1. 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

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

3. 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

4. Symptoms Rhinorrhoea Nasal congestion Nasal itching Eye symptoms
Sneezing

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

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

7. 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

8. 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.

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

10. 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

11. 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

12. Practical points
Diabetes
Mouthwashes and gargles