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The table provides a structured overview of the approach to managing Allergic Rhinitis (AR) in primary care. It delineates a stepwise treatment protocol, ranging from initial interventions to specialist care, emphasizing both pharmacological and non-pharmacological measures. The guidance ensures a systematic progression in treatment, ensuring patient safety and therapeutic effectiveness.
| Step | Guidance | Medications & Recommendations |
|---|---|---|
| Step 1 | Moderate to severe symptoms (ARIA criteria): Begin Step 1 and Step 2 simultaneously. | ○ Nasal Douching: Saline solution (BSACI Guidance). ○ Seasonal allergic rhinitis: Allergy UK and BSACI guidance & NHS Choices. ○ Perennial (House dust mite): BSACI guidance. ○ Allergen Avoidance. |
| Step 2 | Start with an antihistamine (for dominant pruritus) or nasal corticosteroid (for dominant congestion). Info for management in pregnancy/breastfeeding: Refer to CKS. | ○ Regular long-acting non-sedating antihistamine: Consider OTC options for adults ○ Nasal corticosteroid sprays: Mometasone furoate, Beclometasone proprionate, Fluticasone propionate, Fluticasone furoate. Check BNF & BNFC for dosages & age. • 1st line antihistamines: Cetirizine or Loratadine. • 2nd line: Fexofenadine. • Nasal antihistamine: Azelastine (if oral antihistamines aren't suitable). |
| Step 3 | Trial of oral antihistamine and nasal corticosteroid from Step 2. | |
| Step 4 (Primary care/specialist initiation) | Use... |
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