Allergic rhinitis

Template

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FindingsChoose any

Nasal steroidChoose one

AntihistamineChoose one

Nasal antihistamineChoose any

EyesChoose one

CounselingChoose any

Associated conditionsChoose any

Before the seasonChoose any

ReferralChoose any

Follow-upChoose one

Counseling

Nasal steroid sprays work best used every day and can take 1-2 weeks for full effect; aim the spray toward the outside of the nostril, away from the middle. A brief pause helps if the nose gets irritated or bleeds. Recommended supportive care with an emphasis on saline rinses, limiting outdoor time on high pollen days, and showering after outdoor play; avoid decongestant sprays for more than a few days. Return precautions given including symptoms that are not controlled, trouble breathing, wheezing, nosebleeds, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Allergy medicine can be used on days with symptoms, and a daily nasal steroid spray can be added if symptoms become more frequent. Recommended supportive care with an emphasis on saline rinses, limiting outdoor time on high pollen days, and showering after outdoor play; avoid decongestant sprays for more than a few days. Return precautions given including symptoms that are not controlled, trouble breathing, wheezing, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Allergic rhinitis
• Flonase
• Discussed the role of antihistamines, allergen avoidance, and nasal saline rinses with boiled and cooled or distilled water
• Follow up as needed

Nasal steroid sprays work best used every day and can take 1-2 weeks for full effect; aim the spray toward the outside of the nostril, away from the middle. A brief pause helps if the nose gets irritated or bleeds. Recommended supportive care with an emphasis on saline rinses, limiting outdoor time on high pollen days, and showering after outdoor play; avoid decongestant sprays for more than a few days. Return precautions given including symptoms that are not controlled, trouble breathing, wheezing, nosebleeds, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Intranasal steroid first line
Oral antihistamines (adjunct)
Intranasal antihistamine (azelastine), first line with steroid
Allergic conjunctivitis drops (olopatadine, ketotifen)
Antihistamines, avoidance, saline (boiled or distilled water)
Skin testing; immunotherapy if medicines fail
Daily use; side effects; avoid long-term decongestants

Return precautions in the template

symptoms that are not controlledtrouble breathingwheezingnosebleeds

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.