Thinking Ahead

Guidelines
NICE Clinical Knowledge Summaries (CKS)
q  Allergic rhinitis (Nov 2012) includes seasonal rhinitis (hay fever). Information on the management of mild, moderate and severe symptoms, treatment failure and treatment in pregnancy. Also includes patient information leaflets.
q  Conjunctivitis - allergic (Aug 2012) Includes information on management of seasonal or perennial allergic conjunctivitis. / Newer Treatments

DTB (Athens password or subscription may be required)

DTB: Grazax for hay fever – what’s new? 2010 – Update of 2008 review and DTB Select: 1 February 2011

q  Licensed as a ‘disease-modifying’ treatment in adults and children (5 yrs and over).
q  DTB still remains unconvinced of any worthwhile benefit and does not recommend its use.
DTB: Azelastine and fluticasone nasal spray: any advantage? Feb 2014
q  New combination product Dymista.
q  Statistically significant improvements in nasal symptoms seen in short term studies, but clinical significance of results unclear.
q  Has not been compared with concomitant use of an oral antihistamine with an intranasal corticosteroid.
Patient Information
NHS Choices:
q  Hay Fever - Patient information on various aspects of hay fever including symptoms, causes, diagnosis, treatment and prevention.
q  Live well – Hay Fever - Includes specific information on hay fever in children and hay fever and the weather.
q  Antihistamines - General information about uses, how they work and side effects.
Patient UK:
q  Hay Fever - Includes information on symptoms, avoidance methods and overview of treatment options.
Other Useful Information
q  Q&A 29.6: Which medicines can be used to treat intermittent allergic rhinitis during pregnancy? (May 2014).
q  BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy 2008;38:19-42.
q  BSACI guidelines: Immunotherapy for allergic rhinitis. Clin Exp Allergy 2011; 41:1177-2000.
q  Subcutaneous immunotherapy and pharmacotherapy in seasonal allergic rhinitis: A comparison based on meta-analyses Allergy Clin Immunol. 2011;128:791-9.
Cochrane Reviews
q  Sublingual immunotherapy for treating allergic conjunctivitis (2011)
q  Helminth therapy (worms) for allergic rhinitis (2011). Insufficient evidence to support to support its use.
q  Sublingual immunotherapy for allergic rhinitis (2009)
q  Topical nasal steroids for intermittent and persistent allergic rhinitis in children (2006). Available evidence to support use is weak and unreliable.
General Reviews
q  An update on the management of Hay Fever in adults. DTB 2013;51:30-33 (password or subscription required for full text).
q  Lancet Seminar: Allergic rhinitis. Lancet 2011;378:2112-22. (Athens password or subscription may be required).

Produced by Nicola Watts, Medicines Information Pharmacist, Wessex Drug & Medicines Information Centre, Southampton.

May 2014