From the Guidelines
The primary treatment for allergic rhinitis should include a combination of oral antihistamines, nasal corticosteroids, and avoidance of allergens, with immunotherapy considered for severe cases unresponsive to initial treatments, as recommended by the most recent guidelines 1. The treatment approach for allergic rhinitis can be tailored based on the severity of symptoms.
- For mild symptoms, starting with an oral second-generation antihistamine like cetirizine (10mg daily) or loratadine (10mg daily) is recommended, as they block histamine receptors, reducing sneezing, itching, and runny nose, and are generally safe for long-term use 1.
- For moderate to severe symptoms, using a nasal corticosteroid spray like fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) is advised, as they reduce inflammation in the nasal passages, alleviating congestion and other symptoms, and may take 1-2 weeks to see full effects 1. Some key considerations for treatment include:
- Combining treatments for better relief, such as using the nasal spray daily as directed, taking an antihistamine as needed for breakthrough symptoms, and rinsing sinuses with saline solution to remove allergens and mucus.
- Identifying and avoiding triggers when possible, such as using air purifiers, keeping windows closed during high pollen days, and showering after outdoor exposure to remove allergens.
- Considering immunotherapy (allergy shots or sublingual tablets) for severe cases unresponsive to initial treatments, to desensitize the immune system to specific allergens over time, as recommended by recent guidelines 1. Intranasal corticosteroids are typically the most effective medication class for controlling sneezing, itching, rhinorrhea, and nasal congestion, the 4 major symptoms of allergic rhinitis, and should be considered for initial treatment without a previous trial of antihistamines and/or oral decongestants 1.
From the FDA Drug Label
Your doctor may want to consider if other medicines are needed. The treatment options for Allergic Rhinitis may include other medicines as determined by a doctor.
- The use of Fluticasone Propionate Nasal Spray is one option, but the decision to use it or other medicines should be made in consultation with a doctor 2.
- If symptoms are not better after one week of using Fluticasone Propionate Nasal Spray, patients should stop use and ask their doctor, as they may have an infection.
From the Research
Treatment Options for Allergic Rhinitis
The treatment options for allergic rhinitis include:
- Avoiding inciting allergens 3
- Pharmacotherapy, such as:
- Second-generation H1 antihistamines (e.g., cetirizine, fexofenadine, desloratadine, loratadine) 4, 3, 5, 6
- Intranasal antihistamines (e.g., azelastine, olopatadine) 3, 5
- Intranasal corticosteroids (e.g., fluticasone, triamcinolone, budesonide, mometasone) 3, 5
- Oral and intranasal decongestants 5
- Oral and intranasal anticholinergics 5
- Leukotriene receptor antagonists 5
- Immunotherapy 5
Selection of Treatment
The selection of treatment for allergic rhinitis depends on the severity and frequency of symptoms, as well as patient preference 3, 5. For mild intermittent or mild persistent allergic rhinitis, second-generation H1 antihistamines or intranasal antihistamines may be used as first-line treatment 3. For persistent moderate to severe allergic rhinitis, intranasal corticosteroids may be used as first-line treatment, either alone or in combination with an intranasal antihistamine 3.
Specific Medications
Specific medications that have been shown to be effective in the treatment of allergic rhinitis include: