An algorithm recommendation for the pharmacological management of allergic rhinitis in the UK: a consensus statement from an expert panel

Allergic rhinitis (AR) is a frequent presenting problem in primary care in the UK, and has increased in prevalence over the last 30 years. When symptomatic, patients report significant reduction in their quality of life and impairment in school and work performance. Achieving adequate symptom control is pivotal to successful AR management, and relies mostly on pharmacotherapy. While it is recognised that most mild-moderate AR symptoms can be managed successfully in primary care, important gaps in GP training in relation to AR have been identified. With the availability of new effective combination therapies, such as the novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in a single device (Dymista® 30 ; Meda), the majority of AR symptoms can be treated in the primary care setting. The primary objective of this consensus statement is to improve diagnosis and treatment of AR in primary care, and offer guidance on appropriate referral of difficult-to-treat patients into secondary care. The guidance provided herein outlines a sequential treatment pathway for AR in primary care that incorporates a considered approach to improve the management of AR symptoms and improve compliance and patient satisfaction with therapy. Adherence with this care pathway has the potential to limit the cost of providing effective AR management in the UK by avoiding unnecessary treatments and investigations, and avoiding the need for costly referrals to secondary care in the majority of AR cases. The fundamentals presented in this consensus article should apply in most healthcare settings.