ARIA
Allergic Rhinitis
and its Impact
on Asthma
ARIA Guidelines – 2016 Revision

In patients with seasonal allergic rhinitis, it’s suggested either a combination of an intranasal corticosteroid with an oral H1-antihistamine or an intranasal corticosteroid alone.1
This is a conditional recommendation; thus, different choices will be appropriate for different patients. A combination therapy may be a reasonable choice, especially in patients who are not well controlled with INCS alone, those with pronounced ocular symptoms or those commencing treatment because of likely faster onset of treatment effects.1

This recommendation concerns regular use of newer, less sedative OAH and INCS in seasonal AR.1

ARIA: Allergic Rhinitis and its Impact on Asthma; OAH: oral antihistamines; INCS: intranasal corticosteroids
1. Brozek JL, Bousquet J, Agache L, et al., Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950-958.
EUFOREA
European Forum for
Research and Education
in Allergy and Airway
Diseases
EUFOREA Treatment Algorithm for Allergic Rhinitis

Oral non-sedating antihistamines are recommended for AR patients presenting with rhinorrhea/itchy nose.1

Oral antihistamines are often used as first-line therapy in patients with rhinitis symptoms. The use of these H1 receptor antagonists had long been limited due to sedating side effects; however, the newer second-generation drugs are extremely safe and efficacious with far less sedation. Oral non-sedating antihistamines are most beneficial for the suppression of nasal pruritus, sneezing, rhinorrhea, and accompanying ocular symptoms.2

AR: allergic rhinitis.
1. https://www.euforea.eu/news/euforea-treatment-algorithm-allergic-rhinitis. 2. In-Depth Review of Allergic Rhinitis. World Allergy Organization.
BSACI
The British Society for
Allergy & Clinical
Immunology
BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017)

Oral antihistamines are considered the first-line therapy for mild-to-moderate intermittent and mild persistent rhinitis.

Use of first-generation antihistamines is not recommended. First-generation antihistamines are less useful due to sedation and cognitive impairment, which can worsen driving and examination results already impaired by rhinitis.

BSACI: The British Society for Allergy & Clinical Immunology.
1. Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline (Revised Edition 2017). Clin Exp Allergy. 2017;47(7):856-889.
American
Academy of
Otolaryngology–
Head and Neck Surgery
AAO-HNSF

Clinicians should recommend oral second-generation/less sedating antihistamines for patients with AR and primary complaints of sneezing and itching (Strong recommendation).

  • Advantages of oral antihistamines include rapid onset of action, once-daily dosing, maintenance of effectiveness with regular use, and the availability of some drugs without a prescription.
  • Maximum benefit is seen with continuous use but use on an as-needed basis can provide significant symptom relief and is appropriate for some patients, especially those with intermittent symptoms.
AAO-HNSF: American Academy of Otolaryngology–Head and Neck Surgery; INS: intranasal steroid; AR: allergic rhinitis.
Ref: Seidman MD, Gurgel RK, Lin SY, et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngol Head Neck Surg. 2015;152(1_suppl):S1-S43. doi:10.1177/0194599814561600.
AAAAI:
American Academy of Allergy,
Asthma and Immunology

ACAAI:
American College of Allergy,
Asthma and Immunology
AAAAI/ACAAI Allergy Practice Parameters

Recommend against prescribing a first-generation antihistamine and are in favor of a second-generation antihistamine.

Strength of recommendation: Strong. Certainty of evidence: High. Selecting a second-generation antihistamine reduces the potential side effects including sedation, performance impairment, poor sleep quality, and anticholinergic-mediated symptoms (e.g., dry eyes/mouth, constipation, urinary hesitancy/retention) that have been associated with the first-generation antihistamines.

AAAAI: American Academy of Allergy, Asthma and Immunology; ACAAI: American College of Allergy, Asthma and Immunology; AR: allergic rhinitis.
Ref: Dykewicz MS, Wallace DV, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020;146(4):721-767. doi:10.1016/j.jaci.2020.07.007. PMID: 32707227.

Publications

(Click on any publication to explore it)
  1. https://onlinelibrary.wiley.com/doi/10.1111/all.15032 EAACI guidelines: Anaphylaxis (2021 update)
  2. https://onlinelibrary.wiley.com/doi/10.1111/pai.13496 EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update)
  3. https://www.jacionline.org/article/S0091-6749(19)31187-X/fulltext Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis
  4. https://onlinelibrary.wiley.com/doi/10.1111/all.13162# Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis – A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement
  5. Scadding GK, Smith PK, Blaiss M, et al. Allergic Rhinitis in Childhood and the New EUFOREA Algorithm. Front Allergy. 2021;2:706589. Published 2021 Jul 14. doi:10.3389/falgy.2021.706589