Questionnaire/history: Onset? Bilateral symptoms within minutes following allergen exposure? - Tree, grass or weed pollens? - House dust mites? - Animal dander? - Occupational? Sneezing? Nasal itching? Nasal discharge (rhinorrhoea)? Nasal congestion? Additional symptoms? - Postnasal drip? - Itching of the palate? - Cough? - Features suggestive of chronic nasal congestion (eg snoring, mouth breathing, halitosis)? - Eye symptoms (eg bilateral itching, redness, tearing)? Past medical history? Family history (eg atopy (asthma, eczema or allergic rhinitis)? Current medication? Drug allergies? Examination: Nasal intonation of the voice? Deviated or perforated nasal septum? Depressed or widened nasal bridge? Nasal mucosa swelling and greyish discolouration? Hypertrophic nasal turbinates? Purulent nasal discharge suggesting sinusitis? Eye involvement suggesting allergic conjunctivitis? (Note: the nasal appearance may be normal in people with allergic rhinitis) Management: Advised: - To read information 'Allergic rhinitis' at www.nhs.uk - To try nasal irrigation with saline to rinse the nasal cavity using a spray, pump, or squirt bottle, which can be purchased without prescription - Allergen avoidance techniques if specific identified causative allergen: If grass pollen allergy: - Avoid walking in grassy, open spaces, particularly during the early morning, early evening, and during mowing, when the pollen count is high - Avoid drying washing outdoors when the pollen count is high - Keep windows shut in cars and buildings - Plan holidays to avoid the pollen season, where possible - Shower or wash hair following high pollen exposure If house dust mite allergy following allergy testing: - Not fit mattresses, pillows and duvets with house dust mite impermeable covers - Use synthetic pillows and acrylic duvets, and keep furry toys off the bed - Wash all bedding and furry toys at least once a week at high temperatures - Choose wooden or hard floor surfaces instead of carpets, if possible - Fit blinds that can be wiped clean instead of curtains. Surfaces should be wiped regularly with a clean, damp cloth If mild-to-moderate intermittent or mild persistent symptoms: Antihistamine, depending on the person's age and personal preference Azelastine hydrochloride nasal spray If moderate-to-severe persistent symptoms, or initial drug treatment is ineffective: Mometasone furoate nasal spray Advised onset of action is 6–8 hours after the first dose, but the maximal effect may not be seen until after two weeks Advised to see contact own GP after 2–4 weeks if symptoms persist after initial treatment Reference(s): NICE CKS: Allergic rhinitis Information for patient/carer(s): NHS Health A to Z: Allergic rhinitis