Rhinitis Right Care

Following the launch of Asthma Right Care and COPD Right Care, we are excited to announce our new change programme: Rhinitis Right Care. 

Rhinitis including allergic rhinitis and non-allergic rhinitis is a very common (allergic rhinitis affects 10–40% of the population) and bothersome problem, affecting school and work performance and quality of life and therefore many people seek help from pharmacies and general practice. However, gaps in primary care knowledge and guidance can affect the quality of care, leading to poor outcomes and inefficient use of resources. With the current shortage of secondary care specialists it is particularly important to extend primary care confidence.  Our goal is to describe what good quality care looks like, as we have done for asthma and COPD, and offer support to improve primary care competence and confidence to diagnose and manage these conditions, using teaching, leadership and social movements.

We start with hunches about the problems that we need to address:

  • Under-diagnosis of rhinitis, leading to ineffective and wasteful use of medication designed for allergic rhinitis for people with non-allergic rhinitis
  • Overuse of first-generation antihistamines which are sedative and can lead to car and work accidents and also Parkinsonism symptoms
  • Overuse of unnecessary antibiotics, increasing risk of antimicrobial resistance
  • Overuse of topical decongestants (more than five days) which can cause intolerance and rebound problems and therefore long term harm
  • Underuse of allergic rhinitis medication during the respective season (i.e. not using daily) leading to unnecessary symptoms
  • Over-purchase and use of combinations of medicines where they add no additional value causing personal cost and waste
  • Misuse of effective medication such as nasal steroids eg harming the septum, and also therefore not getting the medicine into the nose
  • Waste of personal finance by the purchase of heavily advertised but unnecessary and poorly-evidenced prevention measures such as pillows, blankets, and air cleaning devices
  • Underuse of simple and effective prevention measures for rhinitis and allergic rhinitis such as closing windows; personal barriers such as sunglasses; avoiding line drying of washing which introduces pollen spores into the home when bringing in the washing; nasal irrigation,;blowing your nose properly; car filters.

Solutions

Rhinitis Right Care will address learning needs to improve the diagnosis and management of patients with respiratory allergy, addressing both competence and confidence using our Right Care approach:

  1. Define the problems and learning needs
  2. Gain consensus these are important for primary care
  3. Offer hope that there are feasible solutions
  4. Provide innovative education starting with clinical teachers so that there is the potential to scale up and sustain positive changes in the long-term

Right Care means doing the right things and only the right things in the right way for the right people at the right time in the right place, whatever that means in the local context.

We will scale up this programme and announce the first Rhinitis Right Care initiatives and resources in the future. If you are interested in getting involved, please get in touch!

ARIA

IPCRG collaborates with Allergic Rhinitis and Its Impact on Asthma (ARIA) guideline group.  The guidelines are under review in late 2024/early 2025.  See current guideline and  the protocol for systematic reviews informigg the 2024/25 guideline.

The MASK-air app (see sidebar) is freely available to download and use by people who are bothered by the symptoms of allergic rhinitis.

The goal is to give users the opportunity to regularly record all their symptoms that they can share with their primary care professional, facilitate optimal management of their condition and improve their quality of life and day to day living with allergic rhinitis.  This is important to reduce:

  • Fatigue
  • Absence from school or work,
  • Ability to concentrate
  • Likelihood of developing asthma or having worsening symptoms
  • Inability to sleep due to allergic rhinitis (hay fever) symptoms