Synopsis
Distinguish allergic inflammation from irritant and medicine related nasal symptoms, select proportionate treatment, and recognise obstruction that requires investigation.
- Itch, repeated sneezing, watery rhinorrhoea and itchy eyes linked to exposure favour allergic rhinitis.
- Smoke, perfume, temperature change, spicy food and medicines can provoke non-allergic symptoms; mixed disease is common.
- Ask about sleep, concentration, work exposure and asthma control rather than judging severity by nasal discharge alone.
Key red flags
Persistent unilateral bloody discharge or obstruction requires prompt examination and urgent ENT assessment for structural disease or malignancy.
Investigation priorities
Establish the working diagnosis before requesting allergy investigations.
Management branches
Bilateral allergic symptoms cause persistent discomfort or impair daily activities.
- Agree practical trigger reduction and explain that perfect allergen avoidance is often unrealistic.
- Use a regularly administered intranasal corticosteroid for moderate or severe symptoms, demonstrating technique before prescribing escalation.
Key medicines
Mometasone furoate 50 micrograms per spray, NasonexFor allergic rhinitis, administer two sprays into each nostril once daily, giving 200 micrograms daily. Once controlled, reduce to one spray per nostril daily. The prescription product permits up to four sprays per nostril once daily if necessary, with subsequent reduction; reassess response and use the lowest effective maintenance dose.
Azelastine and fluticasone propionate nasal spray, DymistaFor adults and adolescents aged 12 years or over, administer one spray into each nostril twice daily. Use regularly during the period of allergen exposure, then review ongoing need and control.