12.2.1 Drugs used in nasal allergy

General guidance

• Mild cases of allergic rhinitis can be controlled by topical nasal corticosteroids or oral antihistamines; systemic nasal decongestants are of doubtful value.
• More persistent symptoms and nasal congestion can be relieved by topical nasal corticosteroids and cromoglycate.
• In seasonal allergic rhinitis (e.g. hay fever) treatment should begin 2 to 3 weeks before the season commences and may have to be continued for several months.
• In perennial rhinitis, short term use of ipratropium nasal spray may be considered.
• Betamethasone drops may be useful in initiating therapy in chronic rhinitis or in children, although a nasal spray is preferred for long term treatment.

Full Allergic rhinitis treatment pathway

​Recommended drugs

First line: Beclometasone nasal spray or drops (Beconase) £

Second line: Mometasone nasal spray (Nasonex) £££ 

Third line: Fluticasone furoate (Avamys) £££

Third line: Dymista (after mometasone and fluticasone, once oral antihistamines have proved effective in line with the pathway provided)

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low