ARIA endorses the recommendations around avoiding allergens where possible. Among the standard non-therapeutic approaches for house dust mite allergy, BSACI says the evidence is strongest for using bedding covered in an allergen-impermeable fabric. Use of acaricides on carpets and soft furnishings is also well evidenced.4,9

Self-care treatments such as saline nasal washes, irrigation or sprays are well tolerated, safe and inexpensive, but evidence is limited regarding effectiveness.9

ARIA asks pharmacists to consider that AR patients’ treatment goals will include:

·      sleeping well;

·      any impairment of everyday activities is minimised – at home, work, or school;

·      symptoms are managed so they are not troublesome;

·      there are no or minimal side effects from treatment(s).

It also emphasises the need to educate the patient on AR and management options, including the importance of treatment adherence and using topical devices properly.

One study quoted in the guidelines found an adherence rate of only 35 per cent for intranasal corticosteroids. The guideline therefore asks that patients are trained on how to use an intranasal device, possibly with a placebo device, in much the same way as a patient should be shown how to use an inhaler for asthma.