Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.

Evidence: ARIA-EAACI Guidelines 2024–2025 revision, Part II (oral &… 2025 · sources last checked 2026-08-20

Reference tool — not medical advice. Thresholds, targets, and first-line agents differ by guideline body and change over time — switch the lens to compare. Clinician judgement, dosing/monitoring, contraindications, and live coverage always required. Runs entirely in your browser — no data is collected.

Allergic rhinitis selector

Choose the guideline lens (CSACI / ARIA / AAAAI-ACAAI), the severity, pattern and predominant symptom — get the plan: antihistamine for mild, INCS first-line for moderate-severe, INCS+intranasal-antihistamine combination for inadequate control (not oral antihistamine), with montelukast gated behind its boxed warning.

Guideline lens

Severitychoose one

Sleep / activity impairment / bother

Patternchoose one

Predominant symptomchoose one

Comorbidities

Special

ARIA class

Mild, intermittent

First-line

Second-generation oral (or intranasal) antihistamine, PRN

Notes

  • • Escalation when INCS monotherapy is inadequate: add an intranasal antihistamine (fixed INCS+antihistamine combination, e.g., Dymista) — superior to adding an oral antihistamine. Do NOT combine an INCS with an oral antihistamine (no congestion benefit; systemic effects). ARIA also recommends against adding an LTRA to an oral antihistamine.
  • • Montelukast (LTRA) carries a boxed warning for serious neuropsychiatric events — it is NOT a first-line agent; reserve for patients with inadequate response/intolerance to alternatives, and it has a modest added role mainly when asthma coexists.

Suggested drug classesPer CSACI (Canada) 2024.

Select severity and pattern to begin.

Switch the lens to compare escalation: ARIA/CSACI prefer INCS+intranasal-antihistamine combo over adding an LTRA or oral antihistamine.

Guidelines

References

  1. [1]Ellis AK, et al. Focused allergic rhinitis practice parameter for Canada. Allergy Asthma Clin Immunol 2024;20:45 (INCS first-line; INCS+intranasal-antihistamine combo over adding oral antihistamine). link
  2. [2]ARIA-EAACI Guidelines 2024–2025 revision, Part II (oral & ocular treatments). Allergy 2025 (INCS > oral antihistamine > LTRA; against adding LTRA to an oral antihistamine). Montelukast boxed warning (Health Canada / FDA 2020). link
  3. [3]Dykewicz MS, et al. Rhinitis 2020: A Practice Parameter Update (AAAAI/ACAAI Joint Task Force). J Allergy Clin Immunol 2020;146:721. link