From the Guidelines
The most appropriate referral for a 14-year-old girl with significant seasonal allergy symptoms who has failed over-the-counter medications would be to an allergist or immunologist. This recommendation is based on the strongest and most recent evidence from the 2017 joint task force on practice parameters, which suggests that patients with moderate to severe seasonal allergic rhinitis may benefit from specific allergen immunotherapy, a disease-modifying therapeutic method 1.
Key Considerations
- The patient's age and failure of over-the-counter medications justify a referral to a specialist for comprehensive allergy testing and development of a tailored treatment plan.
- An allergist or immunologist can provide education on environmental control measures to reduce allergen exposure and monitor for potential complications like asthma.
- The specialist can consider prescription-strength medications, such as intranasal corticosteroids, which are recommended as initial treatment for seasonal allergic rhinitis in persons aged 12 years or older 1.
Treatment Options
- Intranasal corticosteroids, such as fluticasone propionate, may be prescribed as monotherapy for initial treatment of seasonal allergic rhinitis 1.
- For moderate to severe cases, the combination of an intranasal corticosteroid and an intranasal antihistamine may be recommended for initial treatment 1.
- Allergen immunotherapy, which is the only disease-modifying therapeutic method, may be considered for patients with moderate to severe seasonal allergic rhinitis 1.
From the FDA Drug Label
Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: Seasonal or perennial allergic rhinitis The most appropriate referral for a 14-year-old girl with significant seasonal allergy symptoms who has failed over-the-counter medication’s is to consider corticosteroid (IN) therapy, as indicated in the drug label for seasonal allergic rhinitis 2.
- Key points:
- The patient has failed over-the-counter medications.
- Corticosteroid (IN) is indicated for severe or incapacitating allergic conditions.
- Seasonal allergic rhinitis is a condition listed in the drug label.
From the Research
Referral Options for Seasonal Allergy Symptoms
The most appropriate referral for a 14-year-old girl with significant seasonal allergy symptoms who has failed over-the-counter medications may involve a combination of the following:
- Consultation with an allergist or immunologist to discuss further treatment options, such as immunotherapy 3
- Referral to a primary care physician or an ear, nose, and throat specialist for re-evaluation and consideration of prescription medications, including intranasal corticosteroids and antihistamines 4, 5, 6
- Discussion of lifestyle modifications and avoidance of allergens to help manage symptoms 4, 7
Treatment Considerations
Treatment options for seasonal allergy symptoms may include:
- Intranasal corticosteroids, which have been shown to be effective in improving nasal and ocular symptoms 5
- Antihistamines, which can be used in combination with intranasal corticosteroids for added efficacy 5, 6
- Immunotherapy, which may be considered for patients with severe or persistent symptoms 3
- Combination therapies, such as azelastine-fluticasone, which have been shown to be effective in improving symptoms and quality of life 5
Monitoring and Management
Tools such as visual analogue scales and mobile applications may be used to facilitate monitoring and management of rhinitis, optimizing care and improving patient self-management 4