What are the treatment options for seasonal allergic rhinitis?

From the Guidelines

For initial treatment of seasonal allergic rhinitis in persons aged 12 years or older, I strongly recommend prescribing monotherapy with an intranasal corticosteroid rather than an intranasal corticosteroid in combination with an oral antihistamine. This approach is supported by the 2017 joint task force on practice parameters 1. The use of intranasal corticosteroids as a first-line treatment is due to their effectiveness in reducing symptoms of sneezing, itching, rhinorrhea, and nasal congestion.

Some key points to consider when treating seasonal allergic rhinitis include:

• Intranasal corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis 1
• Oral antihistamines can be used to reduce symptoms of rhinorrhea, sneezing, and itching, but have little effect on nasal congestion 1
• Non-medication approaches such as keeping windows closed during high pollen days, showering after being outdoors, and using air purifiers with HEPA filters can also help alleviate symptoms
• If symptoms persist after 2-3 weeks of consistent treatment, consultation with a healthcare provider about prescription options or allergy immunotherapy may be necessary

It's essential to note that the combination of an intranasal corticosteroid and an intranasal antihistamine may be recommended for initial treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older, although this is a weak recommendation 1. Additionally, specific allergen immunotherapy (subcutaneous or sublingual) may be beneficial for patients with moderate-to-severe seasonal allergic rhinitis, as it is the only disease-modifying therapeutic method 1.

From the FDA Drug Label

Fluticasone Propionate Nasal Spray, USP helps relieve a broad range of symptoms from many allergens. For example, Fluticasone Propionate Nasal Spray, USP helps with: Fluticasone Propionate Nasal Spray, USP not only relieves sneezing, itchy nose, runny nose and itchy, watery eyes, but also relieves nasal congestion. Uses: Temporarily relieves these symptoms due to hay fever or other upper respiratory allergies runny nose sneezing itchy, watery eyes itching of the nose or throat

Seasonal Allergy Treatment: Fluticasone Propionate Nasal Spray, USP and cetirizine can be used to relieve symptoms of seasonal allergies, including sneezing, runny nose, itchy eyes, and nasal congestion.

• Fluticasone Propionate Nasal Spray, USP works directly in the nose to block allergic reactions and relieve symptoms.
• Cetirizine temporarily relieves symptoms due to hay fever or other upper respiratory allergies, including runny nose, sneezing, itchy, watery eyes, and itching of the nose or throat. It is recommended to follow the instructions for use and consult a doctor if symptoms persist or worsen 2, 2, 3.

From the Research

Seasonal Allergy Treatment Options

• Intranasal corticosteroids, such as fluticasone propionate, are effective in treating seasonal allergic rhinitis, as shown in a study published in 1998 4
• Oral antihistamines, like loratadine, can also be used, but may not be as effective as intranasal corticosteroids, according to the same study 4
• Second-generation antihistamines, including cetirizine, desloratadine, and fexofenadine, are considered a better alternative to first-generation antihistamines due to their lower risk of sedation and other adverse effects, as discussed in a 2005 study 5

Treatment Guidelines

• The treatment of seasonal allergic rhinitis should be based on the severity and frequency of symptoms, as well as patient preference, according to a 2024 review 6
• For mild intermittent or mild persistent allergic rhinitis, second-generation H1 antihistamines or intranasal antihistamines may be used as first-line treatment, while patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid, either alone or in combination with an intranasal antihistamine, as recommended in the same review 6
• New guidelines for the treatment of seasonal allergic rhinitis emphasize the importance of nasal glucocorticoids, nasal and oral antihistamines, and antileukotrienes, as discussed in a 2019 paper 7

Pharmacological Management

• Pharmacologic options for the management of allergic rhinitis include oral and intranasal antihistamines, intranasal corticosteroids, oral and intranasal decongestants, oral and intranasal anticholinergics, and leukotriene receptor antagonists, according to a 2017 review 8
• 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, as discussed in the same review 8
• Combination therapy of intranasal corticosteroids and oral antihistamines may be effective in treating allergic rhinitis, as shown in studies comparing fluticasone propionate with cetirizine or loratadine, according to the same review 8