Improving approaches to the treatment of allergic rhinitis: an expert consensus document

On September 16, 2025, a meeting of an interdisciplinary Expert Council in the fields of allergology, otorhinolaryngology, and pediatrics was held in Moscow, dedicated to improving approaches to the treatment of allergic rhinitis. The primary goal of treating allergic rhinitis is to achieve control over the disease’s symptoms. The Visual Analogue Scale is recognized as a simple, convenient, and valid tool for symptom monitoring. Differences between national clinical guidelines for the treatment of allergic rhinitis and the international ARIA 2024 guidelines were analyzed. It was established that the ARIA 2024 guidelines are patient-oriented and offer the possibility of prescribing any group of pharmacological agents already at the first assessment of allergic rhinitis control using the Visual Analogue Scale. The national clinical guidelines do not prohibit initiating therapy at any step; however, the proposed algorithm limits the physician to a sequential prescription of drugs.

Current issues of allergic rhinitis in pediatric practice were discussed, including delayed diagnosis, low quality of life for patients, and insufficient attention to atopic multimorbidity. The role of surgical correction of anatomical abnormalities of the nasal septum in patients with allergic rhinitis, which hinder the effective delivery of intranasal medications, was examined in detail.

The problem of low patient adherence to allergic rhinitis therapy is considered one of the key factors in achieving disease control. Approaches to improving adherence were discussed, including transitioning from a paternalistic doctor-patient interaction model to a shared decision-making model regarding therapy, taking into account patient preferences.

Special attention was paid to the place of fixed-dose combinations of intranasal glucocorticosteroids and intranasal antihistamines in the treatment of allergic rhinitis. It was shown that in approximately two-thirds of patients, monotherapy does not provide control of allergic rhinitis symptoms, and they require combination therapy. Fixed-dose combinations demonstrate advantages such as effect potentiation, reduced incidence of side effects, synergistic action, and increased treatment adherence.

The Expert Council proposed an updated algorithm for choosing therapy for allergic rhinitis, considering the possibility of starting treatment at any step based on assessing the number and severity of symptoms using the Visual Analogue Scale. The use of fixed-dose combinations as initial therapy is recommended in the presence of persistent symptoms (more than 4 days per week) and a Visual Analogue Scale score of ≥ 5, especially in cases of severe nasal congestion. This algorithm is planned to be used as a basis for updating the national clinical guidelines for the treatment of allergic rhinitis.