From the Guidelines
For initial treatment of seasonal allergic rhinitis in persons aged 12 years or older, intranasal corticosteroids are recommended over oral antihistamines due to their superior efficacy in reducing nasal symptoms. According to the 2017 Joint Task Force on Practice Parameters 1, intranasal corticosteroids are the most effective medication class for controlling symptoms of seasonal allergic rhinitis. The guideline recommends monotherapy with an intranasal corticosteroid rather than an intranasal corticosteroid in combination with an oral antihistamine for initial treatment of seasonal allergic rhinitis in persons aged 12 years or older.
Some key points to consider when treating allergic rhinitis include:
- Identifying and avoiding triggers such as pollen, dust mites, or pet dander
- Using intranasal corticosteroids such as fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) for nasal congestion
- Considering second-generation antihistamines like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily) for reducing sneezing, itching, and runny nose with minimal sedation
- Using nasal saline irrigation to clear allergens and mucus
- Considering leukotriene modifiers like montelukast (10mg daily for adults) for patients with concurrent asthma
- Considering allergen immunotherapy (allergy shots or sublingual tablets) for persistent symptoms.
It's worth noting that the evidence from the 2017 Joint Task Force on Practice Parameters 1 suggests that intranasal corticosteroids are more effective than oral antihistamines in reducing nasal symptoms, and that combination therapy with an intranasal corticosteroid and an oral antihistamine may not provide additional benefit over monotherapy with an intranasal corticosteroid. However, for moderate to severe seasonal allergic rhinitis, the clinician may recommend the combination of an intranasal corticosteroid and an intranasal antihistamine for initial treatment 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Allergic Rhinitis
The recommended treatment for allergic rhinitis includes:
- Avoiding inciting allergens 2
- Pharmacotherapy, such as:
- Second-generation H1 antihistamines (e.g., cetirizine, fexofenadine, desloratadine, loratadine) for mild intermittent or mild persistent allergic rhinitis 2, 3
- Intranasal antihistamines (e.g., azelastine, olopatadine) for mild intermittent or mild persistent allergic rhinitis 2
- Intranasal corticosteroids (e.g., fluticasone, triamcinolone, budesonide, mometasone) for moderate to severe allergic rhinitis 2, 3, 4
- Combination therapy with an intranasal corticosteroid and an oral antihistamine may be considered for some patients 5
Oral Anti-Histamines for Allergic Rhinitis
Oral anti-histamines, such as:
- Cetirizine
- Fexofenadine
- Desloratadine
- Loratadine are commonly used to treat allergic rhinitis 2, 3, 4 These medications can help relieve symptoms such as nasal congestion, sneezing, and itching of the eyes, nose, and throat 2, 3
Effectiveness of Treatment Options
Studies have shown that:
- Intranasal corticosteroids are effective in reducing nasal symptom scores 4, 5
- Combination therapy with an intranasal corticosteroid and an oral antihistamine may provide benefits similar to monotherapy with an intranasal corticosteroid 5
- Second-generation oral antihistamines and intranasal corticosteroids are the mainstays of treatment for allergic rhinitis 4