Allergic Rhinitis

[2013 update]

Introduction to this self-study CME activity


Allergic rhinitis, the most common form of rhinitis, affects 20-40 million people in the United States annually, including 10-30% of adults and up to 40% of children. This CME activity addresses the diagnosis and cost-effective treatment of allergic rhinitis in children and adults. The educational material provides useful summaries on practical aspects of care, including an algorithm for steps in diagnosis and treatment, alternative diagnoses to consider, advantages and disadvantages of pharmacologic and immunotherapy, and information on most types of pharmacologic therapy commonly used.

New information in this revision:

  • Oral second generation (non-sedating) antihistamines are recommended over first generation antihistamines due to significant side-effects of sedating antihistamines.

-  Multiple second generation antihistamines are now available over-the-counter.  A second generation antihistamine can often be tried as initial therapy, as it will provide relief in most cases.

-  Inhaled nasal steroids can be used as effective monotherapy.

  • Drug table (Table 6) is updated with new medications, generic status, and pricing. Additionally, drug table information is reformatted to view pediatric and adult dosing separately.

Key aspects of care include:

  • Avoidance of allergen exposure is the first step in treatment.
  • Multiple therapies are available, with nasal corticosteroids considered the most potent medications available for treating allergic rhinitis.
  • Consider referral if patients:
    • have contraindication to or have failed medical therapy
    • need testing to identify specific allergens for avoidance
    • have comorbidities (asthma, nasal polyps, recurrent sinusitis).


Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of allergic rhinitis in children and adults.


This self-study activity is appropriate for primary care clinicians and other health care providers involved in the diagnosis and treatment of allergic rhinitis in children and adults.


Team Leaders

  • David A. DeGuzman, MD
    General Medicine

Team Members

  • Catherine M. Bettcher, MD
    Family Medicine
  • R. Van Harrison, PhD
    Medical Education
  • Christine L. Holland,MD
  • Lauren M. Reed, MD
  • Tami L. Remington, PharmD
    Pharmacy Services
  • Mark A. Zacharck, MD

Author Disclosures

Neither the team lead, the team members, nor the consultants have financial relationships with commercial companies whose products are discussed in this CME activity.
David A. DeGuzman, MD
Catherine M. Bettcher, MD
R. Van Harrison, PhD
Christine L. Holland,MD
Lauren Reed, MD
Tami Remington, PharmD
Mark Zacharack, MD
Entellus, Teva Respiratory

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant Greenberg, MD, MA, MHSA
  • R. Van Harrison, PhD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was prepared for release in October 2013. CME credit may be awarded for a maximum of three years from its release date, specifically from October 2013 through September 2016. The activity was reviewed for currency of content in August 2016 and availability of credit extended through August 2019. Continuation of credit from that date depends on a thorough review of the content currency and accuracy.      

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.