What are the AAO-HNSF guidelines on the treatment of allergic rhinitis?

Updated: Jan 02, 2020
  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
  • Print

Avoidance of known allergens or environmental controls (eg, removal of pets; the use of air filtration systems, bed covers, and acaricides) may be advised for patients who have identified allergens that correlate with clinical symptoms. (Option)

The presence of any of the following associated conditions should be documented in medical records: (Recommendation)

  • Asthma
  • Atopic dermatitis
  • Sleep-disordered breathing
  • Conjunctivitis
  • Rhinosinusitis
  • Otitis media

Management recommendations also include the following:

  • Clinicians should treat allergic rhinitis with intranasal steroids when patients' symptoms impair their quality of life (Strong recommendation)
  • Clinicians should recommend second-generation oral antihistamines, which are less likely to cause drowsiness, for patients complaining primarily of sneezing and itching (Strong recommendation)
  • For patients with seasonal, perennial, or episodic allergic rhinitis, intranasal antihistamines may be offered (Option)
  • Oral leukotriene receptor antagonists (LTRAs) should not be offered as primary therapy (Recommendation against)
  • Combination pharmacologic therapy may be offered to patients who do not have an adequate response to monotherapy (Option)
  • If patients have an inadequate response to pharmacologic therapy, with or without environmental controls, immunotherapy (sublingual or subcutaneous) should be offered (Recommendation)
  • For patients with nasal airway obstruction and enlarged inferior turbinates who have failed medical management, inferior turbinate reduction may be offered (Option)
  • For patients who prefer nonpharmacologic therapy, acupuncture may be offered (Option)

As a result of limited knowledge of herbal medicines and concern about the quality of standardization and safety, no recommendation was made on the use of herbal therapy.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!