What is the recommended first-line treatment for seasonal allergies?

From the Guidelines

For initial treatment of seasonal allergic rhinitis in persons aged 12 years or older, intranasal corticosteroid monotherapy is the recommended first-line treatment. This approach is based on the strong recommendation from the 2017 joint task force on practice parameters, as outlined in the Annals of Internal Medicine 1. The guideline suggests that intranasal corticosteroids should be prescribed over combination therapy with an oral antihistamine for initial treatment.

Some key points to consider when prescribing intranasal corticosteroids include:

• They are effective in reducing inflammation in the nasal passages
• They can provide relief from symptoms such as sneezing, itching, runny nose, and nasal congestion
• They are most effective when used regularly throughout the allergy season
• It may take 1-2 weeks to reach maximum effectiveness

In addition to medication therapy, avoiding allergen exposure can complement treatment. This can be achieved by:

• Keeping windows closed during high pollen seasons
• Showering after outdoor activities
• Using air purifiers

It's also important to note that for patients with moderate to severe seasonal allergic rhinitis, the combination of an intranasal corticosteroid and an intranasal antihistamine may be considered for initial treatment, as per the weak recommendation from the guideline 1. However, intranasal corticosteroid monotherapy remains the preferred first-line treatment.

From the FDA Drug Label

The efficacy of SINGULAIR tablets for the treatment of seasonal allergic rhinitis was investigated in 5 similarly designed, randomized, double-blind, parallel-group, placebo- and active-controlled (loratadine) trials conducted in North America. Four of the five trials showed a significant reduction in daytime nasal symptoms scores with SINGULAIR 10-mg tablets compared with placebo.

The recommended first-line treatment for seasonal allergies is montelukast (SINGULAIR) 10-mg tablets.

• Key benefits: Significant reduction in daytime nasal symptoms scores.
• Dosage: 10-mg tablets, once daily.
• Note: The efficacy of montelukast for the treatment of seasonal allergic rhinitis has been demonstrated in clinical trials 2.

From the Research

First-Line Treatment for Seasonal Allergies

• The recommended first-line treatment for seasonal allergies includes allergen avoidance, pharmacotherapy, and immunotherapy 3, 4.
• For mild to moderate cases, either an oral/intranasal second-generation antihistamine or an intranasal corticosteroid alone can be used 3.
• Intranasal corticosteroids are recommended as first-line treatment for moderate to severe allergic rhinitis 4.
• Second-generation oral antihistamines, such as loratadine, cetirizine, or montelukast, can also be used as first-line treatment 4, 5.
• The choice of treatment depends on the type, duration, and severity of symptoms, comorbidities, prior treatment, and patient preference 4.

Treatment Options

• Intranasal corticosteroids, such as fluticasone propionate, have been shown to be effective in reducing nasal symptom scores and improving quality of life 4, 5.
• Combination therapy of an intranasal corticosteroid and an oral antihistamine may also be effective in treating seasonal allergic rhinitis 4, 5.
• Oral second-generation antihistamines, such as bilastine, are also recommended as first-line treatment for allergic rhinitis and urticaria in children 6.

Guidelines and Recommendations

• The latest guidelines recommend nasal glucocorticoids, nasal and oral antihistamines, and antileukotrienes as first-line treatment for seasonal allergic rhinitis 7.
• The selection of drugs for the therapy of seasonal allergic rhinitis should be based on the latest guidelines and should take into account the individual patient's needs and preferences 7.