CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Allergic rhinitis - Management
What treatment can I offer if there is inadequate benefit with current treatment?
- For people taking oral antihistamines add in an intranasal corticosteroid and review after 2 to 4 weeks.
- For people taking an intranasal corticosteroid, ensure they are using their medication correctly. Step up to the maximum licensed dose of intranasal corticosteroid, and review after 2 to 4 weeks.
- For people with residual symptoms on a maximum licensed dose of intranasal corticosteroid, continue with treatment and:
- If there is persistent nasal itch, sneezing, rhinorrhoea, or allergic conjunctivitis add in an oral antihistamine.
- If rhinorrhoea persists despite combined use of intranasal corticosteroid and antihistamine add in intranasal ipratropium.
- If nasal blockage is a problem prescribe an intranasal decongestant for up to 7 days.
- For people requiring rapid resolution of severe symptoms impairing their quality of life, start or continue treatments to control symptoms long–term and consider prescribing a short course of oral corticosteroids for 5–10 days. Experts recommend prednisolone 20–40 mg a day in adults, and 10 mg a day in children.
- Refer people with persistent symptoms on maximal medical therapy for specialist assessment and management.
© NHS Institute for Innovation and Improvement