• For people who want an 'as-required' treatment for occasional symptoms, prescribe an antihistamine.
• For people with allergic conjunctivitis, children less than 5 years of age, and people who prefer oral treatment, prescribe an oral antihistamine.
• For all other people, prescribe intranasal azelastine.
• For people who want preventive treatment to control more frequent or persistent symptoms explain the importance of regular treatment and good nasal spray/drop technique to control symptoms.
• If the predominant symptom is nasal blockage or nasal polyps are present, prescribe an intranasal corticosteroid.
• If the predominant symptoms are sneezing or nasal discharge, prescribe either an oral antihistamine or an intranasal corticosteroid. Explain the characteristics of antihistamines and intranasal corticosteroids and prescribe:
• An antihistamine when oral treatment is preferred or allergic conjunctivitis is present.
• An intranasal corticosteroid when more effective treatment is required.
• If pregnant or breastfeeding prescribe an intranasal corticosteroid first-line.
• If this is not tolerated or additional treatment is required, CKS recommends prescribing oral loratadine.
• Intranasal sodium cromoglicate and nasal douching can be used as alternative or add on treatments.
• If rapid relief of symptoms is required while awaiting preventive treatment to take effect:
• If nasal congestion is a problem prescribe an intranasal decongestant for up to 7 days.
• If using a intranasal corticosteroid, prescribe an oral antihistamine.
• If symptoms are severe, impairing the quality of their life, prescribe a 5–10 day course of prednisolone 20–40 mg a day in adults, and 10 mg a day in children.
• Advise people to reconsult after 2–4 weeks if symptoms remain inadequately controlled.

For a discussion on the comparative advantages and disadvantages of different treatment regimens, see Additional information.