Intranasal corticosteroids are the most effective treatment for rhinitis, including allergic and non-allergic types, and are recommended for regular use in moderate to severe, persistent cases NICE CKS.
They should be prescribed at the lowest effective dose, especially in children, with growth monitoring advised due to potential impact, although second-generation corticosteroids like mometasone, fluticasone furoate, or fluticasone propionate have minimal systemic absorption NICE CKS.
Intranasal corticosteroids may be started two weeks prior to a known allergen season to achieve maximal effect, which may not be seen until after two weeks of treatment NICE CKS.
In cases of persistent rhinitis, if symptoms do not improve with initial treatment or if anatomical obstruction is suspected, referral to an ear, nose, and throat specialist should be considered NICE CKS.