From the Guidelines
Allergic rhinitis treatment should prioritize the use of intranasal corticosteroids as the most effective medication class for controlling symptoms, according to the most recent and highest quality study 1.
Treatment Options
The treatment of allergic rhinitis typically involves a combination of medications and environmental control measures.
- For mild symptoms, over-the-counter antihistamines like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily) can provide relief by blocking histamine receptors that trigger allergy symptoms 1.
- Nasal corticosteroid sprays such as fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) are considered first-line treatments for moderate to severe symptoms, as they reduce inflammation and can be used long-term 1.
Environmental Control Measures
Environmental measures are equally important:
- Keep windows closed during high pollen seasons
- Use air purifiers with HEPA filters
- Wash bedding weekly in hot water
- Shower after outdoor exposure to remove allergens These treatments work by either blocking the allergic response pathway or reducing exposure to the allergens that trigger symptoms.
Immunotherapy
For persistent symptoms despite these measures, consult a healthcare provider who may recommend immunotherapy (allergy shots) to gradually desensitize your immune system to specific allergens, as recommended by the 2015 clinical practice guideline 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. The primary outcome variable was mean change from baseline in daytime nasal symptoms score (the average of individual scores of nasal congestion, rhinorrhea, nasal itching, sneezing) as assessed by patients on a 0-3 categorical scale 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
Allergic Rhinitis Treatment:
- Seasonal Allergic Rhinitis: Montelukast (SINGULAIR) 10-mg tablets have been shown to significantly reduce symptoms of seasonal allergic rhinitis in four out of five trials.
- Perennial Allergic Rhinitis: Montelukast (SINGULAIR) 10-mg tablets have been shown to significantly reduce symptoms of perennial allergic rhinitis in one out of two trials. Montelukast is effective in treating allergic rhinitis, as demonstrated by a significant reduction in daytime nasal symptoms scores in patients with seasonal and perennial allergic rhinitis 2 2.
From the Research
Allergic Rhinitis Treatment Options
- Allergen avoidance, pharmacotherapy, and immunotherapy are the main management strategies for allergic rhinitis 3, 4, 5
- Pharmacologic options include:
- Oral and intranasal antihistamines
- Intranasal corticosteroids
- Oral and intranasal decongestants
- Oral and intranasal anticholinergics
- Leukotriene receptor antagonists 3
- Second-generation oral antihistamines and intranasal corticosteroids are the mainstays of treatment, with intranasal corticosteroids recommended as first-line treatment for moderate to severe allergic rhinitis 3, 4, 5
Treatment Guidelines
- For mild intermittent or mild persistent allergic rhinitis, second-generation H1 antihistamines (e.g., cetirizine, fexofenadine, desloratadine, loratadine) or intranasal antihistamines (e.g., azelastine, olopatadine) may be used as first-line treatment 4
- For persistent moderate to severe allergic rhinitis, intranasal corticosteroids (e.g., fluticasone, triamcinolone, budesonide, mometasone) are recommended as first-line treatment, either alone or in combination with an intranasal antihistamine 4
- Combination therapy of intranasal corticosteroids and oral antihistamines may be effective for some patients 3, 6
Treatment in Specific Populations
- In infants and children, second-generation antihistamines (e.g., cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine) and the leukotriene receptor antagonist montelukast are relatively safe and effective for treating allergic rhinitis 7
- Alternative dosage forms, such as liquids or oral disintegrating tablets, are available for most agents, allowing ease of administration to young children and infants 7