Treatment of Severe Allergic Rhinitis with Prednisone

Indications and Usage

The American Academy of Allergy, Asthma, and Immunology recommends oral corticosteroids like prednisone for patients with severe, intractable nasal symptoms that are unresponsive to other treatment modalities 1
Short courses (5-7 days) of oral prednisone may be appropriate when symptoms are extremely severe and significantly impact quality of life 3

Intranasal corticosteroids are the most effective medication class for controlling all four major symptoms of allergic rhinitis (sneezing, itching, rhinorrhea, and nasal congestion), according to the American College of Allergy, Asthma, and Immunology 4, 3
Second-generation oral antihistamines are effective for symptom relief with less sedation than first-generation options, as recommended by the American Academy of Allergy, Asthma, and Immunology 5
Leukotriene receptor antagonists (e.g., montelukast) may be used, though they are generally less effective than intranasal corticosteroids, according to the American College of Physicians 6, 7

Single administration of parenteral corticosteroids is discouraged, and recurrent administration is contraindicated due to greater potential for long-term side effects, as warned by the American Academy of Allergy, Asthma, and Immunology 1
Potential for adrenal suppression should be considered in any patient receiving oral corticosteroids, according to the American College of Allergy, Asthma, and Immunology 1
Oral corticosteroids should not be administered as therapy for chronic rhinitis except in rare cases, as recommended by the American Academy of Allergy, Asthma, and Immunology 1