Treatment & management
Guidelines agree on the path: avoid what you can, rinse the nose, use the right medication regularly, and consider immunotherapy for long-term change.
Four pillars of treatment
Allergen avoidance
Reduce exposure to your specific triggers — the safest step, with no side effects.
Nasal hygiene
Daily saline rinses flush allergens and mucus, and soothe the lining.
Medication
Intranasal corticosteroids are the first-line treatment; antihistamines help for milder symptoms.
Immunotherapy
The only treatment that changes the disease course, not just the symptoms.
A stepwise approach that matches your symptoms
- Mild, occasional symptomsStart with avoidance plus saline rinses. If needed, a non-drowsy antihistamine before exposure or at the first sign of symptoms.
- Moderate or persistent symptomsAdd a daily intranasal corticosteroid — the most effective class for allergic rhinitis. Use it regularly for days to reach full effect. Combination sprays (antihistamine + steroid) are an option for faster, stronger control.
- Still not controlled?Review the diagnosis with your clinician — confirm the allergens with testing, check the spray technique, and consider stepping up the dose or adding treatment.
- Persistent, significant symptomsDiscuss allergen immunotherapy (shots or under-the-tongue tablets/drops) with an allergist — the only option that retrains the immune system over 3–5 years.
What the guidelines say. Current international guidance (ARIA 2020 and the 2024–2025 update) recommends intranasal corticosteroids as first-line treatment for persistent or moderate-to-severe allergic rhinitis, with fluticasone among the preferred options. Antihistamines are recommended mainly for mild, intermittent symptoms.
Start with the basics you can do today
- Check your pollen season and plan around it (our pollen calendar does the maths)
- Run a saline rinse morning and evening during the season
- If you use a nasal spray, learn the technique — most "it doesn't work" cases are technique and consistency problems
- Track your symptoms for two weeks to see what actually changes
What about natural and complementary remedies?
Some people find humidifiers, steam inhalation and local honey helpful anecdotally, but the evidence is limited and honey does not contain the pollens that matter. Be very cautious with unproven supplements — some interact with medicines. The safest, best-evidenced "natural" tools are saline rinses and allergen avoidance. Discuss anything else with your pharmacist or doctor.
Children and pregnancy. Many treatments are safe and widely used in children and during pregnancy, but choices matter — always check with the child's doctor or your obstetrician before starting or changing any medicine. Saline rinses are safe for everyone.
Questions to ask your doctor: What am I allergic to, exactly? Is a daily nasal spray right for me? What is the correct technique? Would immunotherapy suit me? When should we review?