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Mrs Gray is a 29 year old female who has requested an appointment to discuss a recent flare of hay fever. She explains that over the last three weeks she has developed worsening nasal discharge, pruritis and is sneezing a lot. Mrs Gray is known to have allergic rhinitis and usually presents in early spring with similar symptoms. Whilst she is keen to start some form of preventive treatment, she is apprehensive as she is thirty-weeks pregnant. This is her first pregnancy, and she is low risk so being managed by her local community midwives. She has no other significant medical history or regular medications but she informs you that she has been using an intranasal corticosteroid with minimal symptom improvement.

What is the next most appropriate management?

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