Mild Intermittent Allergic Rhinitis: When Initial Treatments Have Not Resolved Nasal Congestion, Rhinorrhea, or Nasal Ocular Symptoms
Clinical Scenario
Mild intermittent allergic rhinitis is defined by symptoms occurring fewer than four days per week or fewer than four weeks per year, at a severity that does not interfere with quality of life. Initial management is directed at resolving nasal congestion, rhinorrhea, and nasal ocular symptoms.
When the First-Line Approach Has Not Worked
A first-line strategy for mild intermittent disease — which may include nasal irrigation, a decongestant, ipratropium, or an intranasal antihistamine — targets resolution of nasal congestion, rhinorrhea, and nasal ocular symptoms. When those goals remain unmet, a further step is indicated.
Next-Step Approach (Overview Only)
The next line of management involves an immunotherapy-based approach. The full structured protocol details the specific options, eligibility criteria, and clinical considerations.
Complete regimen, sequencing, and criteria available in the full protocol →
References
- Frequency can be divided into intermittent or persistent (more than four days per week and more than four weeks per year, respectively).
- Severity can be divided into mild (symptoms do not interfere with quality of life) or severe (symptoms impact asthma control, sleep, sports participation, or school or work performance).
- The International Primary Care Respiratory Group; British Society for Allergy and Clinical Immunology; and American Academy of Allergy, Asthma, and Immunology recommend intranasal corticosteroids alone for the initial treatment of persistent symptoms affecting quality of life and second-generation nonsedating antihistamines for mild intermittent disease.
- Consider subcutaneous or sublingual immunotherapy.
- Immunotherapy should be considered for moderate or severe persistent allergic rhinitis that is not responsive to usual treatments, in patients who cannot tolerate standard therapies or who want to avoid long-term medication use, and in patients with allergic asthma.
View source ↗