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.