What is the best treatment for allergic rhinitis, and how much does allergic rhinitis treatment cost in Singapore?

Many patients with allergic rhinitis have lived with it for so many years they think it is something they have to accept. That need not be so, and treatment can really improve your daily quality of life and sleep.

Managing allergic rhinitis reduces snoring, mouth breathing, eczema and asthma too.

To get a sustained improvement for your likely symptoms of itching, runny or blocked nose and sinus congestion, it is most important that you find out what you are allergic to.

If nasal medications have been used for a long time and your symptoms recur after 1 to 2 months of stopping medications, it is time to consider testing for allergens or immunotherapy.

I usually offer the patient a skin prick test in clinic to identify allergens early too. The skin prick test (SPT) is not painful, and we do it for even babies.

My allergy nurses can do the test in 2 minutes, and will read the results of your skin's reaction to the allergens 20 minutes later. They then do a full counselling session to advise on how to control for those allergens.

We can test for both airborne (eg dust mites, cockroach, grass and tree, mold) and also food (eg soy, meat, fish, wheat, egg) allergens. In some cases, blood tests are needed to identify the allergens.

Some nasal medications may be needed for the first few months as control is being done. This usually includes a nose steroid spray daily, with or without an antihistamine tablet.

Nasal rinsing of the nose is also incredibly helpful, reducing allergen burdens without the need for actual medications.

In more recalcitrant cases, my patients have found immunotherapy tablets or drops very helpful. They have to be taken daily for 2 to 3 years for best results and a long term cure. You can think of immunotherapy as a method for desensitizing your body to the offending allergen.

For example, you may be in a room full of dust mites but no longer react to the dust mites, and thus not have those uncomfortable nose symptoms. There are no harmful effects to this, with young children also benefiting from it, though there may be some itching under the tongue in the first 2-3 weeks.

Most ENT visits would be between SGD150 to SGD250 for a first time consult. The allergy test is usually from SGD150 onward depending on how many allergens you choose to be tested for.

If a nose scope is needed to exclude polyps or sinus or nasal bone problems that may mimic allergic rhinitis, it usually costs between SGD 200 to 350.

Kind regards,

Dr Lynne Lim

Allergic rhinitis as you mention is an allergic condition. So we have to be clear in our minds what are the symptoms that we want to treat.

If you want to treat the blockage: you might need to see an ENT to clear physical blockage that is due to large nasal bones (inferior turbinate), slanted nasal bones (deviated nasal septum) or sinus blockages (persistent sinusitis). This might entail some procedures and the cost can vary, depending on what is done.

If we are talking about the running nose and sneezing: we have to use medications to treat. Oral medications are a good start, but after a while might not work as well. Nasal sprays are good, but after you stop for a while, the condition recurs. You can consider immunotherapy as it is the only cure to allergies. You can see a GP like us with special interest in allergies, an immunologist or ENT for that. That is a long drawn treatment for 4 years comprising of an oral medicine or spray daily.

There are other ways to control allergies, but mainly, reduce humidity and dust mites. Take care and hopefully you find a cure.

Dr Paul Ang has provided a good summary of the treatment options for Allergic Rhinitis and I agree with him that the treatment options depend on which symptoms affect you the most, your willingness to use nasal steroid sprays on a long term basis or if you are aiming for a potential cure (which may take 3-5 years of immunotherapy if you have a known inhalant allergy).

As the treatment cost varies greatly depending on the treatment options chosen and whether it is done in a public vs private clinic/hospital, I would only be able to provide a "rough range" of cost of treatment (in private clinics) as follows:

• Nasal steroid sprays - Approximately SGD40- SGD60 per bottle. Each bottle may last 2weeks-2month depending on dosage/day
• Immunotherapy - Approximately SGD100- SGD150/month. Need to use for at least 3 years.
• Surgery - Depending on the type of surgery performed (Inferior turbinate reduction surgery with or without septoplasty) the total cost could be anywhere between SGD800 (for pure office-based turbinate reduction procedure to SGD10000 (for a combination of turbinoplasty and septoplasty under general anaesthesia in a private hospital)

I would suggest consulting a GP (if you wish to use nasal steroid sprays for a start) or an ENT Specialist (if you wish to consider Immunotherapy or surgical options for blocked nose). For more information on Rhinitis, do refer to my article on Rhinitis (which was published in Human). Hope this helps and all the best!