Written by Dr Fiona Magee, GP, Tully Family Practice
Source: Irish Pharmacy News, June 2026, page 24.
Allergic Rhinitis
Allergic rhinitis (AR) is a common chronic condition affecting both adults and children. It can be seasonal or year-round. The seasonal (pollen-induced) type is often called “hay fever”. AR can negatively impact sleep, work, leisure activities and overall quality of life.
What is AR?
AR is allergy-induced inflammation of the lining of the nose and sinuses, caused by inhaled triggers called “allergens” in susceptible individuals. Typical symptoms include sneezing, a runny nose, postnasal drip, congestion and nose blockage.
“Allergic conjunctivitis” — allergy-related eye symptoms such as itch, redness and watering — commonly occurs as part of AR. Itching of the nose, ears, palate or throat are also common. Symptoms can range from mild and intermittent to severe and persistent. Nose blockage is generally considered a more severe symptom than sneezing or a runny nose.
What causes AR?
People with AR may react to one or several inhaled allergens. The most common triggers are grass pollen, tree pollen and house dust mite. Pet dander (cats and dogs), weed pollen and mould are other possible triggers.
Pollen allergies are seasonal, while house dust mite allergy typically causes symptoms throughout the year. In Ireland, peak tree pollen season is in Spring, whilst grass pollen season is late Spring to mid-Summer.
AR and asthma
There is a strong association between AR and asthma: up to 80% of people with asthma also have AR. This overlap is often under-recognised, as attention tends to focus on lower airway symptoms (asthma) rather than upper airway symptoms (AR).
Poorly controlled AR can worsen asthma, whilst appropriate treatment of AR can improve asthma, alongside usual asthma management such as inhalers.
Recognising AR
People with AR commonly present in the community to pharmacists or GPs, both of whom play important roles in managing this condition.
The first step is to determine whether symptoms are due to AR or another cause. Respiratory viruses eg headcolds are a very common cause of runny or blocked nose and are by far the most common cause in pre-school children. Treatments used for AR, such as antihistamines and nasal steroid sprays, are not generally helpful for viral upper respiratory infections.
Patients whose AR symptoms are poorly controlled with over-the-counter treatments, or where the diagnosis is uncertain, should be advised to consult their GP.
Management of AR in the community
1. Allergen avoidance
Where possible, reducing exposure to the relevant allergen can help. During pollen season, keeping windows closed, showering after outdoor exposure, and applying a suitable balm inside the nostrils may reduce symptoms.
For house dust mite allergy, measures such as reducing bedroom clutter, regular vacuuming around the bed and mattress, and washing bed linen at 60°C or higher can help reduce mite exposure. Saline nose and sinus rinses are helpful at reducing all inhaled allergens.
2. Oral antihistamines
Non-sedating oral antihistamines may be taken as needed or regularly during symptomatic periods for mild or intermittent AR. Sedating antihistamines are generally not recommended because of their side effects.
3. Nasal decongestants
Nasal decongestants can provide short term relief of congestion, but regular use should be avoided because rebound congestion can occur. They should not be used for more than five days.
4. Nasal steroid sprays
For AR that is either moderate or severe and persistent, nasal steroid sprays are advised. They should be used daily for best effect. They can be used all year for allergies that are year-round or started several weeks before the relevant pollen season then continued throughout that season.
Perceived treatment failure is often due to incorrect spray technique or inconsistent use, so patient education is important.
Fluticasone is preferred over beclomethasone because of its effectiveness and much lower systemic steroid absorption. Both are available in OTC or prescription options.
5. Combined nasal steroid and antihistamine sprays
If symptoms persist despite nasal steroid use alone, a combined steroid-antihistamine spray on prescription is the next step. Fluticasone-azelastine is the preferred option and is licensed for patients aged 12 years and older.
6. Antihistamine eye drops
These are useful when allergic eye symptoms are prominent. Sodium cromoglycate drops are available over the counter and are usually used four times daily. Olopatadine is prescription-only and is administered twice daily.
Management of AR in specialised clinics
Patients with persistent symptoms despite adherence to the above measures may benefit from referral to a clinician with expertise in allergy. Some GPs with a special interest in allergy provide this service.
1. Allergy testing
Specialist clinics may offer skin prick testing to identify relevant inhaled allergens. Serum IgE blood tests are an alternative method.
2. Optimisation of standard treatment
Existing treatment is often first optimised by reviewing adherence, ensuring correct nasal spray technique, and stepping up therapy where needed.
3. Sublingual immunotherapy (SLIT)
SLIT is a form of desensitisation treatment for patients with troublesome AR symptoms despite optimised standard treatment. Immunotherapy is the only “disease-modifying” treatment option for AR, as opposed to treating symptoms only. Identification of the relevant allergen on testing is required before considering SLIT.
In Ireland, SLIT options are available for grass pollen, tree pollen and house dust mite AR, each of these licensed now from the age of 5 years. Treatment must be initiated by a clinician with expertise in allergy, with the first dose supervised in clinic.
SLIT involves taking a daily tablet under the tongue for three years and can significantly reduce allergy symptoms over time. Standard treatments (antihistamines and nasal steroid sprays) are usually continued initially and then used as needed. At present, only grass pollen SLIT is covered under the GMS/DPS schemes, so cost can be a barrier to the other types.
Summary
Allergic rhinitis is a common condition that can significantly affect quality of life. Most AR can be managed successfully in the community using allergen avoidance measures, oral antihistamines, nasal steroid sprays with or without antihistamine and antihistamine eyedrops. Those with persistent symptoms may benefit from specialist assessment, allergy testing and, where appropriate, sublingual immunotherapy.
