Allergy and Asthma: Allergic Rhinitis and Allergic Conjunctivitis.
Allergic rhinitis and allergic conjunctivitis are among the most common conditions seen in family medicine practice. Most cases are due to seasonal allergens, such as pollens, or year-round allergens, such as dust mites, mold, and animal dander. The clinical diagnosis can be made when symptoms of nasal congestion, sneezing, rhinorrhea, nasal or ocular pruritus, or eye tearing are present along with physical findings, such as clear rhinorrhea, pale nasal mucosa, or red watery eyes. Patients should be assessed for any comorbid conditions, such as asthma or eczema, and for symptoms that indicate impaired quality of life, such as poor sleep, daytime somnolence, or irritability. Prevention involves allergen avoidance and environmental controls. Monotherapy with oral antihistamines, intranasal steroids, or intranasal antihistamines are the initial management options for nasal and ocular symptoms. Antihistamine eye drops are fast-acting and safe for management of ocular symptoms; intranasal antihistamines are effective for nasal symptoms. Current guidelines recommend against combining intranasal steroids and oral antihistamines, as this provides no additional benefit. Select patients also may benefit from allergy skin testing or consideration for allergen immunotherapy.