Allergic rhinitis
IgE-mediated inflammation of the nasal mucosa in response to allergen exposure. Presents with rhinorrhea, nasal congestion, sneezing, and itching.
ICD-10 J30.922 drugs
Also known as: Hay fever, Seasonal allergic rhinitis
Drugs used for this condition
- ABilastineFirst line · Second-generation antihistamineFirst-line for seasonal and perennial allergic rhinitis per ARIA 2020 and EAACI 2022, on par with other second-generation antihistamines (desloratadine, levocetirizine, fexofenadine, rupatadine). Dose 20 mg once daily on empty stomach. Bilastine has the lowest sedative potential in the class (Wang 2016 psychomotor studies showed no cognitive impairment); EASA permits its use by commercial airline pilots.
- ACetirizineFirst line · Second-generation antihistaminesFirst-line treatment for seasonal and perennial allergic rhinitis per ARIA guidelines. Reduces sneezing, rhinorrhea, and nasal/conjunctival itching. Adult dose is 10 mg once daily. Efficacy is comparable to loratadine, though cetirizine causes slightly more drowsiness.
- ADesloratadineFirst line · Second-generation antihistamineFirst-line for seasonal and perennial allergic rhinitis under ARIA 2020 and EAACI 2022 alongside other second-generation antihistamines. Standard dose 5 mg once daily. Children 1–5 years: 1.25 mg (2.5 mL syrup) once daily. Tolerability and sedation comparable to bilastine and fexofenadine.
- AEbastineFirst line · Second-generation antihistamineFirst-line for allergic rhinitis under ARIA 2020 alongside other second-generation antihistamines. Standard dose 10 mg once daily; 20 mg is acceptable for severe symptoms. Onset 1–3 hours after intake, with effect lasting at least 24 hours.
- AFexofenadineFirst line · Second-generation antihistamineFirst-line for seasonal and perennial allergic rhinitis under ARIA 2020. Adult dose 120 mg once daily for rhinitis; children 6–11 years take 30 mg twice daily. Efficacy and tolerability match cetirizine and loratadine; near-zero sedation makes it convenient for working patients and drivers.
- AFluticasoneFirst line · Inhaled and intranasal corticosteroidSeasonal and perennial allergic rhinitis in adults and children from 4–6 years (depending on formulation). Per ARIA 2020 and SEAIC 2023, intranasal corticosteroids are first-line for moderate-to-severe and persistent symptoms. Fluticasone propionate dose: 100–200 µg (2 sprays per nostril) once daily; fluticasone furoate (Avamys): 27.5–55 µg once daily. Effect at 6–12 hours, full effect at 3–7 days. Long-term safety on childhood growth confirmed at standard doses (Skoner 2018).
- AFluticasone furoate (nasal)First line · Intranasal corticosteroidFirst-line for moderate-to-severe allergic rhinitis per ARIA 2020 alongside other intranasal corticosteroids (mometasone, budesonide, fluticasone propionate). Adults and children over 12: 2 sprays (55 mcg) per nostril once daily; children 6–11: 1 spray. Particularly effective with seasonal allergic rhinitis with conjunctivitis symptoms.
- ALevocetirizineFirst line · Second-generation antihistamineFirst-line for seasonal and perennial allergic rhinitis under ARIA 2020 and EAACI 2022 alongside other second-generation antihistamines (bilastine, desloratadine, fexofenadine, rupatadine). Standard dose 5 mg once daily. Children 6–11 years: 2.5 mg once daily. Onset within 1 hour; effect lasts at least 24 hours.
- ALoratadineFirst line · Second-generation antihistaminesFirst-line allergic rhinitis treatment per ARIA. Efficacy is confirmed in numerous RCTs. Advantage over cetirizine: minimal drowsiness, which matters for drivers and precision workers. Adult dose is 10 mg once daily.
- AMometasoneFirst line · Inhaled, intranasal, and topical corticosteroidSeasonal and perennial allergic rhinitis in adults and children from 2–3 years (Nasonex from 2). Per ARIA 2020 and SEAIC 2023, intranasal corticosteroids are first-line. Dose: 100–200 µg (2 sprays per nostril) once daily. Effect at 11 hours, full effect at 1–2 weeks. In children 2–11 years, standard dose is 100 µg once daily. Long-term safety on childhood growth confirmed up to 1 year of daily use (Schenkel 2000).
- AMometasone furoate (nasal)First line · Intranasal corticosteroidFirst-line for moderate-to-severe allergic rhinitis under ARIA 2020. Intranasal corticosteroids beat antihistamines on all nasal symptoms, particularly congestion. Adults and adolescents from 12 years: 2 sprays (100 mcg) per nostril once daily; children 3–11 years: 1 spray per nostril once daily.
- ARupatadineFirst line · Second-generation antihistamine with additional PAF antagonismFirst-line for seasonal and perennial allergic rhinitis under ARIA 2020 and EAACI 2022, on par with other second-generation antihistamines. Dose 10 mg once daily. Efficacy is comparable to cetirizine and loratadine; PAF antagonism may give an additional benefit on nasal congestion in some trials.
- BChlorpheniramineSecond line · First-generation moderately sedating antihistamineAllergic rhinitis, symptomatic cold relief. Per ARIA 2023 – second-line after 2nd-generation. Dose 4 mg 3–4 times daily. Mostly as a component of OTC cold combinations.
