ACAAI Releases Updated Allergic Rhinitis Treatment Guidelines

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The new guidelines for seasonal allergic rhinitis encourage shared decision-making with patients.
The new guidelines for seasonal allergic rhinitis encourage shared decision-making with patients.

In an update of guidelines for the treatment of seasonal allergic rhinitis published in Annals of Allergy, Asthma, & Immunology, the Joint Task Force on Practice Parameters offered recommendations for the types and dosages of medications for seasonal allergic rhinitis.

The guidelines were developed using the Grading of Recommendations, Assessment, Development, and Evaluations methodology and a systematic review of the literature. This was the first update of the guidelines for seasonal allergic rhinitis since 2008.


For the initial treatment of seasonal allergic rhinitis, the guidelines recommend monotherapy with an intranasal corticosteroid over combination treatment with an oral antihistamine. Additionally, intranasal corticosteroids are recommended over leukotriene receptor antagonists.

Furthermore, for treatment of moderate to severe seasonal allergic rhinitis in adults, clinicians may consider intranasal corticosteroids in combination with intranasal antihistamines. This combination therapy is more expensive than monotherapy, which should be taken into account by clinicians and patients.


The practice parameters also highlight the importance of shared decision making with patients, who should be informed about the potential lack of benefit of combination therapy compared with monotherapy.

In a press release regarding the new guidelines, allergist Dana Wallace, MD, past president of the American College of Allergy, Asthma and Immunology and co-author of the guidelines, said, "We want physicians to know it is a very different type of guideline than our previous practice parameters." Dr Wallace added that she believes the recommendations should mirror the experiences of most allergists.


Dykewicz MS, Wallace DV, Baroody F, et al. Treatment of seasonal allergic rhinitis: an evidence-based focused 2017 guideline update [published online November 2, 2017]. Ann Allergy Asthma Immunol. doi:10.1016/j.anai.2017.08.012

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