BSACI updated it guidelines for the diagnosis and management of allergic and non-allergic rhinitis in 2017.4

Both oral second-generation antihistamines and topical antihistamines can be considered as the first line choice for mild to moderate intermittent rhinitis, and mild persistent rhinitis. For mild cases, non-sedating antihistamines are helpful, “but most people need a regular topical nasal corticosteroid spray which is more effective.”4,16

Oral antihistamines ease neural-mediated symptoms such as itch, sneezing and rhinorrhoea but make little impact on congestion. Second-generation antihistamines are preferred, due to their non-drowsy properties, but beware of concerns about the potential risk of cardiac arrhythmias across many antihistamines in this group.4

Topical H1-antihistamines are considered “superior to oral antihistamines in attenuating rhinitis symptoms, and in decreasing nasal obstruction.” Benefits include a fast onset of action making them suitable for breakthrough symptoms, but BSACI recommends continuous use to keep symptoms under control.

Ipratropium bromide is useful for watery rhinorrhoea, and could be used as an add-on to intranasal corticosteroids and antihistamines.