Allergic Rhinitis allergic rhinitis inflammatory response release of histamine allergens (grass pollens, tree pollens and fungal mould spores) (house dust mite, animal dander) Perennial Allergic Rhinitis Seasonal Allergic Rhinitis

Questions to be asked Age Duration… Symptoms…. Previous history Danger symptoms/associated conditions…. Medication

Duration Intermittent. Occurs less than 4 days/week or for less than 4 weeks Persistent. Occurs more than 4 days/week and for more than 4 weeks Mild. All of the following – normal sleep; normal daily activities, sport, leisure; normal work and school; symptoms not troublesome Moderate. One or more of the following – abnormal sleep; impairment of daily activities, sport, leisure; problems caused at work or school; troublesome symptoms

Symptoms Rhinorrhoea Nasal congestion Nasal itching Eye symptoms Sneezing

Danger symptoms/associated conditions Wheezing Tightness of chest with cough Earache and facial pain Purulent conjunctivitis

When to refer Wheezing and shortness of breath Tightness of chest Painful ear Painful sinuses Purulent conjunctivitis Failed medication

Management Duration, 5 days Antihistamines + Decongestants for treatment of Mild and moderate. Steroid nasal sprays (beclomethasone, budesonide , mementasone) for treatment and prophylaxis of moderate and severe. Sodium cromoglicate nose and eye drops, prophylaxis. Topical antihistamines (azelactine), prophylaxis

Sore throat Most sore throats that present in the pharmacy will be caused by viral infection (90%) only 1 in 10 being due to bacterial infection. Clinically it is almost impossible to differentiate between the two. The majority of infections are self-limiting. often associated with other symptoms of a cold. Once the pharmacist has excluded more serious conditions, an appropriate OTC medicine can be recommended.

Questions to be asked Age Duration Associated symptoms Previous history Smoking habit Present medication

Symptoms for Direct Referral Hoarseness (long lasting) Dysphagia (Difficulty in swallowing) Appearance of throat …Thrush Glandular fever Sore throat lasting 1 week or more Failed medication Recurrent bouts of infection

Management Oral analgesics Mouthwashes and sprays… Paracetamol, aspirin and ibuprofen Mouthwashes and sprays… Anti-inflammatory (e.g. benzydamine) Local anaesthetic (e.g. benzocaine) Lozenges and pastilles

Practical points Diabetes Mouthwashes and gargles