Guidelines Summary

Joint Task Force on Practice Parameters (JTFPP)

In 2020, the Joint Task Force on Practice Parameters (JTFPP) released updated recommendations for the treatment of allergic rhinitis and nonallergic rhinitis in adolescents and adults. Updated guidelines are as follows:^[79]

Allergic Rhinitis

In patients aged 12 years or older, mild intermittent symptoms should be treated initially with a second-generation oral antihistamine (OAH) or intranasal antihistamine (INAH) as needed. For moderate/severe, intermittent symptoms it is similarly recommended to treat initially with a second-generation OAH or INAH as needed, with the next step adding intranasal corticosteroids (INCS) to the INAH.
In patients aged 12 years or older, mild persistent symptoms should be treated initially with an INCS while moderate/severe persistent symptoms should have INAH and INCS combination therapy.
Leukotriene receptor antagonists are not recommended for initial treatment of allergic rhinitis. Corticosteroid injections are no longer recommended given their side effect profile.

Nonallergic rhinitis

In patients aged 12 years or older, mild intermittent symptoms as well as moderate/severe symptoms of NAR are recommended to be treated by an INAH initially.
In patients aged 12 years or older with mild persistent symptoms of NAR, it is recommended to treat with an INAH. Moderate/severe persistent symptoms should be treated with both INAH and INCS.

American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNS)

In 2015, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNS) released guidelines for treating patients ages 2 and up who suffer from allergic rhinitis.^{[80, 81]}

Key recommendations include the following:

For patients with a stuffy nose, nasal passage discoloration, and/or red and watery eyes, doctors should forgo sinus imaging process in favor of specific immunoglobulin E screening. Sinonasal imaging exposes patients to unnecessary radiation.
Intranasal steroids and oral antihistamines are recommended as first lines of treatment. Oral leukotriene receptor antagonists are not.
Sublingual or subcutaneous immunotherapy should be offered to patients who do not respond to pharmacologic therapy.

Medication

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Author

Tiffany Jean, MD Assistant Clinical Professor, Division of Basic and Clinical Immunology, University of California Irvine Medical Center

Tiffany Jean, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology

Disclosure: Nothing to disclose.

Coauthor(s)

Ahdad Ziyar, MD Fellow, Division of Basic and Clinical Immunology, University of California Irvine Medical Center

Ahdad Ziyar, MD is a member of the following medical societies: American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Stephen C Dreskin, MD, PhD Professor of Medicine, Departments of Internal Medicine, Director of Allergy, Asthma, and Immunology Practice, University of Colorado Health Sciences Center

Stephen C Dreskin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association for the Advancement of Science, American College of Allergy, Asthma and Immunology, Clinical Immunology Society, Joint Council of Allergy, Asthma and Immunology, American Association of Immunologists

Disclosure: Received consulting fee from Genentech for consulting; Received grant support from NIH for research; Received consulting fee from Clinical Immunization and Safety Assessment (CISA) Network (administered by Vanderbilt University) for consulting; Received consulting fee from o Member, Medical Expert Panel, Division of Vaccine Injury Compensation (DVIC), Department of Health and Human Services. for med legal reviews; Received consulting fee from o Member, Medical Expert Panel, Vaccine Review, Pfize.

Chief Editor

Michael A Kaliner, MD Clinical Professor of Medicine, George Washington University School of Medicine; Medical Director, Institute for Asthma and Allergy

Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, Association of American Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Javed Sheikh, MD Assistant Professor of Medicine, Harvard Medical School; Clinical Director, Division of Allergy and Inflammation, Clinical Director, Center for Eosinophilic Disorders, Beth Israel Deaconess Medical Center

Javed Sheikh, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology

Disclosure: Received grant/research funds from Genentech for other.

William F Schoenwetter, MD Consultant in Allergic Diseases, Brainerd Medical Center, Brainerd, Minnesota

William F Schoenwetter, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, American Medical Association, Joint Council of Allergy, Asthma and Immunology, Minnesota Medical Association

Disclosure: Nothing to disclose.

Umer Najib, MD Clinical Research Fellow, Department of Medicine, Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center

Disclosure: Nothing to disclose.