• For symptoms of asthma and manage accordingly. For further information see the CKS topic on Asthma.
• The most likely allergen causing allergic rhinitis:
• The responsible allergen may be identifiable from the history — see Diagnosis.
• Allergy testing to confirm the responsible allergen is indicated when burdensome allergen avoidance strategies, such as house dust mite avoidance measures, are being considered.
• Factors influencing the choice of drug treatment to control allergic rhinitis.
• Ask about:
• Frequency and persistence of symptoms.
• Subjective distress caused by symptoms and their adverse effect on aspects of daily life, such as sleep, recreation, and work.
• Associated allergic conjunctivitis.
• Personal preference for oral or intranasal treatments and the effectiveness of any previous treatments for allergic rhinitis.
• Examine the nose if nasal blockage is a problem. Examine for nasal polyps, deviated nasal septum and mucosal swelling.

• 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.

• Advise allergen avoidance for people with:
• Suspected pollen allergy.
• House dust mite allergy when symptoms are inadequately controlled with maximal preventive drug treatment and the responsible allergen has been confirmed by allergy testing.
• Suspected animal allergy after confirming the responsible allergen by allergen testing.
• For people with:
• Grass pollen allergen: advise avoiding walking in grassy open spaces, particularly during the early morning, evening, and night, when pollen counts are at their highest, and to keep windows shut in cars and buildings. Advise changing car pollen filters with each service, if these are fitted.
• Confirmed house dust mite allergy inadequately controlled by drug treatment:
• For people who want to try house dust mite avoidance measures, advise fitting mattresses and pillows with house dust mite impermeable covers; use synthetic pillows and acrylic duvets, and keep furry toys off the bed. Wash all bedding and furry toys at least once a week at high temperatures. If possible, choose wooden or hard floor surfaces instead of carpets. Blinds that can be wiped clean should be fitted instead of curtains. Surfaces should be wiped regularly with a clean, damp cloth.
• Confirmed animal allergy: advise that ideally the animal should not be allowed in the house. When this is not acceptable, advise restricting their presence to the kitchen.

• Advise people who have achieved adequate control of their symptoms with drug treatment that they should continue with treatment until they are no longer likely to be exposed to the suspected allergen:
• For people allergic to house dust mites and people allergic to pets that remain in their homes, symptoms are usually present throughout the year, requiring ongoing treatment.
• For people allergic to tree pollens, treatment is usually required from early to late spring.
• For people allergic to grass pollens, treatment is usually required from late spring to early summer.
• Advise people who have recurrent episodes of allergic rhinitis controlled by intranasal corticosteroids to restart treatment at least 7 days before re-exposure to allergen. When the time of re–exposure to antigen is uncertain, such as the start of the pollination season, start treatment several weeks before the most likely time of re–exposure.