Case review

A gardening apprentice with 'hayfever' and shortness of breath

Jo A Douglass



An 18-year-old gardening apprentice presents with worsening symptoms of hayfever and dyspnoea that have caused him concern about his choice of career. How should he be managed and what advice can be offered to him?

Key Points

  • The symptoms of allergic rhinoconjunctivitis include watery rhinorrhoea, sneezing and eye itch and irritation.
  • Intranasal corticosteroids are recommended as first-line treatment for seasonal allergic rhinoconjunctivitis, except for mild intermittent disease.
  • Allergic rhinoconjunctivitis is a risk factor for asthma.
  • Immunotherapy is recommended for patients with moderate to severe allergic rhinoconjunctivitis.
  • Two modes of immunotherapy, injections and sublingual, are available, and may be prescribed by an allergy specialist after allergic disease has been accurately diagnosed.

    Picture credit: © Wavebreakmedia/
Model used for illustrative purposes only