What is the best treatment for allergic rhinitis?

From the Guidelines

The most effective treatment for allergic rhinitis is the use of intranasal corticosteroids, which have been shown to be highly effective in reducing inflammation and congestion, as recommended by the 2017 Joint Task Force on Practice Parameters 1.

Key Treatment Options

• Intranasal corticosteroids, such as fluticasone (1-2 sprays per nostril daily) or mometasone (1-2 sprays per nostril daily), are highly effective for reducing inflammation and congestion.
• Second-generation antihistamines, like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily), are recommended for their effectiveness in reducing symptoms with less drowsiness compared to first-generation options.
• For immediate relief of nasal congestion, decongestants like pseudoephedrine can be used short-term (3-5 days maximum to avoid rebound congestion).
• Saline nasal irrigation can help flush allergens and thin mucus.
• For severe cases or when other treatments fail, leukotriene modifiers like montelukast (10mg daily) or allergen immunotherapy (allergy shots) may be considered.

Additional Considerations

• Identifying and avoiding triggers such as pollen, dust mites, pet dander, or mold is crucial for long-term management of symptoms.
• Allergen immunotherapy should be considered for patients with allergic rhinitis who have demonstrable evidence of specific IgE antibodies to clinically relevant allergens, as it may prevent the development of new allergen sensitizations and reduce the risk for the future development of asthma 1.
• The decision to use allergen immunotherapy should be based on the degree to which symptoms can be reduced by avoidance and medication, the amount and type of medication required to control symptoms, and the adverse effects of medications.

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 best treatment for allergic rhinitis is Montelukast (SINGULAIR) 10-mg tablets or Fluticasone (IN), as both have shown significant reduction in symptoms of seasonal and perennial allergic rhinitis in clinical trials 2 3.

• Montelukast (SINGULAIR) has been shown to reduce daytime nasal symptoms scores in patients with seasonal and perennial allergic rhinitis.
• Fluticasone (IN) has been shown to be effective in reducing symptoms of seasonal and perennial allergic rhinitis with a low incidence of adverse reactions.

From the Research

Treatment Options for Allergic Rhinitis

The treatment for allergic rhinitis involves a combination of allergen avoidance, pharmacotherapy, and immunotherapy. The choice of treatment depends on the severity and frequency of symptoms, as well as patient preference.

• Pharmacotherapy:
  • Oral H1 antihistamines, such as cetirizine, desloratadine, and fexofenadine, are first-line therapy for mild-to-moderate allergic rhinitis 4, 5.
  • Intranasal steroids, such as fluticasone, triamcinolone, and budesonide, are first-line therapy for patients with more severe symptoms 4, 5.
  • Intranasal antihistamines, such as azelastine and olopatadine, can be used alone or in combination with intranasal corticosteroids 5, 6.
• Immunotherapy:
  • Allergen-specific immunotherapy can reduce drug consumption and is effective in severe rhinitis uncontrolled with drugs 7, 6.
  • Subcutaneous and sublingual routes are currently used, with sublingual tablets now available 6.
• Other Treatments:
  • Allergen avoidance is an important aspect of treatment, including avoiding inciting allergens and using nasal air filters or intranasal cellulose 5, 6.
  • Saline nasal irrigation can provide significant improvement, particularly in children 6.
  • Combination therapy with intranasal antihistamines and corticosteroids may be beneficial, particularly in monotherapy and AR resistant to previous treatment 8.

Treatment Guidelines

Treatment guidelines for allergic rhinitis recommend a stepwise approach, with treatment selection based on symptom severity and frequency.

• Mild Intermittent or Mild Persistent Allergic Rhinitis:
  • Second-generation H1 antihistamines or intranasal antihistamines can be used as first-line treatment 5.
• Persistent Moderate to Severe Allergic Rhinitis:
  • Intranasal corticosteroids, either alone or in combination with intranasal antihistamines, are recommended as first-line treatment 5, 6.