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Cardiovascular

Abdominal pain in kids

Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB)

Acanthosis Nigricans

Actinic Cheilitis

Acute Kidney Injury (AKI)

Acute Swollen Joint with Fever

Acute Vision Loss

Acute and Progressive Vision Loss

Adjustment Disorder and Anxiety

Adjustment Disorder with Depressed Mood

Age related macular degeneration

Alcohol Cessation

Allergic rhinitis

Angular Cheilitis

Ankylosing Spondylitis (AS)

Anorexia Nervosa

Anticholinergics and TCAs

Antidepressants

Antimetabolite drugs

Antiphospholipid syndrome

Anxiety Disorders

Aortic Dissection

Atrial Fibrillation

Behavioural / learning disorders

Behavioural disturbances

Bell’s palsy and Ramsey Hunt syndrome

Beta-Human Chorionic Gonadotropin (β-hCG)

Biologic agents

Bipolar Disorder

Bleeding disorders

Bronchiectasis (Updated)

CA-125 (Cancer Antigen 125)

CVD Risk Assessment

Calluses and Corns

Candida (Candidiasis as an STI)

Carpal tunnel syndrome and de quervains tenosynovitis

Cervical spondylosis

Chickenpox (Varicella)

Chronic Cough in Children

Chronic Fatigue Syndrome (CFS)

Chronic Kidney Disease (CKD)

Chronic Rhinosinusitis

Chronic Stridor

Clavicular fracture

Colorectal Cancer Screening Recommendations

Congestive Cardiac Failure

Connective Tissue Diseases

Contact Dermatitis

Cutaneous Drug Eruptions

Dacrocystitis, dacyrostenosis, dacyrocystocoele

Deep Vein Thrombosis (DVT)

Depression and Delirium

Dermal melanocystosis (mongolian spot)

Developmental Dysplasia of the Hip (DDH)

Diabetes Insipidus (DI) vs Primary Polydipsia

Diabetic Neuropathy

Dizziness / syncope

Duchenne muscular dystrophy

Dupuytrens / trigger finger

Dyspnoea (Shortness of Breath)

Allergic Rhinitis

Risk Factors

Family history of atopy
Exposure to dust mites
Lack of exposure to animals in early life
Lack of older siblings
Non-attendance of childcare
Heavy maternal smoking in the first year of life
Early introduction of solid foods/formula

Note:

Urban living and environmental pollutants can exacerbate allergic rhinitis.
Strong association with comorbid asthma, eczema, and conjunctivitis (part of the atopic triad).

Pharm Treatment Ladder

1st Line:

Oral/intranasal antihistamines:
- Loratadine 10 mg PO OD
- Azelastine 125 mcg nasal spray, 1 spray BD
ADD intranasal steroids OR montelukast:
- Mometasone 50 mcg, 2 sprays daily

2nd Line:

Montelukast 10 mg daily (5 mg for <14 yrs, 4 mg for <6 yrs)
- ADD both intranasal steroid AND montelukast

For Rhinorrhoea:

Ipratropium 22 mcg/spray, 4 sprays TDS

If above fails:

Consider referral for immunotherapy
Review diagnosis and adherence

Note:

Intranasal saline irrigation can improve symptom control and reduce reliance on medications.
Sublingual immunotherapy (SLIT) may be a better option for patients unable to access allergen-specific immunotherapy.

Additonal Notes:

If allergic rhinitis + asthma, intranasal steroids are 1st line.
Be cautious with montelukast: potential for nightmares, aggression, and depression, which is reversible post-cessation.
Regular re-evaluation of treatment efficacy and compliance is essential for long-term management.

Allergic Rhinitis

Risk Factors

Family history of atopy
Exposure to dust mites
Lack of exposure to animals in early life
Lack of older siblings
Non-attendance of childcare
Heavy maternal smoking in the first year of life
Early introduction of solid foods/formula
Urban living and environmental pollutants exacerbate allergic rhinitis
Strong association with comorbid asthma, eczema, and conjunctivitis

Pharmacological Treatment Ladder

1st Line

Oral or intranasal antihistamines
- Loratadine 10 mg daily
- Azelastine nasal spray 125 mcg, 1 spray each nostril BD
Add intranasal steroids or montelukast if symptoms persist
- Mometasone 50 mcg, 2 sprays daily

2nd Line

Montelukast 10 mg daily (5 mg for children under 14, 4 mg for under 6)
Use both intranasal steroid and montelukast if single-agent therapy inadequate

For Rhinorrhoea

Ipratropium bromide nasal spray 22 mcg/spray, 4 sprays TDS

If Above Fails

Consider referral for immunotherapy (subcutaneous or sublingual)
Review diagnosis and adherence to treatment

Additional Considerations

Intranasal saline irrigation helps symptom control and may reduce medication reliance
Sublingual immunotherapy (SLIT) can be suitable for patients who cannot attend specialist allergen immunotherapy
Intranasal steroids are first line when allergic rhinitis coexists with asthma
Monitor for montelukast-related adverse effects such as nightmares, aggression, or depression, which usually resolve after stopping
Re-evaluate treatment efficacy and compliance regularly, checking inhaler and nasal spray technique if relevant
Environmental measures such as dust mite reduction, pollen avoidance, and pet dander minimisation can reduce allergen exposure and symptom severity
Identify symptom pattern (intermittent vs persistent) to tailor treatment duration and intensity
Skin prick testing or specific IgE tests may clarify triggers for targeted avoidance or immunotherapy
Untreated or poorly controlled allergic rhinitis can contribute to sinusitis, otitis media, and reduced quality of life, so ensuring optimal control is essential

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