What is the treatment for allergic rhinitis (hay fever)?

From the Guidelines

Treatment for allergic rhinitis (hay fever) should start with monotherapy using an intranasal corticosteroid, as recommended by the 2017 Joint Task Force on Practice Parameters 1. This approach is based on strong recommendations that suggest intranasal corticosteroids are more effective than other treatments for controlling symptoms of seasonal allergic rhinitis. Some key points to consider in the treatment of allergic rhinitis include:

• Intranasal corticosteroids like fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) are highly effective for nasal congestion and should be used regularly for best results.
• Antihistamines like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily) can be used to block histamine receptors and reduce symptoms such as sneezing and itching.
• Nasal saline rinses can help clear allergens and mucus, and decongestants like pseudoephedrine can provide temporary relief but should not be used for more than 3-5 days to avoid rebound congestion.
• Environmental measures such as keeping windows closed during high pollen seasons, using air purifiers with HEPA filters, showering after outdoor exposure to remove allergens, and regularly cleaning bedding in hot water are also important.
• For those with known allergen triggers, allergen immunotherapy (allergy shots) may provide long-term relief by gradually desensitizing the immune system. It's worth noting that the combination of an intranasal corticosteroid and an intranasal antihistamine may be considered for initial treatment of moderate to severe seasonal allergic rhinitis, although this is a weak recommendation 1. Overall, the goal of treatment is to reduce the inflammatory response triggered by allergens, prevent the release of histamine and other inflammatory mediators, and alleviate the characteristic symptoms of allergic rhinitis.

From the FDA Drug Label

The precise mechanism through which fluticasone propionate affects allergic rhinitis symptoms is not known. Corticosteroids have been shown to have a wide range of effects on multiple cell types (e.g., mast cells, eosinophils, neutrophils, macrophages, and lymphocytes) and mediators (e.g., histamine, eicosanoids, leukotrienes, and cytokines) involved in inflammation. In 7 trials in adults, Fluticasone Propionate Nasal Spray,USP, has decreased nasal mucosal eosinophils in 66% (35% for placebo) of patients and basophils in 39% (28% for placebo) of patients.

The treatment for allergic rhinitis (hay fever) includes the use of fluticasone propionate nasal spray, which is a corticosteroid that can help reduce inflammation and alleviate symptoms.

• Fluticasone propionate has been shown to decrease nasal mucosal eosinophils and basophils in patients with allergic rhinitis.
• The mechanism of action of fluticasone propionate in treating allergic rhinitis is not fully understood, but it is thought to involve its anti-inflammatory effects on various cell types and mediators involved in inflammation.
• Montelukast is another option for the treatment of seasonal allergic rhinitis and perennial allergic rhinitis, which works by blocking the action of leukotrienes, substances in the body that cause inflammation and allergic symptoms. 2 3

From the Research

Treatment Options for Hay Fever

• Medications such as terfenadine and loratadine can be used to treat hay fever, with studies showing significant improvement in symptoms 4
• Combination therapy of betamethasone and loratadine has been shown to be effective in relieving symptoms of hay fever, particularly in severe cases 5
• Intranasal corticosteroids, such as mometasone furoate, beclomethasone dipropionate, and budesonide, are considered the most effective form of pharmacologic treatment for allergic rhinitis, including hay fever 6
• Topical nasal sprays, including steroids and cromolyn, can be used to treat allergic rhinitis, with nasal steroids being as safe and effective as antihistamines in controlling symptoms 7

Comparison of Treatment Options

• A study comparing the as-needed use of an H(1) receptor antagonist (loratadine) with that of an intranasal corticosteroid (fluticasone propionate) found that the intranasal corticosteroid was more effective in reducing allergic inflammation and improving symptoms 8
• Intranasal corticosteroids have been shown to be superior to oral antihistamines in the treatment of seasonal allergic rhinitis, with significant improvements in quality of life and symptom scores 8

Considerations for Treatment

• The choice of treatment for hay fever should be based on the severity of symptoms and the individual patient's needs
• Patients should be educated on the proper use of nasal sprays and the potential side effects of treatment 7
• The use of topical nasal decongestants should be limited to no more than three days to avoid significant side effects 7