A 36-year-old gentleman has recurrent sneezing, rhinorrhoea, and nasal

The most effective treatment for a 36-year-old man with recurrent sneezing, rhinorrhea, and nasal obstruction occurring seasonally during spring, without significant past medical history or notable eye symptoms, is regular intranasal corticosteroids (INCS). This is because INCS provide superior control of nasal inflammation and congestion, which are typically the most bothersome symptoms in moderate to severe seasonal allergic rhinitis (SAR) presenting with such symptoms without ocular involvement NICE CKS.

Given his predominantly nasal symptoms and seasonal pattern consistent with pollen exposure, starting INCS regularly during the pollen season is recommended to optimize symptom control, ideally beginning 1–2 weeks before expected allergen exposure NICE CKS Shim 2026.

For those with inadequate symptom control on INCS monotherapy, adding an intranasal antihistamine (INAH) can offer additional benefit. Combination intranasal corticosteroid and antihistamine sprays provide faster and more effective symptom relief than either agent alone and can improve sneezing, rhinorrhea, nasal obstruction, and nasal itching NICE CKS Sima et al. 2026.

Among available fixed-dose combination sprays, the olopatadine-mometasone furoate nasal spray (GSP301) has demonstrated superior efficacy and safety compared to monotherapy with either olopatadine or mometasone alone in adults with moderate-to-severe SAR, leading to significant and clinically meaningful improvements in nasal symptoms and quality of life, with a favorable tolerability profile SmPC Azelastine Sima et al. 2026.

Oral non-sedating antihistamines may be considered for mild intermittent symptoms or if rapid symptom relief is desired, but they are less effective for nasal congestion compared with INCS and are not routinely recommended as monotherapy for persistent moderate to severe symptoms NICE CKS Shim 2026.

Saline nasal irrigation and allergen avoidance advice should accompany pharmacologic treatment, although allergen avoidance alone is often insufficient in polysensitized individuals NICE CKS Singh et al. 2025.

Oral leukotriene receptor antagonists are generally reserved as add-on therapy in patients with coexisting asthma, and not as first-line treatment for allergic rhinitis NICE CKS Shim 2026.

In summary, for this patient with seasonal nasal symptoms typical of allergic rhinitis, start regular intranasal corticosteroid therapy during the pollen season, monitor response after 2–4 weeks, and consider combination intranasal corticosteroid/antihistamine spray if symptoms persist. Oral antihistamines may be added for mild symptoms or rapid relief, but monotherapy with oral antihistamines is less effective for nasal congestion NICE CKS Sima et al. 2026 Shim 2026.