As you track your symptoms, potential triggers, medications and treatment outcomes you will gain a clearer understanding
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Allergic Rhinitis patient pack
Patient Name: Doctor / Pharmacist: Date:
This patient pack is designed to assist you more effectively manage your allergic rhinitis (hayfever). Allergic rhinitis means inflammation of the nose caused by an allergy. The wide range of symptoms experienced include blocked / itchy ears, watery / red / itchy eyes, runny nose / sneezing, feeling congested, wheezing / coughing, asthma / shortness of breath, sore throat or sleep disturbance / tiredness. These symptoms are often confused with a cold, or nasal polyps. Allergic rhinitis can be seasonal, usually occurring in Spring and Summer due to grass, weed and tree pollens, or mould spores. It can also be persistent, experienced any time of the year, usually caused by house dust mites or animal fur and skin flakes. This patient pack will help you control your allergic rhinitis more effectively. As you track your symptoms, potential triggers, medications and treatment outcomes you will gain a clearer understanding of which treatments work for you. This patient pack contains: 1. Treatment plan for allergic rhinitis The purpose of the treatment plan is to record which medications and specific dosage instructions have been advised by your doctor or pharmacist. 2.Patient diary The aim of the one month patient diary is to gain an insight into type, pattern and severity of your symptoms experienced as well as to record any potential triggers. The diary will also help you make a record of which medications you have used, and the effectiveness of this medication(s). The diary will also assist your doctor or pharmacist treat you more effectively for allergic rhinitis.
T R E AT M E N T P L A N F O R
www.allergy.org.au
A ll ergic R hinitis ( H ay Fe ve r)
Patient name:
Date:
Plan prepared by:
Signed:
A L L E R G E N M I N I M I S AT I O N Minimising exposure to confirmed allergen/s may assist some individuals in reducing allergic rhinitis symptoms. Information on allergen minimisation is available on the ASCIA website www.allergy.org.au/patients/allergy-treatment
M E D I C AT I O N S Intranasal corticosteroid spray: 1 or 2 times/day/nostril for Additional instructions:
weeks or
months or
1. Prime the spray device according to manufacturer’s instructions (for the first time or after a period of non-use).
continuous
CORRECT
2. Shake the bottle before each use.
INCORRECT
3. Blow nose before spraying if blocked by mucus. 4. Tilt head slightly forward and gently insert nozzle into nostril. Use right hand for left nostril (and left hand for right nostril). 5. Aim the nozzle away from the middle of the nose and direct nozzle into the nasal passage (not upwards towards tip of nose, but in line with the roof of the mouth). 6. Avoid sniffing hard during or after spraying. Note: Onset of benefit may take days, so this treatment must be used regularly. It does not have to be stopped every few weeks. If significant pain or bleeding occurs contact your doctor.
Oral non-sedating antihistamine: as needed Additional instructions:
Dose
Intranasal antihistamine sprays: Additional instructions:
mL/mg 1 or
1 or
2 times/day or
Combined intranasal antihistamine and corticosteroid spray: as needed Additional instructions:
2 times/day; or as needed 1 or
Saline nasal spray or irrigation times/day or Use 10 minutes prior if used in conjunction with intranasal corticosteroid spray Decongestant: nasal spray or to 5 days (not more than 1 course/month)
tablet. Dose
mL/mg
2 times/day; or as needed times/day for up
Other medications:
A L L E R G E N I M M U N OT H E R A PY If allergen immunotherapy has been initiated by a clinical immunology/allergy specialist, it is important to follow the treatment as prescribed. Contact your doctor if you have any questions or concerns. © ASCIA 2015. For further information go to www.allergy.org.au/patients/information This plan was developed by ASCIA as a medical document to be completed and signed by a medical or nurse practitioner. To order additional copies email
[email protected] Printing and distribution of this plan is supported by an unrestricted educational grant from BAYER
patient diary
Name:
Treating concomitant asthma and allergic rhinitis Patient instructions: For each day of the month (columns 1 to 31), please indicate to what degree any symptoms were experienced (mark a 1 for mild symptoms or a 2 for moderate to severe sympthoms); make a note of triggers, then tick what medication, if any, was used and what the outcome was. If no symptoms were experienced, please just tick the top box.
Symptom (1-mild 2-moderate/severe)
Be sure to take your symptom diary with you to your next appointment. Month:
Day
No symptoms Blocked ears Watery eyes Itchy eyes, palate or nose Runny nose Sneezing Feeling congested Wheezing Cough Asthma Short of breath Sore throat Sleep disturbance Tiredness
Triggers
Other Pollen Mould spores Dust mites Animals Medication
Other Antihistamine tablet Intranasal antihistamine spray Intranasal corticosteriod spray Combined intranasal antihistamine and corticosteriod spray Saline spray/irrigation Decongestant Outcome
Other Symptoms improved No difference Symptoms worsened Not relevant
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
