From the Guidelines
The British Society for Allergy and Clinical Immunology (BSACI) guidelines for allergies recommend a structured approach to allergy management, prioritizing patient history and physical examination for diagnosis, and a stepwise treatment approach for allergic rhinitis, starting with non-sedating antihistamines and progressing to intranasal corticosteroids if symptoms persist, as supported by the guidelines outlined in 1 and 1.
Key Recommendations
- Diagnosis: Clinicians should make a clinical diagnosis of allergic rhinitis based on patient history and physical examination, considering symptoms such as nasal congestion, runny nose, itchy nose, or sneezing, as stated in 1.
- Treatment: A stepwise approach is recommended for allergic rhinitis, starting with non-sedating antihistamines like cetirizine (10mg daily) or loratadine (10mg daily), and progressing to intranasal corticosteroids like fluticasone (2 sprays per nostril daily) if symptoms persist, as outlined in 1 and supported by 1.
- Allergy Testing: Clinicians should perform and interpret, or refer to a clinician who can perform and interpret, specific IgE (skin or blood) allergy testing for patients with a clinical diagnosis of allergic rhinitis who do not respond to empiric treatment, or when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy, as recommended in 1 and 1.
- Immunotherapy: Clinicians should offer, or refer to a clinician who can offer, immunotherapy (sublingual or subcutaneous) for patients with allergic rhinitis who have inadequate response to pharmacologic therapy with or without environmental controls, as stated in 1 and supported by 1, 1, and 1.
Considerations
- Patient preferences and quality of life should be considered when deciding on treatment options, as emphasized in 1 and 1.
- Coexisting medical conditions, such as asthma, should be taken into account when managing allergic rhinitis, as noted in 1 and 1.
- Regular follow-up and adjustment of treatment based on symptom control are essential, as highlighted in 1 and 1.
From the Research
BSACI Allergy Guidelines
The British Society for Allergy and Clinical Immunology (BSACI) has published several guidelines for the management of allergic and non-allergic rhinitis. The key points from these guidelines are:
- The management of allergic rhinitis includes allergen avoidance, pharmacotherapy, and immunotherapy 2
- Topical nasal corticosteroids are the treatment of choice for moderate to severe allergic rhinitis 2, 3
- Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy 3
- Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms 3
Diagnosis and Management
The diagnosis of allergic and non-allergic rhinitis is based on history and examination, supported by specific allergy tests 3. The management of rhinitis is associated with benefits for asthma 3. The guidelines also recommend a stepwise approach to treatment, and highlight the relevance of less frequently prescribed treatments, including nasal douching, leukotriene receptor antagonists, and anticholinergics 4.
Special Considerations
The guidelines also include special sections for children, co-morbid associations, and pregnancy 5. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidosis 3. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi, and protozoa 3.
Treatment Options
The treatment options for allergic and non-allergic rhinitis include: