Clinical Practice Guideline

Allergic Rhinitis

(Endorsed 2014) (Reaffirmed, April 2020)

The guideline, Allergic Rhinitis, was developed by the American Academy of Otolaryngology-Head and Neck Surgery and was endorsed by the American Academy of Family Physicians.

Key Recommendations

The diagnosis of allergic rhinitis (AR) should be made when history and physical findings are consistent with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa, and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing.
Individuals with AR should be assessed for the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media.
Specific IgE testing (blood or skin) should be performed for patients with a clinical diagnosis of AR who do not respond to empiric treatment, or when diagnosis is uncertain, or when determination of specific target allergen is needed.
Sinonasal imaging should not routinely be performed in patients presenting with symptoms consistent with allergic rhinitis.
Intranasal steroids should be prescribed for patients with AR whose symptoms affect quality of life.
Oral second-generation/less sedating antihistamines should be prescribed for patients with AR and primary complaints of sneezing and itching.
Intranasal antihistamines may be prescribed for patients with seasonal, perennial, or episodic AR.
Oral leukotriene receptor antagonists should not be prescribed as primary therapy for patients with AR.
Combination pharmacologic therapy may be prescribed for patients with AR who have inadequate response to monotherapy. The most effective combination therapy is an intranasal steroid and an intranasal antihistamine.
Immunotherapy should be prescribed for patients with AR who have inadequate response to pharmacologic therapy.
Avoidance of known allergens or environmental control may be considered in patients with AR who have identified allergens that correlate with their clinical symptoms.
Inferior turbinate reduction may be considered for patients with AR with nasal airway obstruction and enlarged inferior turbinates who have failed medical management.

See the full recommendation for further details, including a treatment flow chart and specific pharmacologic options.

More About Practice Guidelines

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.