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INCS are recommended as first-line treatment by major global

ARIA 2016 1
First-line treatment option for symptomatic patients with or without previous treatment.

AAOHNS 2015 2
Strong recommendation for patients whose symptoms affect their QoL

BSACI 2017 3
Mainstay of anti-inflammatory intervention in AR and first-line therapy for moderate-to-severe persistent symptoms.

AAAAI / ACAAI 2017 4
Strongly recommends first-line use in SAR (over OAH and INCS combination in patients aged ≥12 years and over LTRA in patients aged ≥15 years).

Treatment of AR in children and teenagers 5

Treatment of AR in children guidelines
  • Approach depends on the severity of rhinitis symptoms
  • Use a step-up or step-down therapy, depending on control obtained in response to treatment
  • OAH may be better tolerated, INAH have a more rapid onset of action
  • Reconsider diagnosis if not controlled within 1 to 2 weeks

AAAAI: American Academy of Allergy, Asthma and Immunology; AAOHNS: American Academy of Otolaryngology - Head and Neck Surgery; ACAAI: American College of Allergy, Asthma, and Immunology; AH: antihistamine; AR: allergic rhinitis; ARIA: Allergic Rhinitis and its Impact on Asthma; BSACI: British Society for Allergy and Clinical Immunology; INAH: intranasal antihistamine; INCS: intranasal corticosteroids; LTRA: leukotriene receptor antagonist; OAH: oral antihistamine; QoL: quality of life; Rx: medical prescription; SAR: seasonal allergic rhinitis.


  1. Brozek J, Bousquet J, Agache I, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950–958.
  2. Seidman M, Gurgel RK, Lin SY, et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngol Head Neck Surg. 2015:152(18) S1–S43.
  3. Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis. Clin Exp Allergy. 2017;47:856–889.
  4. Wallace DV, Dykewicz MS, Oppenheimer J, et al. Pharmacologic Treatment of Seasonal Allergic Rhinitis: Synopsis of Guidance from the 2017 Joint Task Force on Practice Parameters. Ann Intern Med. 2017;167(12):876–881.
  5. Santos A, Borrego LM, Rotiroti G, et al. The need for patient-focused therapy for children and teenagers with allergic rhinitis: a case-based review of current European practice. Clin Transl Allergy. 2015;5:2.

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