title: An algorithm recommendation for the pharmacological management of allergic rhinitis in the UK: a consensus statement from an expert panel.
abstract: Allergic rhinitis is a frequent presenting problem in primary care in the UK, and has increased in prevalence over the last 30 years. When symptomatic, patients report significant reduction in their quality of life and impairment in school and work performance. Achieving adequate symptom control is pivotal to successful allergic rhinitis management, and relies mostly on pharmacotherapy. While it is recognised that most mild-moderate allergic rhinitis symptoms can be managed successfully in primary care, important gaps in general practitioner training in relation to allergic rhinitis have been identified. With the availability of new effective combination therapies, such as the novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in a single device (Dymista®; Meda), the majority of allergic rhinitis symptoms can be treated in the primary care setting. The primary objective of this consensus statement is to improve diagnosis and treatment of allergic rhinitis in primary care, and offer guidance on appropriate referral of difficult-to-treat patients into secondary care. The guidance provided herein outlines a sequential treatment pathway for allergic rhinitis in primary care that incorporates a considered approach to improve the management of allergic rhinitis symptoms and improve compliance and patient satisfaction with therapy. Adherence with this care pathway has the potential to limit the cost of providing effective allergic rhinitis management in the UK by avoiding unnecessary treatments and investigations, and avoiding the need for costly referrals to secondary care in the majority of allergic rhinitis cases. The fundamentals presented in this consensus article should apply in most health-care settings.
authors.affiliation: Ninewells Hospital and Medical School, Scottish Centre for Respiratory Research, Dundee, Scotland, UK. b.j.lipworth@dundee.ac.uk.
authors.forename: Brian
authors.initials: B
authors.lastname: Lipworth
authors.affiliation: Forth Valley Royal Hospital, Forth Valley Health Board, Larbert, Scotland, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Newton
authors.affiliation: Aberdeen Royal Infirmary, Grampian Health Board, Aberdeen, Scotland, UK.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Ram
authors.affiliation: Peterhead Surgery, Grampian Health Board, Peterhead, Scotland, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Small
authors.affiliation: Child Life and Health, The University of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schwarze
mesh_terms: D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000465:Algorithms; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D000068298:Fluticasone / Q000627:therapeutic use; D006633:Histamine Antagonists / Q000627:therapeutic use*; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D010793:Phthalazines / Q000627:therapeutic use; D065631:Rhinitis, Allergic / Q000188:drug therapy*; D006113:United Kingdom
chemical_list: D000305:Adrenal Cortex Hormones; D018926:Anti-Allergic Agents; D004338:Drug Combinations; D006633:Histamine Antagonists; D020024:Leukotriene Antagonists; D010793:Phthalazines; D000068298:Fluticasone; C020976:azelastine