​​​1. Cardinal symptoms: sneezing, nasal​ obstruction, rhinorrhoea, post-nasal drip and/or itching (of the eyes, nose, palate)

2. Diagnosis is made clinically when ≥ 2 symptoms are present for ≥ 2 consecutive days for > 1 hour on most days​

3. Presence of common allergens: house dust mite, pets, rodents, cockroaches, indoor moulds, cigarette smoke

4. Presence of asthma, eczema or allergic conjunctivitis

5. Family history of atopy

6. Consider other non-specific environmental triggers such as changes in temperature and humidity and exposure to strong odours

7. History to rule out complications such as facial pain, ear pain, headache, purulent nasal discharge and loss of smell​

1. Intermittent – Symptoms are present < 4 days per week or for < 4 weeks

2. Persistent – Symptoms are present ≥ 4 days per week and for ≥ 4 weeks

1. Mild – Individual does not report any of the symptoms listed below for "moderate-severe"

2. Moderate/severe – ≥ 1 of following symptoms present:

a. Sleep disturbance

b. Impairment of school or work function

c. Impairment of daily activities, leisure, and/or sports activities

​d. Troublesome symptoms​

1. Rhinosinusitis

2. Nasal polyps

3. Adenoid hypertrophy

4. Eustachian tube dysfunction

5. Otitis media with effusion

6. Chronic cough

1. Persistent unilateral symptoms

2. Nasal obstruction without other symptoms

3. Mucopurulent rhinorrhoea

4. Posterior rhinorrhoea with thick mucus and/or no anterior rhinorrhoea

5. Pain

6. Recurrent epistaxis

7. Anosmia

a. ​Second generation oral H1-antihistamines are recommended. First generation oral H1-antihistamines tend to have sedative effects and should be used with care. 

b​. Oral and intranasal decongestants may be used for severe obstruction, but not beyond 1 week duration due to the risk of rhinitis medicamentosa with prolonged use.

c. Second-generation intranasal steroids (e.g. mometasone furoate) with lower bioavailability (<1%) are preferred.

​d. Once symptoms are adequately controlled, intranasal steroid dose can be stepped down at 2 to 4 weekly intervals to the lowest effective dose. Some patients can reduce the use of intranasal steroid sprays gradually and maintain symptom control with every other day or as-needed use. Alternatively, refer to the Step-up Algorithms using VAS scale. 

e. Leukotriene receptor antagonists (e.g. montelukast) that may be considered as a treatment option in patients with allergic rhinitis and concomitant asthma over 6 years of age. Restrict use to patients with inadequate response or are intolerant to alternative therapies. Before starting the medication, patients should be counselled regarding its neuropsychiatric risk.

f. Principles of pharmacological treatment (refers to Para 3 under Management section) are the same in children as in adults with allergic rhinitis, but dosages should be adjusted, and care should be taken to avoid the side effects involving impairment of growth and cognitive development, particularly when using intranasal steroids for long durations.

​a. Persistent symptoms despite compliance to treatment

b. Red flag symptoms (see above – Clinical Approach section)

c. Associated atopy/asthma requiring specialist evaluation (for example, evaluation of allergies by allergy specialist with consideration for skin test/specific immunotherapy)

d. Children under 2 years of age (allergic rhinitis is uncommon in this age group)​​