2026-05-05
Allergic rhinitis: which spray should you choose?
Allergology and Immunology
By Ana Espino | Published on May 5, 2026 | 4 min read
Allergic rhinitis is a common chronic disease characterized by inflammation of the upper airways, with a significant impact on quality of life, school and work productivity, as well as social activities. It is often associated with asthma, which increases its clinical burden and makes it a major public health issue. Despite the existence of guidelines and numerous therapeutic options, management remains limited by high interindividual variability in treatment responses, often insufficient adherence, and constraints related to accessibility and cost depending on the context.
In addition, there are gaps in available data for certain populations and for some therapeutic comparisons. These factors make management complex and highlight the need for more personalized approaches. In this context, the main challenges lie in integrating new data sources (notably from mHealth), taking patient preferences into account, and evaluating treatments beyond their clinical efficacy alone.
The objective of this study is therefore to provide an update of the ARIA 2024–2025 recommendations regarding intranasal treatments, based on a rigorous methodology (GRADE) and diverse data sources, in order to improve clinical decision-making within a patient-centered approach.
The recommendations were developed using the GRADE (Evidence-to-Decision) framework. Several data sources were selected, including randomized trials, pharmacovigilance data, real-world data from mHealth applications, as well as analyses of patient preferences. Eleven priority clinical questions related to intranasal treatments were identified. The criteria analyzed included efficacy (nasal and ocular symptoms, quality of life) and safety (adverse effects).
The results confirm that intranasal corticosteroids are a cornerstone of allergic rhinitis treatment due to their effectiveness and favorable safety profile. Intranasal antihistamines are also effective, although slightly less so. Intranasal antihistamine–corticosteroid combinations provide the best outcomes, with superior efficacy, faster onset of action, and higher patient satisfaction.
In contrast, intranasal decongestants have limited value, particularly in the long term, due to modest efficacy and an increased risk of adverse effects, which restricts their use to very short periods.
Overall, treatments are well tolerated, with few serious adverse effects. However, real-world effectiveness strongly depends on factors such as adherence, treatment acceptability, patient preferences, and economic constraints, all of which play a key role in therapeutic choice.
Allergic rhinitis is a common chronic condition whose management remains complex due to its variability and associated constraints. The main challenges involve adapting treatments to patient profiles, improving adherence, and considering economic and contextual factors. The aim of this update was to propose more robust, patient-centered recommendations.
The results support the preferential use of intranasal antihistamine and corticosteroid combinations. Beyond a simple update of guidelines, this study marks a step toward more personalized management of allergic rhinitis. Patients with more severe or insufficiently controlled symptoms may particularly benefit from intranasal combination therapies, especially those combining antihistamines and corticosteroids.
“The challenge is no longer just to treat allergic rhinitis, but to match the right treatment to the right patient, taking into account their preferences, context, and clinical profile,” the authors emphasize.
It now remains to confirm these approaches in more diverse populations, better integrate real-world data, and refine therapeutic strategies, with a view toward precision medicine applied to respiratory diseases.
About the author – Ana Espino
PhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions.
Allergic rhinitis is a common chronic disease characterized by inflammation of the upper airways, with a significant impact on quality of life, school and work productivity, as well as social activities. It is often associated with asthma, which increases its clinical burden and makes it a major public health issue. Despite the existence of guidelines and numerous therapeutic options, management remains limited by high interindividual variability in treatment responses, often insufficient adherence, and constraints related to accessibility and cost depending on the context.
In addition, there are gaps in available data for certain populations and for some therapeutic comparisons. These factors make management complex and highlight the need for more personalized approaches. In this context, the main challenges lie in integrating new data sources (notably from mHealth), taking patient preferences into account, and evaluating treatments beyond their clinical efficacy alone.
The objective of this study is therefore to provide an update of the ARIA 2024–2025 recommendations regarding intranasal treatments, based on a rigorous methodology (GRADE) and diverse data sources, in order to improve clinical decision-making within a patient-centered approach.
Which spray is the most effective?
The recommendations were developed using the GRADE (Evidence-to-Decision) framework. Several data sources were selected, including randomized trials, pharmacovigilance data, real-world data from mHealth applications, as well as analyses of patient preferences. Eleven priority clinical questions related to intranasal treatments were identified. The criteria analyzed included efficacy (nasal and ocular symptoms, quality of life) and safety (adverse effects).
The results confirm that intranasal corticosteroids are a cornerstone of allergic rhinitis treatment due to their effectiveness and favorable safety profile. Intranasal antihistamines are also effective, although slightly less so. Intranasal antihistamine–corticosteroid combinations provide the best outcomes, with superior efficacy, faster onset of action, and higher patient satisfaction.
In contrast, intranasal decongestants have limited value, particularly in the long term, due to modest efficacy and an increased risk of adverse effects, which restricts their use to very short periods.
Overall, treatments are well tolerated, with few serious adverse effects. However, real-world effectiveness strongly depends on factors such as adherence, treatment acceptability, patient preferences, and economic constraints, all of which play a key role in therapeutic choice.
The right treatment for the right patient
Allergic rhinitis is a common chronic condition whose management remains complex due to its variability and associated constraints. The main challenges involve adapting treatments to patient profiles, improving adherence, and considering economic and contextual factors. The aim of this update was to propose more robust, patient-centered recommendations.
The results support the preferential use of intranasal antihistamine and corticosteroid combinations. Beyond a simple update of guidelines, this study marks a step toward more personalized management of allergic rhinitis. Patients with more severe or insufficiently controlled symptoms may particularly benefit from intranasal combination therapies, especially those combining antihistamines and corticosteroids.
“The challenge is no longer just to treat allergic rhinitis, but to match the right treatment to the right patient, taking into account their preferences, context, and clinical profile,” the authors emphasize.
It now remains to confirm these approaches in more diverse populations, better integrate real-world data, and refine therapeutic strategies, with a view toward precision medicine applied to respiratory diseases.
Read next : Allergies: the molecular revolution is underway
About the author – Ana Espino
PhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions.
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