  Review
At each review, check adherence to medications
and inhaler technique, as for asthma.
Inspect nasal mucosa at least twice per year to
check for mucosal atrophy and monitor resolution of
polyps. Refer to an ENT surgeon if a polyp is
unresponsive to initial INCS therapy.43
Offer referral to an allergy specialist if:43
-
symptoms are persistent, severe
or unresponsive
-
the patient is contemplating
expensive or significant life-changing measures
(e.g. moving house, changing jobs) due to
allergic rhinitis
-
the diagnosis is uncertain.
Key messages
-
Effective management of
concurrent asthma and allergic rhinitis
requires a combined approach.
-
Intranasal
corticosteroids are the most effective
available treatments for allergic and
non-allergic rhinitis.
-
Patients with allergic
rhinitis severe enough to impair
activities or worsen asthma control will
require long-term pre-emptive intranasal
corticosteroids with careful attention
to inhalation technique, just as for
ICS.
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