From the Guidelines
The first-line treatment for allergic rhinitis is monotherapy with an intranasal corticosteroid, as recommended by the 2017 Joint Task Force on Practice Parameters 1. This approach is based on strong evidence that intranasal corticosteroids are the most effective medication class for controlling sneezing, itching, rhinorrhea, and nasal congestion, the 4 major symptoms of allergic rhinitis.
- Key benefits of intranasal corticosteroids include:
- Effective reduction of inflammation and all nasal symptoms
- Minimal systemic side effects when used at recommended doses
- Suitable for treatment of more severe allergic rhinitis and some forms of nonallergic rhinitis
- Proper administration of nasal sprays involves aiming slightly away from the nasal septum and gently sniffing.
- If symptoms persist despite intranasal corticosteroid treatment, adding a second-generation oral antihistamine or consulting an allergist for immunotherapy may be considered.
- It is essential to note that the combination of an intranasal corticosteroid and an oral antihistamine may not provide significant additional benefits over monotherapy with an intranasal corticosteroid, as suggested by the evidence 1.
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 efficacy of SINGULAIR tablets for the treatment of perennial allergic rhinitis was investigated in 2 randomized, double-blind, placebo-controlled studies conducted in North America and Europe. In the study in which efficacy was demonstrated, SINGULAIR 10-mg tablets once daily was shown to significantly reduce symptoms of perennial allergic rhinitis over a 6-week treatment period.
The first-line treatment for allergic rhinitis is not explicitly stated in the provided drug labels. However, based on the information provided, montelukast (SINGULAIR) has been shown to be effective in reducing symptoms of seasonal allergic rhinitis and perennial allergic rhinitis.
- Key points:
- Montelukast has been investigated for the treatment of seasonal allergic rhinitis and perennial allergic rhinitis.
- The studies demonstrated a significant reduction in daytime nasal symptoms scores with montelukast 10-mg tablets compared with placebo.
- Montelukast may be considered as a treatment option for allergic rhinitis, but it is essential to consult the FDA drug label and other relevant resources for the most up-to-date and accurate information 2 2.
From the Research
First-Line Treatment for Allergic Rhinitis
The first-line treatment for allergic rhinitis includes:
- Intranasal corticosteroids, which are accepted as safe and effective therapy for allergic rhinitis 3
- Oral H1 antihistamines are first-line therapy for mild-to-moderate allergic rhinitis, with newer, nonsedating agents recommended over first-generation antihistamines 4
- Second-generation oral antihistamines and intranasal corticosteroids are the mainstays of treatment, with practice guidelines recommending intranasal corticosteroids as first-line treatment for moderate to severe allergic rhinitis 5
Treatment Options
Treatment options for allergic rhinitis include:
- Intranasal corticosteroids, such as beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide 3
- Oral and intranasal antihistamines, intranasal decongestants, oral and intranasal anticholinergics, and leukotriene receptor antagonists 5
- Montelukast add-on therapy, which has been shown to be as efficacious as conventional therapies in controlling total symptom score, but more efficacious in controlling nighttime symptoms 6
Safety and Efficacy
The safety and efficacy of these treatment options have been evaluated in various studies, with intranasal corticosteroids generally considered safe and effective, but with potential side effects such as dryness, burning, and stinging, and headache and epistaxis in 5-10% of patients 3, 7