GPs see many allergy-related disorders, including asthma, rhinitis, conjunctivitis, eczema (particularly in young children), occupational asthma and food intolerance. Rarely, a GP may be faced with a patient with life threatening asthma or anaphylaxis and should know how to recognise and manage this.

Type 1 immunoglobulin E (IgE) mediated response accounts for the majority of these.

Hay Fever (Seasonal Allergic Rhinitis)

History

Symptoms are caused by sensitivity to various pollens, and thus worst in spring and early summer. Patients typically complain of a runny, itchy or blocked nose, sneezing and watery and itchy red eyes. It is common, self-limiting and recurs yearly at the same season. It tends to run in families and hay fever patients who also have eczema and asthma are said to be atopic.

Examination

In addition to a general ENT examination, look out for evidence of allergic shiner – dark shadows around eyes – and nasal polyps which indicate that the nasal mucosa is inflamed (seen best when the nasal cavities are inspected with a nasal speculum).

Diagnosis

Hay fever diagnosis is usually clinical but skin prick tests or serum IgE levels may be indicated.

Management

Patients often require symptomatic relief and advice on how to minimise exposure to allergens (see Box 65.1). Oral antihistamines manage both nasal and ocular symptoms effectively. Newer generation antihistamines (e.g. cetirizine or loratadine) are less sedating. They are effective within hours, but not suitable when pregnant or breast-feeding. If antihistamines are insufficient, intranasal corticosteroid sprays or drops, or antihistamine or mast cell stabilising eye drops may be added.

Perennial Rhinitis

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