Management of rhinitis--the specialist's opinion

The aim of the guidelines in the International Consensus Report on the Diagnosis and Management of Rhinitis was to aid general practitioners (GPs) in the treatment of mild or moderate cases of seasonal allergic rhinitis (SAR), perennial allergic rhinitis (PAR) and non-allergic rhinitis. After the initial strategy of allergen avoidance, GPs have several medications at their disposal. For mild or occasional symptoms of SAR, an oral H1-antihistamine or topical antihistamines or chromones are advised. For moderate symptoms, a topical nasal steroid can be used with or without an oral H1-antihistamine supplemented if necessary with a topical antihistamine or chromone eyedrops. For PAR, patients should be advised on how to minimize their exposure to house-dust mite (HDM) allergens. For intermittent symptoms, an oral H1-antihistamine and an occasional oral decongestant can be used. For persistent symptoms, a topical nasal steroid is advised, possibly supplemented with an antihistamine. For non-allergic rhinitis, irritant factors should be identified and avoided if possible. Topical or oral decongestants can be used for intermittent symptoms. Topical ipratropium bromide is useful for drying up watery rhinorrhea. For moderate symptoms, either a topical nasal steroid or topical ipratropium bromide should be used. For all the conditions, if treatment proves ineffective and symptoms are severe, then a specialist referral is appropriate. Investigations are conducted to identify causative allergens. Further treatment options include immunotherapy and minimal invasive surgery. A large clinical study is ongoing to validate the guidelines and enable the development of simpler therapeutic options according to symptom severity. In the meantime, the current guidelines provide a valuable guide to both the GP and the specialist.