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When it comes to treating seasonal allergies, one drug is often better than two: updated guidelines for the treatment of teen and adult patients with allergic rhinitis recommend initial treatment with an intranasal corticosteroid alone without an oral antihistamine.

The guidelines, appearing in the follow a comprehensive review by a joint task force of the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI).

Mark S. Dykewicz, MD, of St. Louis University, and colleagues conducted a systematic review of the research, which included studies published since the seasonal allergic rhinitis guidelines were last updated in 2008.

Dykewicz 乌鸦传媒 that the task force set out to answer three key questions in their systematic review of the research:

• "For the initial treatment of moderate to severe seasonal allergic rhinitis (SAR) in patients who are ≥12 years of age, is there any clinical benefit of using a combination of an oral antihistamine and an intranasal corticosteroid compared with monotherapy with an intranasal corticosteroid? Recommendation: "Clinicians should routinely prescribe intranasal corticosteroid monotherapy rather than the combination. Based on the studies analyzed, there was no statistically significant superiority for the combination for any of the outcomes.
• "For the initial treatment of moderate to severe SAR in patients who are ≥15 years of age, how does montelukast compare with an intranasal corticosteroid in terms of clinical benefit?" Recommendation: "Clinicians should recommend an intranasal corticosteroid over a leukotriene receptor antagonist."
• "For the initial management of moderate to severe SAR in patients who are ≥12 years of age, is there any clinical benefit to using combination therapy with an intranasal corticosteroid plus an intranasal antihistamine compared to monotherapy with either agent?" Recommendation: "For moderate to severe symptoms, clinicians may recommend the combination of an intranasal corticosteroid and an intranasal antihistamine."

Dykewicz said in addition to updating specific treatment recommendations, the revised guidelines also stress the importance of shared decision-making between clinicians and patients.

"Based on the evidence we reviewed, we concluded that taking two medications, such as an oral antihistamine and an inhaled corticosteroid, is not always better than using a single drug," he said. "Patients need to be made aware of that."

He said in addition to being more costly, using two medications, either combined or separately, increases the likelihood that seasonal allergy sufferers will experience side effects related to treatment.

The task force guideline was developed using Grading of Recommendations, Assessment, Development and Evaluations () methodology.

The writing group noted that the recommendations may not apply to all patients, including older patients, pregnant women, and women who are nursing.

"Although all the therapeutic options are approved for children younger than 12 years, the studies in this systematic review did not include children; therefore, we cannot make definitive conclusions regarding clinical response in this age group," the task force report noted, adding that "the clinician may choose, at times, to extrapolate the conclusions reached for the adult population to children."

"However, method and ease of delivery, concern with long-term adverse effects of some medications, and intolerance of select adverse effects may alter the therapeutic choice in children," they cautioned.