Allergic Rhinitis

AAAAI: New Guidelines For the Pharmacological Treatment of Seasonal Allergies

The American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology have developed new guidelines for the initial pharmacological treatment of seasonal allergic rhinitis in patients aged 12 years and older.

The guidelines were created because “no consensus exists about whether a particular medication should be used for initial treatment or about the benefit of using 2 or more medications concurrently for initial treatment” of allergic rhinitis.
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Among the recommendations:

  • Intranasal corticosteroid monotherapy is strongly recommended for the initial treatment of seasonal allergic rhinitis in patients aged 12 years and older over a combination of an intranasal corticosteroid with an oral antihistamine.
  • For patients aged 15 years and older, intranasal corticosteroid treatment is strongly recommended over a leukotriene receptor antagonist.
  • Physicians may consider treating patients aged 12 years and older with moderate to severe allergic rhinitis with a combination of intranasal corticosteroid and intranasal antihistamine. (weak recommendation)

“When treating patients with seasonal allergic rhinitis, clinicians need to use their expertise to assist patients in evaluating the best treatment choice through shared decision making; consider the potential for benefit as well as the potential for harm, the burden, and the cost of combination therapy; and allow patients to express their values and preferences and participate in the decision-making process,” the authors concluded.

—Melissa Weiss


Wallace DV, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM. Pharmacologic treatment of seasonal allergic rhinitis: synopsis of guidance from the 2017 Joint Task Force on Practice Parameters [published online before print November 28, 2017]. Ann Intern Med. doi:10.7326/M17-2203.