Allergic Rhinitis  Management

Healthcare professtional 1


A tailored approach to allergic rhinitis (AR) treatment

Diagnosis of allergic rhinitis

ARIA AR treatment algorithm1

The management of AR should be tailored according to the severity of the disease, co-morbidities, treatment availability and affordability, and the patient’s preference.1

Treatment of allergic rhinitis

Simplified AR treatment algorithm

Although each treatment option will help to reduce a person’s AR symptoms, clinicians should tailor the treatment option. Each of the following scenarios would have different considerations2:

  1. Person with nasal congestion as the primary complaint
  2. Person with intermittent or episodic nasal AR symptoms
  3. Person with mild AR symptoms
  4. Person with moderate to severe AR symptoms

Recommendations from the AAAAI (American Academy of Allergy Asthma & Immunology)

  • The American Academy of Allergy, Asthma & Immunology (AAAAI) issued practice parameters for treating rhinitis in 2008. These guidelines suggest that pharmacotherapy treatment should be individualized and depends on a variety of factors, including3:
    • Type of rhinitis—seasonal allergic rhinitis (SAR), perennial allergic rhinitis (PAR), or Nonallergic rhinitis (NAR)
    • Symptoms, their duration, and their severity
    • Physical exam findings
    • Comorbidities
    • Age
    • Patient preferences

Overall, INSs are recognized as the most effective class for controlling symptoms of AR3

Pharmacological options

Allergy medicine types

The most commonly used medications in the treatment of AR are4:

ICSs are considered the most effective treatment for moderate intermittent and all stages of persistent rhinitis.5

  • INSs

    INSs have become OTC recently, and they are often used as first-line treatment for patients with mild persistent or moderate-to-severe symptoms. They work locally in the nasal mucosa to block multiple mediators involved in the allergic cascade, including histamine, cytokines, leukotrienes, chemokines, prostaglandins, and tryptases.6-9


    1. Act on both early and late phases of the inflammation process, therefore relieving the symptoms they cause
    2. Provide relief of nasal congestion and itching, runny nose and sneezing, and itchy, watery eyes

    Patients have a tendency to misunderstand how intranasal sprays work. People commonly use INSs incorrectly, or expect that the INS spray will work faster than it does. Many patients expect instant success with an INS, but it could take up to a few days to get the full effect.10

    It is important to explain this to patients to help set their expectations. Opening up the conversation about this can be as easy as asking a simple question to gauge their knowledge.

  • Antihistamines

    When it comes to over-the-counter medications, both INSs and non-sedating antihistamines (NSAs) are quick to come to mind. But single-ingredient antihistamines don’t treat nasal congestion, which can be a problem for a lot of patients.

    INSs are recognized as the most effective class for controlling symptoms of AR.3,5


    • Relieve nasal symptoms
    • Active in both early and late phases of the allergic cascade
    • High concentrations at receptor sites achieved with a single dose

    Since optimal clinical response is determined by the proper application of the nasal spray, patients should be counseled on the appropriate use of applicator devices.12

INSs demonstrate low systemic absorption, although some systemic side effects may occur, including immunosuppression and slower growth in pediatric use.12-14

The role of INSs in the treatment of AR: According to the algorithms

According to the 2008 Rhinitis Updated Practice Parameter from the AAAAI, INSs are the most effective first-line medication class for controlling symptoms of AR.3

  • In the treatment of SAR, INSs have been shown to be more effective than the combined use of an antihistamine and a leukotriene (LT) antagonist. 3
  • INSs may provide significant symptom relief for patients with SAR, whether they’re used on a regular basis or on an as-needed basis.3

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