Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Allergic Rhinitis 95

follow-up

During Treatment

■Assess response to therapy & review/reinforce avoidance measures

w/in 1 month of initial visit

Routine

■Review symptoms & response to meds during pollen season & at

least yearly thereafter

complications & prognosis

Complications

■Sinusitis: common. Treatment: mucolytic agents, decongestants,

saline lavage; amoxicillin±clavulanate for 3-wk course for refrac-

tory cases

■Asthma: Assess w/ office spirometry & treat w/ inhaled beta-agonist

& inhaled or systemic steroids as warranted

■Otitis media: Amoxicillin±clavulanate for 10-day course

■Snoring/sleep disruption/apnea: during pollen season in 10–30% of

pts. Treat underlying inflammation; add decongestants

■Nasal polyps: obstructive symptoms. May require polypectomy if

unresponsive to prednisone

Prognosis

■About 80% of pts improve w/ avoidance measures & medical therapy

■Complications generally improve w/ treatment of allergic rhinitis

■Nasal polyps recur in 40% of pts after polypectomy

■Pts not responding to medical management & avoidance measures

may benefit from immunotherapy.

■Indications include:

➣Severe & prolonged seasonal or perennial allergic rhinitis

➣Symptoms unresponsive to meds

➣Intolerance of or inability to take meds

➣Unavoidable allergens

Contraindications to immunotherapy

➣Severe or poorly controlled asthma

➣Compromised lung function

➣Poorly controlled hypertension

➣Coronary artery disease

➣Use of beta-blockers (topical or systemic)