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PATIENT CARE PROCESS

Patient Care Process for the Management of Allergic Rhinitis

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Collect

  • Primary complaint(s) (e.g., sneezing, clear rhinorrhea, postnasal drip, nasal congestion, ocular or otic symptoms, pruritic nose or palate)

  • Patient characteristics (e.g., age, race, sex, pregnant)

  • Past medical history and allergy testing

  • Patient family, social history—dietary habits; presence of pets, mold, or wall-to-wall carpeting; times of year, situations, or locations (indoor or outdoor) when symptoms are worse

  • Current OTC products, prescription medications, dietary supplements; past medications or interventions used for treating rhinitis symptoms

  • Past or current use of environmental controls of potential allergens (e.g., removal of carpeting or pets, air-filtration systems)

  • Objective data (see Box 13-1)

    • Presence of allergic "shiners" (dark circles under eyes) or "salute" (crease across nose caused by constant rubbing)

    • Labs when available (e.g., IgE, serum eosinophil count)

    • Other diagnostic tests when available (e.g., allergy testing)

Assess

  • Presence of atopic disorders (e.g. asthma, atopic dermatitis) and complications of allergic rhinitis (e.g. acute otitis media, middle ear effusion, sinusitis, epistaxis)

  • Timing of symptoms – seasonal or persistent (see Figure 95-2)

  • Effectiveness for environmental controls of allergens (primarily for persistent cases)

  • Which symptoms to control (e.g. nasal congestion, clear rhinorrhea, sneezing, pruritus, ocular conjunctivitis)

  • Appropriateness and effectiveness of current regimen

Plan*

  • Nonpharmacologic interventions (e.g., allergen avoidance, nasal rinses, nasal strips; see Table 95-3)

  • Drug therapy regimen including specific agent(s), dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Table 95-2 and Figure 95-2)

  • Monitoring parameters including efficacy (e.g., bothersome symptoms), safety (e.g. drowsiness, anticholinergic effects, effects on blood pressure; medication-specific adverse effects; see Table 95-8)

  • Patient education (e.g., purpose of treatment, allergen avoidance, nonpharmacologic interventions, drug therapy; immunotherapy)

  • Self-monitoring of symptoms and adverse effects—where and how to record results

  • Referrals to other providers when appropriate (e.g., physician, allergist)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up if needed

Follow-up: Monitor and Evaluate

  • Assess patient perception of control of bothersome symptoms

  • Presence of adverse effects

  • Continued presence of physical signs of nasal and ocular pruritus

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

CONTENT UPDATE

Content Update

December 10, 2017

Guidance on Initial Pharmacotherapy of Seasonal Rhinitis: A workgroup of the Joint Task Force on Practice Parameters of the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI) provided guidance on initial drug therapy for seasonal allergic rhinitis in persons aged 12 and older. The workgroup recommended: 1) monotherapy with an intranasal corticosteroid rather than in combination with an oral antihistamine in persons aged 12 and older (strong recommendation); 2) an intranasal corticosteroid over a leukotriene receptor antagonist in persons aged 15 and older (strong recommendation); and 3) consideration of the combination of an intranasal corticosteroid and an intranasal ...

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