ARIA 2024–2025 guideline update – intranasal therapies for allergic rhinitis Review article

Abstract

Allergic rhinitis (AR) represents the most common manifestation of allergy, and epidemiological studies estimate the prevalence of this condition in Poland at 14–22%. The clinical presentation of AR includes runny nose, nasal itching, nasal congestion, and sneezing attacks following exposure to an allergen. Allergic conjunctivitis or allergic bronchial asthma often coexist with AR, and viral infections, among others, should be considered in the differential diagnosis. The latest update of the ARIA 2024–2025 standards for nasal therapies introduced a number of innovative recommendations focused on patient needs and behaviors, based on analyses of therapy’s effectiveness, safety, and acceptability, using databases describing patient behavior in daily clinical practice. The authors of the ARIA standards highly value the combination of an intranasal glucocorticosteroid (INCS) with an intranasal antihistamine (INAH) in the pharmacotherapy standards for AR. INCS (with fluticasone as the preferred molecule) remain the cornerstone of treatment for allergic rhinitis – they are effective, safe, usually cheaper, and better accepted. The advantage of INAH is a faster onset of action, but a strong recommendation only applies to the use of this group of drugs as monotherapy, compared to no treatment. Fixed combinations of INAH and INCS (especially azelastine-fluticasone) offer rapid and often better control and higher patient satisfaction. Therefore, this treatment is preferred over INCS or INAH monotherapy in many clinical situations (especially those with high symptom burden), at an acceptable cost. Administration technique and adherence determine the success of therapy, and patient education is an essential element of daily practice.