Rhinitis and rhinosinusitis: When to think allergy and what to do

Rhinitis and sinusitis are very common conditions seen in primary care. Most sufferers can be helped by accurate diagnosis and medical treatment. Simple measures include douching the nose with saline and avoiding provoking factors such as allergens and pollutants, including environmental tobacco smoke. Additionally, pharmacotherapy can be useful for allergic rhinitis, and involves topical nasal corticosteroids, antihistamines or a combination of the two intranasally. Immunotherapy is reserved for those whose symptoms remain uncontrolled despite pharmacotherapy, and who have one or two major allergens driving their disease. Rhinosinusitis, whether acute or chronic, involves impaired sinus ventilation and drainage due to inflammation, which can be eosinophilic, neutrophilic or a combination of the two. Medical treatment should be tried initially, unless the patient has orbital cellulitis or intracranial signs in which case urgent surgical attention is needed. Few patients need referral to secondary care, bu...