Non Seasonal Allergic Rhinitis/Conjunctivitis (Adult) Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.


This guidance refers to:

  • Diagnosis and management of perennial (non-seasonal) allergic rhinitis/conjunctivitis
  • Adults 18+

This guidance does not cover


Signs and Symptoms

  • Bilateral nasal itching
  • Congestion and rhinorrhoea
  • Sneezing
  • Bilateral conjunctivitis.

Ask about triggers (e.g. pets) if symptoms intermittent all year round (perennial).

Differential Diagnosis

For diagnostic algorithm see; BSACI – Guidelines/Algorithm-RhinitisPCCL

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • Unilateral symptoms
  • Polyps
  • Persistent blood stained discharge or persistent purulent discharge


Undertake the following to aid diagnosis, inform management or prior to referral:

  • Send blood for specific IgE to suspect aero-allergen (most commonly house dust mite and pets if exposed).


Allergen avoidance
  • Advise house dust mite reduction measures or pet avoidance
Mild symptoms
  • should be treated with oral non-sedating antihistamines at doses up to twice BNF maximum dosing (cetirizine 10mg, loratadine 10mg, or fexofenadine 180mg up to twice daily).
  • A self-care approach should be adopted where the patient should be encouraged to buy their own antihistamines cheaply from the supermarket or other outlets
Moderate-severe symptoms
  • Should be treated with intranasal corticosteroid (e.g. beclometasone, two sprays into each nostril twice daily; consider alternative (e.g. mometasone or Avamys®) in addition to non-sedating antihistamines - Again a self-care approach is advised as this product can be bought cheaply OTC
  • Consistent daily use of intranasal use is vital, given maximal effect may not be apparent for up to 3 months.
  • An alternative nasal spray is mometasone which is available on prescription, again in addition to non-sedating antihistamines
  • Systemic corticosteroids (in addition to intranasal corticosteroid) at doses of 15 - 20mg for a maximum of 5 days as a one-off course can be used for severe symptoms uncontrolled on conventional therapy, to control symptoms during important periods (e.g. exams or other major events).
  • Topical sodium cromoglicate eye drops are useful to manage allergic conjunctivitis

Consider a concomitant diagnosis of asthma and manage according to guidelines

Avoid sedating antihistamines, depot corticosteroids, and chronic use of decongestants.

Treatment failure should prompt a review of the diagnosis, compliance with therapy (regular therapy is more effective than "as required" treatment), and intranasal corticosteroid technique.


Referral Criteria

  • Red Flags
  • Perennial symptoms that are severe and resistant to treatment (when combination treatment at maximum doses has been attempted for at least 3 months)

Referral Instructions

  • e-Consultation is not currenlty available for this speciality
  • Red Flags should be referred to ENT
  • Referrals should be made via ICG to TRISH (if training has been undertaken) - See user guides (EMIS & S1) for further information.
  • For those Practices who have not received ICG training routine referrals should be made to ENT via eRS
  • Please identify speciality and clinic type

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation

Patient information/Public Health/Self Care

Evidence/additional information

Assurance & Governance

  • This guidance was developed on: 10.2017
  • This Care Pathway was ratified by: The OSCAR Assurance Group
  • Date ratified: 10.2017
  • Publication Date: 12.2017
  • Review Date: 10.2019
  • Ref No: AL8 - 03.2017
Any feedback or suggestions to improve this guidance should be sent to:
Only the electronic version is maintained, once printed this is no longer a controlled document


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