What are the recommended first-line treatments for allergic rhinitis in adults and children?

For adults and children with allergic rhinitis, the recommended first-line treatment is the use of intranasal corticosteroids, which effectively reduce nasal inflammation and symptoms such as congestion, sneezing, and rhinorrhoea. These are considered the most effective monotherapy for moderate to severe symptoms and can be used in both age groups with appropriate dosing adjustments ¹ (Brożek et al., 2017).

In addition to intranasal corticosteroids, oral or intranasal antihistamines are recommended as first-line options, particularly for mild to moderate symptoms or when nasal corticosteroids are not tolerated. Non-sedating oral antihistamines are preferred to minimise sedation, especially in children (Okubo et al., 2020). Antihistamines can be used alone or in combination with nasal corticosteroids for better symptom control ¹ (Tosca et al., 2024).

For children, treatment should be age-appropriate, and intranasal corticosteroids with established safety profiles in paediatrics are preferred. Careful consideration of dosing and monitoring for side effects is advised ¹ (Brożek et al., 2017). Additionally, saline nasal sprays or rinses may be used as adjunctive therapy to relieve nasal symptoms and improve mucosal clearance, although they are not a substitute for pharmacological treatment ¹ (Okubo et al., 2020).

Overall, the initial management strategy involves starting with intranasal corticosteroids and/or antihistamines, tailored to symptom severity and patient age, with regular review to assess efficacy and tolerability ¹ (Tosca et al., 2024).