Search

This guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.

As a result of a previous audit on the management of sleep apnoea hypopnoea syndrome (SAHS) which showed long waiting times that were primarily due to unnecessary interspecialty referrals, a change in practice was adopted. All referrals are now sent a questionnaire about symptoms suggestive of SAHS, the Epworth Sleepiness Scale score and their body mass index (BMI) which when returned are categorized into having a high, intermediate or low risk of SAHS. Those patients with a high probability have home overnight oximetry and those with intermediate probability have video oximetry. Those with a low probability are referred directly to ENT. We audited the first 100 patients referred. All were General Practitioner referrals to either ENT or respiratory medicine. Only two patients had a low probability score and were seen directly in ENT. Following sleep study analysis, 10 patients were referred directly to ENT with no respiratory medicine follow-up and nine were discharged back to the General Practitioner with no apnoea or snoring. Eighty-one patients were followed up by respiratory medicine. Of these, 49 received a trial of nasal continuous positive airway pressure (nCPAP) and six were referred to ENT. Therefore the majority justified an investigation to exclude SAHS in the first instance and an unnecessary initial ENT appointment was avoided. We have reduced the average waiting times to sleep study by approximately 90 days and to nCPAP trial by 32 days, mostly due to decreased delays in interspeciality referrrals. We have also demonstrated a greater than 50 per cent reduction in ENT clinic visits, a small increase in the number of sleep studies but no increase in respiratory clinic workload.

From 1200 households selected at random, 2114 questionnaires were returned from individuals over 14 years old. They reported that in the previous year the prevalence of 'symptoms of nasal obstruction every day for more than 14 consecutive days' was 16.9%; 19.8% had had a 'runny nose'; 7.1% reported sneezing bouts; and 19.6% had hay fever during the same period. Also, 13.7% had had rhinosinusitis in the previous year using the criterion of 'two out of three symptoms of congestion, rhinorrhoea and sneezing for more than 1 h per day for a period in excess of 2 weeks'. The prevalence of perennial symptoms in individuals who did not have hay fever was 8.6%. Over the previous 2 years 18.2% of all respondents had visited their General Practitioner and 0.2% had visited a hospital as a result of their hay fever. Individuals who responded as having hay fever were significantly more likely to have worked in an environment with a lot of dust in the last 2 years than asymptomatic respondents (chi 2, P = 0.002), although fume exposure was not found to be a significant risk factor (P = 0.0681). Individuals with perennial symptoms were no more likely to have been working in a dusty or smoky environment. In those with either seasonal or perennial symptoms there was no significant effect of either social class or manual/non-manual occupation.