Clinical Conversations: Allergic and Non-Allergic Rhinitis – A Practical Approach for GPs | Part two

Dr Jessica Tattersall

writer

Dr Jessica Tattersall

Allergist and Medical Rhinologist, Sydney Allergy Clinic

Claim CPD for this activity

Educational Activities (EA)

0 hours

These are activities that expand general practice knowledge, skills and attitudes, related to your scope of practice.

Reviewing Performance (RP)

0 hours

These are activities that require reflection on feedback about your work.

Measuring Outcomes (MO)

0 hours

These are activities that use your work data to ensure quality results.

EA
0 minutes

These are activities that expand general practice knowledge, skills and attitudes, related to your scope of practice.

RP
0 minutes

These are activities that require reflection on feedback about your work.

MO
0 minutes

These are activities that use your work data to ensure quality results.

 

Allergic and non-allergic rhinitis are extremely common and distressing conditions. Dr Jessica Tattersall discusses the importance of history in order to differentiate between the two and to maximise improvement. She also discusses the co-morbidities and updated management options. This is part two, the final part of this article.

This is part two of this series. Listen to Part 1 >>

Practice points

• Inflammatory types of rhinitis can be a Type 2 hypersensitivity response without being IgE-mediated. These types will respond well to steroids, especially combined with topical antihistamines. The triggers are similar to non-allergic rhinitis, plus smoke and occupational aspects.
• It is important to find out if there is a preventable cause in chronic non-inflammatory rhinitis, but it is still most likely idiopathic. Common triggers include things like perfume, hairspray, cosmetics, antiperspirants, deodorants, any kind of aerosols, cleaning products, soaps, powders, candles, incense, scented flowers, paints and solvents.
• In occupational triggers, the inflammatory as well as non-inflammatory causes often occur together “mixed rhinitis”. There often with this condition a history of allergic rhinitis that has been worsened by the onset of non-allergic rhinitis, roughly about the age of thirty to thirty-five years.
• Senile rhinitis (patients over seventy years of age) is a non-inflammatory rhinitis. Patients have no other symptoms apart from a profuse runny nose and ipratropium bromide, works brilliantly.
• Gustatory rhinitis is non-inflammatory and occurs only when eating spicy or other precipitating foods, is not associated with blockage, sneeze or itch and ipratropium bromide works well.
• Far too much importance is put on the positive blood test or skin prick test in rhinitis, because the positive test does not equate to having the allergy; there must be a cause and effect and so the history is most important.
• It doesn’t matter if the rhinitis is more allergic or more non-allergic, because the corticosteroid, especially combined with an antihistamine, works well for both.
• For non-allergic rhinitis refractory to corticosteroids, our clinic uses capsaicin spray four to five times a day, at least twenty minutes apart, until the burning sensation ceases. That can take five days up to two weeks, then it is used periodically as maintenance. Warn the patient that is stings.

PASSWORD RESET

Forgot your password or password not working? Please enter your email address. You will receive an email with the link to set a new password.

Icon 2

NEXT LIVE Webcast

:
Days
:
Hours
:
Minutes
Seconds
Dr Jo-Ann See

Dr Jo-Ann See

Management of Acne in Teens

Dr Robert Hungerford

Dr Robert Hungerford

An Update on Heart Failure in General Practice

A/Prof Daryl Cheng

A/Prof Daryl Cheng

Invasive Pneumococcal Disease – What GPs Need to Know

A/Prof Yvonne Zissiadis

A/Prof Yvonne Zissiadis

Innovations in Breast Radiation

Join us for the next free webcast for GPs and healthcare professionals

High quality lectures delivered by leading independent experts

Once you confirm you’ve read this article you can complete a Patient Case Review to earn 0.5 hours CPD in the Reviewing Performance (RP) category.

Select ‘Confirm & learn‘ when you have read this article in its entirety and you will be taken to begin your Patient Case Review.

I invite you to join the upcoming Healthed webcast where I will update clinicians on the current recommendations for vaccination against Strep.pneumoniae - the vaccines available, which vaccine, when and for whom, which vaccines are funded and special groups to consider.

Tuesday 5th August, 7pm AEST