Seasonal Allergic Rhinitis Guidelines Update Stress Shared Decision-Making

A newly-updated clinical guideline provides recommendations on the best types and amounts of medications to treat seasonal allergic rhinitis (SAR). The guidelines, published in the Annals of Allergy, Asthma and Immunology, offer health care providers practical advice on the treatment of SAR in patients aged 12 years and younger.

The guideline was developed by the Joint Task Force on Practice Parameters using a Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. In the systematic review, the authors offered 3 key recommendations:

• For initial treatment of SAR in adults, clinicians should routinely prescribe monotherapy with an intranasal corticosteroid (INCS) rather than INCS in combination with an oral antihistamine.
• For initial treatment of SAR in adults, clinicians should recommend an INCS over a leukotriene receptor antagonist.
• For treatment of moderate to severe SAR in adults, clinicians may recommend the combination of an INCS and an intranasal antihistamine for initial treatment.

Additionally, the authors noted the importance of shared decision-making with patients, as well as encouraging health care providers to inform patients that taking 2 medications may not always be better than taking a single drug.

Although using a combination of an intranasal antihistamine and an intranasal corticosteroid dose often provides better relief than use of either medication by itself, the combination of the 2 types of drugs will likely be more expensive.

Health care providers should also make patients aware that using both medication, either combined or separately, may increase risk for adverse effects, according to the guidelines.

Reference

Dykewicz MS, Wallace DV, Baroody F, et al. Treatment of seasonal allergic rhinitis. Annals of Allergy, Asthma & Immunology. 2017. Doi: http://dx.doi.org/10.1016/j.anai.2017.08.012