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Recognising differentiating symptoms
Recognising differentiating symptoms
Other conditions may present with symptoms similar to hay fever.2 These conditions do not warrant use of Dymista® Control and alternative therapies or referral to a doctor should be considered. Therefore, it is important to carefully assess symptoms to ensure appropriate treatment.
Click through the carousel below for information that may help to assess your customer’s symptoms. Full information on differential diagnoses can be found in the Pharmacy Essential Guide.
BILATERAL SYMPTOMS
Symptoms of hay fever are usually bilateral; affecting both sides of the nose and/or both eyes.2
If your customer has unilateral symptoms, this is more likely to indicate nasal structural abnormalities or a blockage, such as polyps or the presence of a foreign body.2
NASAL DISCHARGE AND/OR NOSEBLEEDS
Rhinorrhoea, a classic symptom of hay fever, is a runny nose with clear, thin mucus.2
Differentiating symptoms
Could it be... ?
Discoloured nasal discharge2,13
Common cold or infective rhinitis
Green or yellow mucus from the nose
Sinusitis15
Recurrent bloody discharge or nosebleeds
Nasal structural abnormalities2
ASSOCIATED COUGH
Hay fever can be associated with a cough due to a post-nasal drip irritating the throat.16
If you or your customer are concerned about their cough, e.g. due to its duration, persistence, the presence of blood, or because they are really unwell, you should refer them to their GP for further investigation.17
ASSOCIATED BREATHING DIFFICULTIES
Hay fever may be associated with possible mouth breathing due to nasal congestion, but no breathing difficulties or shortness of breath.2
If your customer has shortness of breath, is wheezing, has other breathing difficulties or chest/arm/jaw pain you should consider an alternative diagnosis, such as asthma, a chest infection or a cardiovascular condition.10
MEDICATION AND RECREATIONAL DRUGS
Hay fever is caused by an allergic reaction due to exposure to pollen.2
Rhinitis may be caused by medication such as alpha-blockers, ACE inhibitors, beta-blockers, chlorpromazine, aspirin, NSAIDs and phosphodiesterase inhibitors. It may also occur as a result of recreational drug use, e.g. cocaine.10
Rebound symptoms and a paradoxical increase in nasal congestion may occur when stopping prolonged treatment with intranasal decongestants due to rebound vasodilatation.2
TIMING OF SYMPTOMS
When do symptoms occur?
What could it be?
Around the same time each year, in response to grass, tree and/or weed pollen2
Hay fever (seasonal AR)
All year round, in response to house mites, mould or animal dander2
Perennial AR
All year round, due to exposure to allergens in the work environment2
Occupational AR
Symptoms coincide with pregnancy, starting the oral contraceptive pill, hormone replacement therapy (HRT) or hypothyroidism2
Hormonal rhinitis
Symptoms typically follow known exposure to a physical cause or chemical irritant2
Autonomic or irritant rhinitis
ONSET OF SYMPTOMS
How quickly do symptoms appear?
What could it be?
Within minutes after exposure to pollen12
Hay fever (seasonal AR)
Gradually over 2-3 days13
Common cold or infective rhinitis
DURATION OF SYMPTOMS
How long do symptoms last?
What could it be?
Weeks or even months14
Hay fever (seasonal AR)
1-2 weeks14
Common cold or infective rhinitis
PRESENCE OF FEVER
Despite its name, hay fever is not generally associated with a raised body temperature.
If a fever is present alongside symptoms similar to hay fever, consider whether your customer has a common cold or infective rhinitis, sinusitis, a chest infection, tuberculosis or granulomatosis with polyangiitis (GPA).10
BILATERAL SYMPTOMS
Symptoms of hay fever are usually bilateral; affecting both sides of the nose and/or both eyes.2
If your customer has unilateral symptoms, this is more likely to indicate nasal structural abnormalities or a blockage, such as polyps or the presence of a foreign body.2
NASAL DISCHARGE AND/OR NOSEBLEEDS
Rhinorrhoea, a classic symptom of hay fever, is a runny nose with clear, thin mucus.2
Differentiating symptoms
Could it be... ?
