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- W137293950 abstract "Editor—Although the 10-minute consultation on rhinitis serves as a useful guide for treatment of this common condition, certain points merit clarification.1We agree that unilateral nasal blockage and bleeding warrant prompt referral since these symptoms may indicate an underlying malignancy. Contrary to the authors' suggestion, however, this is an uncommon presentation of nasopharyngeal carcinoma, which is more frequently associated with unilateral glue ear or cervical lymphadenopathy. Examination of the nose by an experienced doctor using adequate illumination is essential to exclude other diagnoses, such as septal deflection, turbinate enlargement, and nasal polyposis. We are also surprised that no mention is made of the diagnostic value of allergy testing, which has been shown to be feasible in primary care.2With regard to treatment, the authors do not emphasise that topical nasal decongestants such as oxymetazoline should be avoided in prolonged courses owing to the incidence of rebound oedema and rhinitis medicamentosa.3 We disagree with the assertion that steroid drops should not be used in chronic allergic rhinitis since they increase systemic absorption.Betamethasone nasal drops do cause appreciable systemic bioavailability and in protracted regimens have been associated with undesirable side effects. This is not the case, however, with fluticasone nasal drops, which have negligible absorption (0.06%), less even than fluticasone spray (0.51%).4 Along with budesonide, they do not contain benzalkonium chloride preservative, which is found in most other topical preparations and to which some patients are sensitive.5 These preparations are therefore of particular use in patients developing nasal discomfort with more commonly prescribed sprays.Either betamethasone or fluticasone nasal drops are preferable to the course of 20 mg oral prednisolone suggested by the authors—a treatment rarely given for allergic rhinitis even by specialists. Equally, the authors are unwise to suggest referral for immunotherapy as a realistic option in primary care, since this controversial technique is used in only a few centres.We agree that many patients with allergic rhinitis can be treated successfully in primary care but believe that more emphasis should be placed on adequate initial examination of the patient and particularly on referral to a specialist otolaryngologist or allergist should initial treatment fail." @default.
- W137293950 created "2016-06-24" @default.
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- W137293950 date "2002-05-18" @default.
- W137293950 modified "2023-09-26" @default.
- W137293950 title "10-minute consultation: Rhinitis" @default.
- W137293950 cites W1559040908 @default.
- W137293950 cites W1966772376 @default.
- W137293950 cites W2079456443 @default.
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- W137293950 doi "https://doi.org/10.1136/bmj.324.7347.1219/a" @default.
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