Hay Fever (Seasonal Allergic Rhinitis)

Definition: allergic rhinitis can be either intermittent (lasting for <4 d per week or <4 weeks) or persistent (lasting for >4 d per week or >4 wks).

Suggested management steps

• Patient education

• Allergen avoidance (if possible)

Mild cases:

• Less-sedating antihistamines:

  • – fexofenadine 60 mg (o) bd/120 mg (o) single dose, or desloratadine 5 mg (o)/d or cetirizine 10 mg (o)/d, or loratadine 10 mg (o)/d, or

  • – levocabastine nasal spray ±

• decongestant, e.g. pseudoephedrine, phenylephrine

Moderate to severe cases:

• intranasal corticosteroids (the most effective). Select from:

  • – beclomethasone dipropionate 100 mcg per nostril bd

  • – budesonide 128 mcg per nostril daily

  • – ciclesonide 2 sprays per nostril daily

  • – mometasone furoate 2 sprays per nostril daily

  • – fluticasone furoate 2 sprays per nostril daily

  • – fluticasone proprionate 2 sprays per nostril daily

  • – triamcinolone 2 sprays per nostril daily

• prednisolone 25 mg (o)/d, reducing over 10 d if others ineffective

Use sodium cromoglycate (Opticrom) drops for eye irritation. Can use oral corticosteroids if topicals ineffective. Consider intranasal antihistamines (e.g. levocabastine) to relieve excessive itching and sneezing. Consider immunotherapy if applicable and leukotriene receptor antagonist if concurrent asthma. Be vigilant with thunderstorm asthma—treat prophylactically.