Rhinitis Management

Initial Treatment

The American Academy of Allergy, Asthma, and Immunology recommends intranasal corticosteroids as the first-line treatment for patients with moderate to severe or persistent rhinitis, while second-generation oral antihistamines or intranasal antihistamines are appropriate for mild intermittent symptoms 1, 2
For allergic rhinitis with mild intermittent symptoms, the American College of Allergy, Asthma, and Immunology suggests starting with a second-generation oral antihistamine or an intranasal antihistamine, which effectively control sneezing, itching, and rhinorrhea 1
Intranasal corticosteroid monotherapy is recommended as first-line treatment for moderate to severe or persistent allergic rhinitis, relieving all nasal symptoms and preventing late-phase allergic responses 1, 2

The American Academy of Otolaryngology recommends implementing allergen avoidance and using environmental control measures, such as staying indoors in air-conditioned environments with closed windows and doors, for severe seasonal allergic rhinitis 1, 2
Topical decongestants should be limited to a maximum of 3 days to prevent rhinitis medicamentosa, and may be used short-term to reduce severe congestion and allow intranasal corticosteroids to penetrate nasal mucosa effectively 3, 4
Nasal saline irrigation is recommended as a cornerstone therapy for rhinitis sicca, providing mechanical moisturization and crust removal 5

The American Academy of Pediatrics recommends avoiding oral decongestants in children under 6 years of age due to significant risks, including tachyarrhythmias, insomnia, hyperactivity, and even death at recommended doses 4
Infectious rhinitis should be treated with supportive measures to relieve ostiomeatal obstruction, and judicious antibiotics should only be used for suspected bacterial sinusitis 2, 6

The American College of Allergy, Asthma, and Immunology recommends evaluating multiple parameters at follow-up, including nasal symptoms, physical signs, quality of life, and comorbid conditions, to assess treatment response 1, 2, 6
Patients with prolonged manifestations despite treatment, complications, comorbid asthma or chronic sinusitis, or significant quality of life impairment should be referred to an allergist/immunologist 1, 2, 6