New US guidelines favour one treatment for hayfever

They are in line with existing Australian recommendations

New guidelines recommend corticosteroid nasal sprays to prevent and treat seasonal allergic rhinitis in people aged 12 and over, rather than oral antihistamines or a combination of both.


Developed by a joint task force of US allergy, asthma and immunology specialists, the guidelines are in line with recommendations from the Australasian Society of Clinical Immunology and Allergy (ASCIA), which has long recommended intranasal corticosteroids as a first-line treatment.

Writing in the Annals of Internal Medicine, the authors say the evidence found no benefit to adding an oral antihistamine to the mix, noting adverse effects associated with the antihistamines, including sedation.

The updated guidance is as follows:

  • For initial treatment of seasonal allergic rhinitis in people aged 12 or older, routinely prescribe monotherapy with an intranasal corticosteroid rather than an intranasal corticosteroid in combination with an oral antihistamine.
  • For initial treatment of seasonal allergic rhinitis in those aged 15 or more, recommend an intranasal corticosteroid over a leukotriene receptor antagonist.
  • For treatment of moderate to severe seasonal allergic rhinitis in people 12 or older, you may recommend the combination of an intranasal corticosteroid and an intranasal antihistamine initially.

Read more about the guidelines here