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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Seasonal Allergic Rhinitis

Seasonal Allergic Rhinitis or Hayfever is a common condition that may affect up to 10% of the population between May and August. Treatment is based upon use of oral antihistamines and nasal corticosteroids.

Prodigy categorises symptoms as follows:

  • Mild intermittent
  • Mild persistent or moderate-severe intermittent
  • Moderate-severe persistent

Treatment selection can be based upon the severity of symptoms and patient preference for oral or topical treatment. Prodigy and the MeReC Bulletin titled Common questions about hay fever (2004) recommend that:

  • Mild intermittent symptoms are treated with oral antihistamines
  • Mild persistent or moderate-severe intermittent are treated with oral antihistamines or intranasal corticosteroids
  • Moderate-severe persistent are treated with intranasal corticosteroids

A previous MeReC Bulletin titled Treatment of seasonal allergic rhinitis (hay fever) (1998) stated "There is no difference in efficacy between the individual nasal steroids". Similarly, Clinical Evidence can find no evidence to support preferential use of any individual oral antihistamine.

Based upon the above the main consideration becomes cost-effectiveness of individual treatments. Cetirizine and Loratadine are half the price of other drugs in the class including desloratadine, fexofenadine, levocetirizine and mizolastine.

Intranasal corticosteroids can vary four-fold in cost depending upon the dose used. It would seem sensible to use the lowest effective dose for the shortest duration to minimise adverse effects. Beclometasone and Budesonide 100mcg nasal sprays 25-50% less expensive than alternative product depending upon the dose used.

Action: Depending upon the severity of symptoms, patients with seasonal allergic rhinitis should be offered first line treatment with Cetirizine or Loratadine where an oral antihistamine is indicated and Beclometasone or Budesonide 100mcg where an intranasal corticosteroid is indicated.

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