Practice Guidelines

Treatment of Seasonal Allergic Rhinitis: A Guideline from the AAAAI/ACAAI Joint Task Force on Practice Parameters


Am Fam Physician. 2018 Jun 1;97(11):756-757.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Patients 12 years and older should be treated with intranasal corticosteroid monotherapy over combined intranasal corticosteroid and oral antihistamine therapy to treat seasonal allergic rhinitis.

• Combined intranasal corticosteroid and intranasal antihistamine therapy can be considered for allergic nasal symptoms for patients 12 years and older.

• For patients 15 years and older, an intranasal corticosteroid is preferred over a leukotriene receptor antagonist.

From the AFP Editors

Seasonal allergic rhinitis, which has a prevalence of 14% among U.S. adults, can be mild (i.e., symptoms do not affect quality of life) to severe (i.e., symptoms do affect quality of life). Although treatment options include environmental controls and allergen immunotherapy, it is often treated with pharmacologic therapy, which is the focus of this guideline. However, there is no consensus about whether one medication is superior to another, or if using at least two medications in combination is beneficial. To outline quality improvement opportunities for the treatment of seasonal allergic rhinitis, the Joint Task Force on Practice Parameters, consisting of experts from the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI), created a guideline to outline initial pharmacologic treatment in persons at least 12 years of age with moderate to severe seasonal allergic rhinitis.


Pharmacologic therapy includes intranasal and oral formulations of antihistamines, decongestants, and corticosteroids, and intranasal cromolyn, intranasal anticholinergics, and oral leukotriene receptor antagonists. However, the three questions addressed in the updated guideline focused on only certain medications based on clinical importance, new data, and the opportunity to support improved care or better cost effectiveness. Because combination therapy with oral antihistamines and intranasal corticosteroids

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



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