By vgreene, 14 April, 2017 Consider comorbid conditions that may respond to surgical tx: severe septal deviation, inferior turbinate hypertrophy, adenoid hypertrophy39-41
By vgreene, 14 April, 2017 Consider DDx: nonallergic rhinitis (eg, vasomotor, infectious, pregnancy/hormonal, drug-induced), mimics (eg, nasal polyps, septal deformity, adenoid hypertrophy)32,33
By vgreene, 14 April, 2017 Consider referral to allergist/immunologist for allergen immunotherapy to identify/manage allergens in complex cases (eg, poor control, med side effects, comorbid dz)38
By vgreene, 14 April, 2017 Offer immunotherapy to pts w/ confirmed IgE to relevant allergen, not responding to med tx + environmental control/avoidance (or avoidance unfeasible), or undesirable burden of meds (side effects, cost)34-37
By vgreene, 14 April, 2017 Avoid irritant triggers (eg, smoke, chemical fumes, temp change, perfumes),28,29 occupational triggers (allergic or irritant)30,31
By vgreene, 14 April, 2017 Avoidance of animals effective for animal allergy;19-22 highly pollen-allergic pts should stay indoors during high pollen counts;23 benefit of other environmental measures uncertain24-27
By vgreene, 14 April, 2017 ✓ technique. Consider combo tx, trigger avoidance, immunotherapy referral, surgical tx for comorbid conditions
By vgreene, 14 April, 2017 Complementary: WHO-ARIA advises against acupuncture,17 while AAO says it may be offered.18 Don’t use homeopathy, butterbur/other herbs, phototherapy, or other complementary tx17,18
By vgreene, 14 April, 2017 If severe allergic rhinitis/conjunctivitis:14-16 Oral steroids (not parenteral) may be used x5-10 days
By vgreene, 14 April, 2017 If ocular sx/allergic conjunctivitis: may require ophthalmic med; dual-action antihistamine/mast-cell stabilizers (azelastine, epinastine, ketotifen, olopatadine) most effective12,13
