Clinical recommendation	Evidence rating	References
The initial treatment of mild to moderate allergic rhinitis should be an intranasal corticosteroid alone, with the use of second-line therapies for moderate to severe disease.	A	4, 5, 7
Compared with first-generation antihistamines, second-generation antihistamines have a better adverse effect profile, including less sedation (with the exception of cetirizine [Zyrtec]).	A	22
The adverse effects and higher cost of intranasal antihistamines, as well as their decreased effectiveness compared with intranasal corticosteroids, limit their use as first- or second-line therapy for allergic rhinitis.	A	28, 29
Although safe for general use, intranasal cromolyn (Nasalcrom) is not considered first-line therapy for allergic rhinitis because of its decreased effectiveness at relieving the symptoms of allergic rhinitis and its inconvenient dosing schedule.	C	1, 3
Nasal saline irrigation is beneficial in treating the symptoms of chronic rhinorrhea and may be used alone or as adjuvant therapy.	B	53
Although dust mite allergies are common, studies have not found any benefit to using mite-proof impermeable mattress and pillow covers.	A	54–56
Interventions without documented effectiveness in the prevention of allergic rhinitis include breastfeeding, delayed exposure to solid foods in infancy, and the use of air filtration systems.	B	57–61