doses) 1-2 sprays per nostril once daily (£6.44*)

These medications are only available on prescription.

Please click on the medication to read the Patient Information Leaflet for important information about each drug before selecting your treatment. 

*Prices shown are cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy. 

 

Self-help

Nasal Irrigation

Cleaning your nasal passages regularly with a salt water solution can help keep your nasal lining clear of irritants. You can buy over-the-counter saline (salt water) drops or spray from the pharmacy. You may also make a saltwater solution at home using half a teaspoon each of salt and baking powder mixed in 500ml of cooled boiled water. Hold some of the solution in your hand and breathe it into each nostril. This can be repeated as frequently as required but use a fresh solution each time. 

There are many different environmental allergens which may trigger allergies. Please see the following advice for some potential allergens:

House dust mite:

  • Use impermeable dust mite covers on mattresses and pillows.
  • Using synthetic instead of natural pillows and acrylic duvets.
  • Wash bedding at high temperatures regularly, at least weekly.
  • Keep furry toys off the bed.
  • Choose hard floors instead of carpets where possible.
  • Choose blinds instead of curtains.
  • Wash all surfaces regularly with a damp, clean cloth.

Pollen:

  • Check your local pollen count.
  • Pollen levels are usually highest between 5am-10am and on windy days.
  • Avoid grassy or heavily planted open areas.
  • Keep windows at home and in the car shut when the pollen count is high.
  • Shower and wash your hair after going out.

Information about Fexofenadine

Fexofenadine is generally a non-drowsy antihistamine; however, it may still cause drowsiness in a few people. Before you drive or use machinery, please ensure that it does not cause drowsiness and that your reactions are normal. 

You should ideally take Fexofenadine before a meal with a drink of water. Try to take the tablets at the same time each day.

Do not take indigestion remedies during the two hours before or the two hours after you take a Fexofenadine tablet. This is because indigestion remedies can reduce the absorption of Fexofenadine making it less effective.

Alcohol can increase the risk of side-effects from antihistamines.

Never give your medication to other people even if their condition appears to be the same as yours.

Possible side effects to Fexofenadine

All medications have the potential to cause side effects, but not everyone experiences them. The most common ones for Fexofenadine include:

  • feeling sick (nausea) or vomiting
  • a headache
  • tiredness or feeling dizzy.

The side effects will often improve as the body gets used to the medication. If any of them become bothersome, then speak to a pharmacist or your doctor.

Information about Avamys

Avamys is a steroid nasal spray. It is to be used once a day to each nostril. Try to use the spray at the same time each day. Please ensure that you read the manufacturer's instructions to ensure you know how to use the spray correctly and for a full list of side effects. 

Steroid nasal sprays act slowly and may take days or weeks to have maximal effect. They are effective for most of the symptoms of allergic rhinitis including a blocked nose, a runny nose, itching, and sneezing.

Nasal sprays are safe for long-term use in adults when used within the recommended dosage. 

How to use a steroid nasal spray:

  • Shake the bottle and blow your nose.
  • Tilt your head forward.
  • Hold the spray bottle angled straight up then insert the tip of the spray bottle just inside one nostril. Close the other nostril with your other hand, and apply one or two sprays as prescribed.
  • Breathe in gently as you spray (avoid sniffing forcefully as the medication will end up in the throat instead of the nose).
  • Repeat in the other nostril.

If your nose is very blocked and the spray does not get through the mucous to work, then a nasal decongestant spray may be useful at immediately clearing the nose. Once your nose feels clear, then Avamys may be used. Please check with the pharmacist with regards to the suitability of nasal decongestants for you, and do not use them for more than five days.

Once your symptoms have settled, you may still need to use the steroid spray to stop the symptoms returning. 

Never give your medication to other people even if their condition appears to be the same as yours.

Possible side effects to Avamys

Along with their useful effects, most medicines can cause side-effects but not everyone experiences them.

Steroid nasal sprays rarely cause side-effects. Since the steroid spray is applied directly to the nose, very little of the steroid is absorbed into the body. However, occasionally side effects can occur. This will include nasal dryness, crusting or slight bleeding may occur. If these symptoms become recurrent or persistent, then treatment may need to be stopped. Please discuss this with a doctor or pharmacist.

Systemic side effects (affecting the rest of your body)

Systemic effects of nasal steroids may occur, particularly at high doses prescribed for longer periods. These effects are much less likely to occur than with oral steroids and may vary between different people. 

Possible systemic effects may include Cushing's syndrome, Cushingoid features, adrenal suppression, cataract, glaucoma and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression. 

Visual disturbance

Tell your doctor or call NHS 111 and stop the nasal spray immediately if you notice any blurred vision or other problems with your vision.

There is a rare risk of Central Serous Chorioretinopathy (CSCR) which is where fluid builds up underneath the retina and can lead to retinal detachment. It tends to affect one eye.

Patients on ritonavir

Should not use Avamys due to an increased risk of systemic side effects.

Allergic reactions to medications

All medications can cause allergic reactions, however, serious allergic reactions are rare. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop any of the following symptoms, then you must STOP the medication and seek medical advice immediately (from your GP, Out of Hours Service, Urgent care centre, NHS 111). Call an ambulance or go to A&E if the symptoms are severe:-

  • Wheeze
  • Difficulty in Breathing
  • Swelling of the eyelids, face or lips or throat
  • A rash particularly if affecting your entire body
  • Severe skin reactions, including large fluid-filled blisters, sores and ulcers
  • Chest pain
  • Fainting or collapse
When to seek further medical advice

Most people improve within a few days of starting treatment.

If your symptoms are worsening or not improving, then you are advised to see a doctor or speak to a pharmacist. 

If you develop symptoms of nasal pain, blockage or bleeding affecting just one side of your nose, then you should see a doctor for a physical assessment. This is to rule out any underlying complications. 

Help finding NHS services near you

In an emergency call 999 for immediate help for life-threatening conditions.

During working hours you can contact your GP surgery for help or call NHS 111. Alternatively, the following links can help you find Urgent Care Centres or Out of Hours care near you:


England 

Website: NHS Choices or telephone NHS 111


Wales

Website: NHS Direct Wales or telephone NHS Direct Wales on 0845 46 47 or the new 111 Wales Service for Swansea Neath Bridgend & Carmarthen


Scotland

Website: NHS Inform  or call NHS 111


Northern Ireland

Website: Health and Social Care

The contact telephone numbers for out of hours GP services in your area can be found here: NI Direct Government Services

Complications of allergic rhinitis

Complications of allergic rhinitis include:

  • poor quality of life
  • poor asthma control
  • sinus infection
  • nasal polyps
  • chronic middle ear infection (otitis media)

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