Patient handout

Allergic rhinitis (seasonal + perennial)

PRODUCTION

1. Your condition

This handout is for allergic rhinitis (seasonal + perennial). Your care team identified this based on: rhinorrhoea, nasal congestion, sneezing, nasal or ocular itch — ige-mediated ar (aria 2016 pmid 28602936).

Other reasons your team may use this plan: seasonal allergen-driven pattern (pollens) or perennial pattern (dust mite, animal dander, mould) — aria classification entry; recurrent otitis with effusion in children or co-existing asthma — atopic-march comorbidity surveillance; inadequate control on otc oral h1 alone — step-up entry to prescription incs or combination.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
cetirizine	10 mg PO (adult); 2.5-10 mg PO peds by weight	PO	once daily PRN	ARIA 2016 (PMID 28602936) + JTF 2017 (PMID 29181536) — second-gen H1 for mild intermittent AR; non-sedating, no anticholinergic burden.
loratadine	10 mg PO (adult); peds by weight	PO	once daily PRN	ARIA 2016 (PMID 28602936) — alternative second-gen H1; preferred in pregnancy among second-gen.
fexofenadine	180 mg PO (adult); peds 30-60 mg	PO	once daily PRN	ARIA 2016 (PMID 28602936) — alternative second-gen H1; consistently least-sedating in head-to-head data.
saline_nasal_irrigation	—	—	—	ICAR-AR 2018 (PMID 29438602) — low-volume isotonic saline reduces symptoms and improves clearance; adjunct to pharmacotherapy.
trigger_avoidance_and_environmental_control	—	—	—	ICAR-AR 2018 (PMID 29438602) — dust-mite covers + HEPA + pollen-window-closure are adjunctive; single-intervention monotherapy is rarely sufficient.

Plan: Allergic rhinitis — ARIA/JTF stepwise INCS-anchored pharmacotherapy with allergen immunotherapy for disease modification

3. When to call your provider

Contact your care team if any of the following happen:

Red-flag features (unilateral, blood, vision, orbital pain, CSF leak) -> route to ENT or CSF-rhinorrhoea workup
Persistent symptoms despite optimised step 3 -> allergist referral for immunotherapy / biologic
CRSwNP suspicion -> ent.chronic-rhinosinusitis.core.v1 for nasal endoscopy + CT sinus + dupilumab consideration

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Unilateral discharge, blood in nasal discharge, vision change, orbital pain, anosmia, or watery clear discharge post-trauma
New or worsening depression / suicidal ideation / behaviour change in patient on montelukast

5. Follow-up

Annual review for symptom control + INCS technique + comorbidity update + immunotherapy progress. Persistent symptoms despite optimised step 3 OR new asthma/eczema → re-examine diagnosis (CRSwNP, AERD) and consider biologic / specialist referral.

6. Sources

Guideline: ARIA 2016 revision (Brożek JL et al, J Allergy Clin Immunol 2017-06; PMID 28602936); ICAR-AR 2018 (Wise SK et al, Int Forum Allergy Rhinol 2018-02; full PMID 29438602, exec PMID 29438600); JTF 2017 practice parameter (Wallace DV, Dykewicz MS et al, Ann Intern Med 2017-11; PMID 29181536)