article · Allergy
Allergic rhinitis negatively affects quality of life as well as workplace and school productivity. To reflect insights from mobile health data and other recent evidence, an updated guideline panel formulated the 2024 to 2025 recommendations for intranasal treatments, a primary approach in managing the condition. Using the GRADE framework, the panel incorporated systematic reviews, mobile health findings, pharmacovigilance reports, and an expert cost survey to address eleven specific clinical questions. These questions focused on choosing between intranasal medication classes, including corticosteroids, antihistamines, fixed combinations of both, and decongestants, as well as specific drugs within these classes. The resulting recommendations generally suggest using fixed combinations of antihistamines and corticosteroids over either monotherapy, and corticosteroids over antihistamines alone. Final treatment choices must account for clinical variability, individual patient values, and medication affordability.
Allergic rhinitis is a common condition that undermines day-to-day productivity and overall well-being. These revised clinical guidelines help patients, caregivers, and medical practitioners select the most effective intranasal therapies based on current evidence. By balancing comparative efficacy, safety, and drug costs, the guidance supports better informed, practical, and personalised care.
The guidelines provide near-market and immediately applicable clinical practice recommendations for healthcare professionals, formulary managers, and mobile health developers. By endorsing fixed-dose combinations over monotherapies, the findings directly inform clinical pathways and pharmaceutical prescribing, while highlighting affordability as a key operational factor. The abstract does not indicate a route for commercial product development beyond guiding the clinical adoption of existing drug classes.
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BACKGROUND: Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024-2025). This manuscript presents the ARIA 2024-2025 recommendations for intranasal treatments, one of the mainstays for AR management. METHODS: The ARIA 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgments and recommendations, including systematic reviews, evaluation of mHealth and pharmacovigilance data, as well as a survey of experts on costs. RESULTS: Eleven guideline questions concerning intranasal treatments for AR were prioritized, leading to recommendations. Overall, these questions concern the choice between different classes of intranasal medications-most notably, intranasal corticosteroids (INCS), antihistamines (INAH), fixed combinations of INAH+INCS and decongestants-or between different individual medications within each class. Four questions had not been evaluated in previous ARIA guidelines, while for the other three there was a change in the strength or directionality of recommendations. Overall, recommendations point to the suggested use of INAH+INCS over INAH or INCS and INCS over INAH. CONCLUSION: This ARIA 2024-2025 article supports patients, their caregivers, and healthcare professionals in choosing an intranasal treatment. However, decisions on AR treatment should consider the clinical variability of the disease, patients' values, and the affordability of medications.
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DOI: 10.1111/all.70131
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