Allergic Rhinitis Guidelines

Updated: Aug 05, 2021
  • Author: Tiffany Jean, MD; Chief Editor: Michael A Kaliner, MD  more...
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Guidelines

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.