Allergic Rhinitis – GP Presentation
Section 1: Data Gathering
■ Presenting Complaint
• 40-year-old man (Jack Smith).
• Sneezing and runny nose.
■ Exploring Symptoms (ODIPARA)
• When did the symptoms first start?
• Are they continuous or seasonal?
• How severe is the runny nose/sneezing?
• Getting worse, better, or fluctuating?
• Any itchy eyes, nasal congestion, loss of smell, post-nasal drip, cough, asthma symptoms, eczema?
• Worse outdoors, around dust/pets/pollen? Do antihistamines help?
■ Red Flags & Differentials
• Any nosebleeds or blood-stained discharge? (rule out nasal pathology)
• Any unilateral blockage or persistent discharge? (rule out polyp or malignancy)
• Any facial pain/pressure with fever? (sinusitis)
• Any history of asthma, eczema, or food allergies? (atopy link)
■ General History (MAFTOSA)
• - Explore PMH, allergies, family history, occupation, lifestyle, medications.
■ Psychosocial Impact & ICE
• - Explore patient’s ideas, concerns, expectations, and how symptoms affect life.
Section 2: Examination & Investigations
Examination:
• Nasal mucosa: swollen, pale, boggy mucosa typical of allergic rhinitis.
• Check for nasal polyps.
• Conjunctiva: red, watery, itchy.
• Throat: post-nasal drip.
• Chest: wheeze if coexisting asthma.
Investigations:
• Usually clinical diagnosis.
• Allergy testing (skin prick or RAST) if unclear or severe.
• Consider sinus imaging only if suspicion of sinusitis/polyps.
Section 3: Diagnosis & Explanation
“Allergic rhinitis happens when your nose lining reacts to things like pollen, dust, or pet dander. Hay
fever is a type of allergic rhinitis that happens seasonally with pollen, but allergic rhinitis can also be all
year round if caused by dust or pets.”
Section 4: Management Plan (GP Setting)
■ Conservative Measures
• Allergen avoidance: close windows in pollen season, shower after being outdoors, use
allergen-proof bedding, avoid pets if sensitive.
• Saline nasal irrigation to reduce congestion.
■ Medical / Surgical Treatment
• Antihistamines (oral or intranasal) as first-line.
• Intranasal corticosteroid spray (e.g. fluticasone) for persistent symptoms.
• Nasal decongestants short-term only.
• Leukotriene receptor antagonists if coexisting asthma.
• Refer to ENT if severe polyps or refractory symptoms.
■ Addressing Patient Questions
• Difference between allergic rhinitis and hay fever? Allergic rhinitis is the general term. Hay fever is
seasonal allergic rhinitis triggered by pollen, while allergic rhinitis can also be due to dust mites,
pets, or mould.
• Is it dangerous? No, but it can affect quality of life.
• Can it be cured? No, but symptoms can be controlled with treatment and lifestyle changes.
■ Safety Netting
• Seek urgent care if sudden swelling of lips/tongue, breathing difficulty (anaphylaxis).
• Return if symptoms persist despite treatment.
■ Follow-Up
• GP review after 4–6 weeks if not controlled.
• Possible referral to allergy clinic if severe/refractory.
■ Patient Information
• NHS leaflet: ‘Allergic Rhinitis and Hay Fever’.
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