Allergic rhinitis

Audience: Patients and providers
Status: Clinical guide · patient + provider
Last updated: 2026-03-27

1. Clinical overview

Allergic rhinitis is an IgE-mediated upper-airway inflammatory disorder that drives nasal symptoms, sleep disruption, and reduced daytime function, often alongside asthma or conjunctival symptoms.

2. Common causes and risk factors

Pollen, dust mites, pets, molds, and occupational allergens are common triggers.
Family history of atopy, asthma, eczema, and ongoing environmental exposure increase risk.

3. Typical symptoms

Sneezing, rhinorrhea, nasal congestion, itchy nose/eyes, postnasal drip, and seasonal or trigger-linked flares.

4. Diagnosis and evaluation

Diagnosis is usually clinical based on symptom pattern, trigger history, and exam findings.
Distinguish allergic rhinitis from viral illness, chronic sinusitis, medication-related symptoms, and structural obstruction.
Review asthma symptoms, sleep impact, work/school impairment, and sedating medication burden.

5. Treatment (non-pharmacologic)

Reduce trigger exposure when feasible: bedding covers, pollen avoidance strategies, pet/indoor allergen mitigation.
Saline irrigation can improve mucus burden and comfort.
Reinforce adherence during active seasons rather than PRN underuse.

6. Treatment (pharmacologic)

Intranasal corticosteroids such as fluticasone, triamcinolone, or budesonide are usual first-line maintenance options.
Add intranasal antihistamine such as azelastine or a non-sedating oral antihistamine such as cetirizine, fexofenadine, or loratadine based on symptom profile.
Combination products such as azelastine/fluticasone can help when monotherapy is inadequate.

7. Monitoring and follow-up

Reassess symptom control, sleep quality, technique, and sedation burden after 2 to 6 weeks of regimen change.
Review whether asthma, sinus symptoms, or recurrent otitis are complicating the picture.

8. Practical counseling points

Daily nasal steroid use works better than intermittent rescue-only use for persistent symptoms.
Review spray technique before intensifying therapy.
Limit sedating antihistamines, especially in older adults and patients with fall or cognitive risk.

9. Red flags and escalation

Reassess urgently for unilateral symptoms, severe facial pain, recurrent epistaxis, fever, or suspected structural lesion.
Consider allergy or ENT referral for refractory symptoms, uncertain diagnosis, or recurrent sinus complications.

10. Guideline references

AAAAI/ACAAI practice parameters.
ARIA allergic rhinitis guidance.
NHLBI asthma guidance where comorbid asthma is present.

Note: Educational guide only; not a substitute for individualized medical care.