Allergic rhinitis remains highly prevalent and can significantly affect asthma control, disrupt sleep, impair daily functioning, and diminish overall quality of life, particularly when left underdiagnosed or undertreated. In recent years, advances in intranasal therapies, immunotherapy, and biologic agents have expanded the options for achieving better symptom control and possible disease modification.

In this Q&A, Dr S Shahzad Mustafa (Rochester Regional Health, Rochester, NY, USA) summarizes expert insights on first-line pharmacologic treatments, allergen avoidance strategies, the role of immunotherapy and biologics, and practical guidance for implementing evidence-based, multidisciplinary care.

The talk “Management Strategies for Allergic Rhinitis” was presented at CHEST 2025, 18–22 October 2025, Chicago, IL, USA.

touchIMMUNOLOGY coverage of CHEST 2025:

What are the most effective first-line strategies for managing allergic rhinitis in patients seen by pulmonologists?

Pulmonologists who manage asthma and other respiratory illnesses will certainly encounter individuals experiencing allergic rhinitis, so it is imperative to have strategies to manage this common co-morbidity. Nasal steroids are a first-line therapy for allergic rhinitis. They are well tolerated and efficacious, but must be used consistently to achieve maximal symptom relief. Many are also available over-the-counter. Nasal antihistamine sprays are also a good choice for nasal symptoms, and have the advantage of being efficacious even with as needed use. Antihistamine pills can provide great relief for itching, sneezing, and rhinorrhea, but do not have significant efficacy for nasal congestion and post nasal drip.

What practical strategies can clinicians recommend to reduce allergen exposure and improve symptom control?

Despite common beliefs, there is very little well conducted research to support environmental control measures. To minimize exposure to dust mites, decreasing ambient humidity seems to be the most effective strategy. Minimizing exposure to pets is very difficult, and cat and dog protein is even present in homes and buildings (like hospitals), where there are no pets.

What role does immunotherapy play in treating allergic rhinitis, and which patients are best suited for it?

Allergen immunotherapy is highly effective at treating allergic rhinitis. In addition to improving symptom control, allergen immunotherapy can decrease the likelihood of developing future environmental allergies, and when used in children, can even decrease the risk of developing asthma. Immunotherapy sometimes also allows individuals to decrease their reliance on medical therapy. Patients with proven sensitization to environmental allergens should consider allergen immunotherapy if they are not adequately responding to medical therapy, or if they are looking for a disease-modifying treatment approach not focusing on medical therapy.

When should biologics be considered for patients with allergic rhinitis overlapping with asthma or other atopic conditions?

FDA-approved biologics for asthma often also have efficacy in additional atopic conditions commonly seen with asthma, such as atopic dermatitis, chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, and allergic rhinitis. In patients with asthma and other atopic comorbidities, the clinician may consider using biologics earlier than typical, to address multiple disease states with a single intervention.

What practical tips can help non-allergist clinicians implement guideline-based care?

Non-allergist clinicians managing allergic rhinitis and other atopic conditions should know the evidence-based medical therapies with proven efficacy. These clinicians should also be familiar with asthma biologics and how they can help with management of these complicated patients. Many patients would benefit from a multi-disciplinary approach, so working closely with an allergist/immunologist can be very helpful as well.