Discoloured nasal discharge2,13
Common cold or infective rhinitis
Green or yellow mucus from the nose
Sinusitis15
Recurrent bloody discharge or nosebleeds
Nasal structural abnormalities2
ASSOCIATED COUGH
Hay fever can be associated with a cough due to a post-nasal drip irritating the throat.16
If you or your customer are concerned about their cough, e.g. due to its duration, persistence, the presence of blood, or because they are really unwell, you should refer them to their GP for further investigation.17
ASSOCIATED BREATHING DIFFICULTIES
Hay fever may be associated with possible mouth breathing due to nasal congestion, but no breathing difficulties or shortness of breath.2
If your customer has shortness of breath, is wheezing, has other breathing difficulties or chest/arm/jaw pain you should consider an alternative diagnosis, such as asthma, a chest infection or a cardiovascular condition.10
MEDICATION AND RECREATIONAL DRUGS
Hay fever is caused by an allergic reaction due to exposure to pollen.2
Rhinitis may be caused by medication such as alpha-blockers, ACE inhibitors, beta-blockers, chlorpromazine, aspirin, NSAIDs and phosphodiesterase inhibitors. It may also occur as a result of recreational drug use, e.g. cocaine.10
Rebound symptoms and a paradoxical increase in nasal congestion may occur when stopping prolonged treatment with intranasal decongestants due to rebound vasodilatation.2
TIMING OF SYMPTOMS
When do symptoms occur?
What could it be?
Around the same time each year, in response to grass, tree and/or weed pollen2
Hay fever (seasonal AR)
All year round, in response to house mites, mould or animal dander2
Perennial AR
All year round, due to exposure to allergens in the work environment2
Occupational AR
Symptoms coincide with pregnancy, starting the oral contraceptive pill, hormone replacement therapy (HRT) or hypothyroidism2
Hormonal rhinitis
Symptoms typically follow known exposure to a physical cause or chemical irritant2
Autonomic or irritant rhinitis
ONSET OF SYMPTOMS
How quickly do symptoms appear?
What could it be?
Within minutes after exposure to pollen12
Hay fever (seasonal AR)
Gradually over 2-3 days13
Common cold or infective rhinitis
DURATION OF SYMPTOMS
How long do symptoms last?
What could it be?
Weeks or even months14
Hay fever (seasonal AR)
1-2 weeks14
Common cold or infective rhinitis
PRESENCE OF FEVER
Despite its name, hay fever is not generally associated with a raised body temperature.
If a fever is present alongside symptoms similar to hay fever, consider whether your customer has a common cold or infective rhinitis, sinusitis, a chest infection, tuberculosis or granulomatosis with polyangiitis (GPA).10
BILATERAL SYMPTOMS
Symptoms of hay fever are usually bilateral; affecting both sides of the nose and/or both eyes.2
If your customer has unilateral symptoms, this is more likely to indicate nasal structural abnormalities or a blockage, such as polyps or the presence of a foreign body.2
When a diagnosis of hay fever cannot be determined using this guidance together with information available in the Pharmacy Essential Guide, the customer must be referred to a doctor.
Summary
If a customer 18 years or older is suffering from moderate to severe hay fever and monotherapy with either an intranasal antihistamine or intranasal corticosteroid is not considered sufficient, and they have no contraindications and are not taking medication that may interact, Dymista® Control nasal spray may be supplied with appropriate advice.
Click on each heading below to see example questions that can help you ascertain Dymista® Control’s suitability for adult customers (18 years or over):
Determine your customer's diagnosis
“WHAT ARE YOUR MAIN SYMPTOMS?”
This will indicate whether they are likely to suffer from hay fever (e.g. runny nose, sneezing, itchy nose, nasal congestion, itchy, red, watery eyes; check for bilateral symptoms)
“WHEN DID YOUR SYMPTOMS START?”
This will help to determine whether symptoms coincide with pollen season and also provide information on duration
Classify the impact of their symptoms
“DO YOUR SYMPTOMS IMPACT YOUR LIFE?”
This will help to determine whether they are suffering from moderate to severe symptoms, i.e. symptoms are troublesome, they cause disturbed sleep, problems at work and/or studies and impairment of daily activities, sport or leisure
Evaluate their current treatment
“WHAT TREATMENT(S) HAVE YOU TRIED ALREADY?”
This will help to determine whether monotherapy with either intranasal antihistamine or intranasal corticosteroid has been tried without providing sufficient symptom relief
Consider their associated health conditions
“DO YOU HAVE ANY OTHER MEDICAL CONDITIONS OR ARE YOU TAKING ANY OTHER MEDICATION?”
This will help to determine whether Dymista® Control nasal spray may be an appropriate option or whether the customer should be referred to a doctor
To complete your learning, please refer to the following material for further information:
Recognising differentiating symptoms
