Home' Australian Pharmacist : June 2011 Contents Vol. 30 -- June #06
Continuing Professional Development
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If it appears likely that she has
allergic rhinitis, and her symptoms
are mild and intermittent, an oral
or intranasal antihistamine may be
recommended to be used when
required. If her symptoms are severe
or persistent (see Table 1) and she has
no contraindications to corticosteroids
she could be given a two-week trial
of an intranasal corticosteroid, with
counselling on the correct technique
for using a nasal spray. Future
therapy or the need for referral will
be determined by her response to
the medication. A discussion on the
avoidance of trigger factors may also
Key learning points
• The prevalence of allergic rhinitis in
Australia has almost doubled over
the past 10--15 years and it often
co-exists with asthma. It can have
a significant impact on a person's
quality of life, leading to reduced
participation in social activities,
impaired learning and behavioural
problems in children, and reduced
productivity and increased absences
from work in adults.
• The classic symptoms of allergic
rhinitis include rhinorrhoea, nasal
congestion, sneezing, and itching
of the nose, throat and eyes.
1. A man has had symptoms of
allergic rhinitis, which have
caused him to have difficulty
sleeping on an average of
three days a week for the past
four weeks. In which category
would his allergic rhinitis be
classified according to the
a) Mild intermittent.
b) Mild persistent.
c) Moderate to severe intermittent.
d) Moderate to severe persistent.
2. Which of the following would
be the MOST APPROPRIATE
initial treatment for a woman
suffering from moderate
to severe intermittent
a) An oral corticosteroid.
b) Ipratropium nasal spray.
c) An intranasal decongestant.
d) An intranasal corticosteroid.
3. Which of the following
symptoms is the
symptom of allergic rhinitis?
b) Nasal congestion.
d) Itchy, watery eyes.
4. In a person with allergic
rhinitis, which of the following
symptoms would necessitate
referral to a doctor?
b) Itchy watery eyes.
c) Allergic shiner.
d) Postnasal drip.
5. Which of the following
statements regarding the
treatment of allergic rhinitis is
A score of 4 out of 5 attracts 1 CPD credit.
a) Sodium cromoglycate is
as effective as intranasal
corticosteroids or antihistamines
but, because it has potentially
serious adverse effects, it should
only be used when there has been
an inadequate response to these
b) Intranasal ipratropium relieves all
the symptoms of allergic rhinitis
but requires three to five days of
regular use before it takes effect.
c) Intranasal antihistamines should
be reserved for short-term use
as they can cause rebound
congestion if used for longer than
four or five days.
d) Although intranasal corticosteroids
may require up to two weeks of
use to reach maximum efficacy,
they can relieve some symptoms
within a few hours and can be
used regularly for prevention or as
required for symptom relief.
A correct diagnosis is important,
as rhinitis also has many non-
• Treatment depends on the
severity and duration of symptoms
and includes oral or intranasal
antihistamines and inhaled
corticosteroids. Avoidance of known
allergens may be helpful, but is
often difficult to achieve.
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