Medication Options for Allergic Rhinitis

First-Line Treatment Options

The American Academy of Allergy, Asthma, and Immunology recommends intranasal corticosteroids as the most effective first-line treatment option for allergic rhinitis symptoms, including runny nose and watery eyes, due to their superior relief of all nasal symptoms, including congestion, rhinorrhea, and ocular symptoms 1, 2
Intranasal corticosteroids have an onset of action typically within 12 hours, and may start as early as 3-4 hours in some patients, and are recommended for continuous use rather than as-needed for optimal effectiveness 1, 2
Second-generation oral antihistamines, such as loratadine and desloratadine, are effective for rhinorrhea, sneezing, and ocular symptoms, though less effective for nasal congestion, and are preferred over first-generation antihistamines due to less sedation and anticholinergic effects 1, 2, 3

Intranasal corticosteroids are more effective than oral antihistamines for overall control of allergic rhinitis symptoms, particularly nasal congestion, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 4
Intranasal antihistamines have a faster onset of action compared to oral antihistamines and are more effective for nasal congestion, as stated by the American Academy of Allergy, Asthma, and Immunology 6

For moderate to severe symptoms, the American Academy of Allergy, Asthma, and Immunology recommends starting with intranasal corticosteroid as monotherapy, and if ocular symptoms predominate, adding oral antihistamine or considering topical ocular antihistamine 1, 2, 7
Combination therapy with intranasal corticosteroid plus oral antihistamine may be considered for patients with inadequate response to monotherapy, as suggested by the American Academy of Allergy, Asthma, and Immunology 1

For patients with both allergic rhinitis and asthma, the American Academy of Allergy, Asthma, and Immunology suggests considering leukotriene receptor antagonists, such as montelukast 4
Continuous treatment is generally more effective than as-needed use for seasonal or perennial allergic rhinitis, according to the American Academy of Allergy, Asthma, and Immunology 5

The American Academy of Allergy, Asthma, and Immunology advises avoiding first-generation antihistamines due to sedation and performance impairment, even when sedation is not subjectively perceived 3
Prolonged use of intranasal decongestants should be avoided due to the risk of rebound congestion, as warned by the American Academy of Allergy, Asthma, and Immunology 1, 2