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.
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.
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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.