- BMontelukastSecond line · Leukotriene receptor antagonistsSecond-line for allergic rhinitis when antihistamines are insufficient. Less effective than intranasal corticosteroids. Per ARIA, may benefit patients with coexisting asthma and rhinitis – one drug addresses both conditions.
- CDexchlorpheniramineSecond line · First-generation sedating antihistaminePer ARIA 2020 and EAACI 2022, not a preferred agent for allergic rhinitis – sedating H1 antihistamines are no longer first-line. Used in short courses when nocturnal sedation is welcome (severe itching, sleep disturbance). Standard dose 2 mg three to four times daily or 6 mg sustained-release at bedtime. In patients over 65, listed in 2023 Beers criteria – high risk of falls, confusion, and cognitive decline.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- CKetotifenNot recommended · Antihistamine + mast cell stabilizerAtopic rhinitis and atopic dermatitis in children and adults. Per ARIA 2023, not first-line – intranasal corticosteroids (mometasone, fluticasone) and 2nd-generation H1-blockers are more effective. 6–12 weeks for onset. Limited use by family tradition.
- DAzoximer bromideNot recommended · Other immunostimulants (local classification)Polyoxidonium for allergic rhinitis is not mentioned in ARIA guidelines. Evidence-based therapy: intranasal corticosteroids and second-generation H1 antagonists (loratadine, cetirizine), montelukast in severe cases, and allergen-specific immunotherapy in persistent disease.
- DBetamethasoneNot recommended · Glucocorticoid for systemic useA depot betamethasone injection is offered, in Russia and elsewhere, as a shot that covers the whole allergy season: one injection in spring and no drops or tablets afterwards. The AEMPS Celestone Cronodose label describes something else: intramuscular use in allergic conditions where oral or local treatment does not fit or is not enough, 1 ml roughly once a week as required rather than once for a season. ARIA 2020 frames allergic rhinitis treatment as a stepwise algorithm, stepped up and down by symptoms. The price of a systemic corticosteroid in a seasonal disease sits in the adverse reactions section: potassium loss, rising glucose, osteoporosis and vertebral compression fractures, posterior subcapsular cataract, glaucoma, and adrenal suppression that lasts for months. If a depot injection is offered as a routine seasonal answer, consider seeking a second opinion.
- DBlack seed (Nigella sativa)Not recommended · Botanical supplement, black seed oil (Nigella sativa, thymoquinone); no EMA HMPC monographBlack seed is an over-the-counter supplement. In the Nikakhlagh RCT (Am J Otolaryngol 2011) in 66 patients with seasonal allergic rhinitis, black seed oil 0.5 mL/day for 6 weeks moderately reduced nasal congestion, itching and sneezing versus placebo. The effect was smaller than with intranasal steroids and antihistamines, the sample was small and methodology weak. No positive systematic review exists. ARIA 2020 and the Spanish SEAIC 2022 consensus recommend intranasal glucocorticoids (mometasone, fluticasone) and second-generation antihistamines (cetirizine, desloratadine) as first line in allergic rhinitis, plus allergen-contact control and immunotherapy when indicated. Black seed is not in international guidelines. If black seed oil was bought instead of the prescribed intranasal steroid, discuss with an allergist; the substitution is not justified.
- DChloropyramineNot recommended · First-generation H1 antihistamine, ethylenediamine derivativeIn allergic rhinitis chloropyramine reduces sneezing, itch and watery discharge, but barely touches nasal blockage: that comes from mucosal swelling rather than histamine directly. The modern approach to persistent rhinitis is built around intranasal corticosteroids, with second-generation antihistamines for episodic and mild symptoms. Chloropyramine loses in that line-up not on efficacy but on profile: it dries the mucosa, causes sleepiness, lasts 4–6 hours and needs repeat dosing, and in older people it adds confusion and urinary retention. The 2023 American Geriatrics Society Beers Criteria list first-generation antihistamines among potentially inappropriate medications at 65 and older. If chloropyramine was prescribed for long-term treatment of allergic rhinitis, consider seeking a second opinion.
- DPycnogenol (French maritime pine bark extract, Pinus pinaster)Not recommended · Plant polyphenol complex, supplement. Standardised maritime pine bark extract with 65–75% oligomeric proanthocyanidinsPycnogenol is sold as a «natural antihistamine complex» for seasonal allergic rhinitis. Wilson 2010 double-blind RCT in 60 patients with birch pollen allergy showed moderate reduction of ocular and nasal symptoms with 100 mg/day pycnogenol started 7–8 weeks before pollen season vs placebo. Sample size small, no meta-analyses published. EAACI ARIA 2020 in allergic rhinitis lists intranasal glucocorticoids (mometasone, fluticasone), H1 antagonists (bilastine, desloratadine, levocetirizine) and allergen-specific immunotherapy (AIT) first-line; pycnogenol is not mentioned in international guidelines. If pycnogenol was recommended for confirmed allergic rhinitis instead of standard therapy, consider seeking a second opinion from an allergist.
- DQuercetinNot recommended · Dietary supplements, flavonoids (local classification). Also registered in Russia as an angioprotective agent.Quercetin is a plant flavonoid sold as an "anti-allergy" supplement and promoted for allergic rhinitis to ease a runny nose and sneezing. Convincing benefit for this use has not been shown, and there is no solid evidence base behind it. Allergic rhinitis responds to proven options: intranasal corticosteroids and antihistamines, and in some cases allergen-specific immunotherapy. Do not take quercetin instead of this treatment, or you risk missing care with proven benefit.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit