Allergic rhinitis

• Fluticasone / Mometasone nasal spray (mild, or first step), Levocetirizine, Fexofenadine, Montelukast (with asthma only — warn about mood and sleep changes), Azelastine + Fluticasone nasal spray (moderate–severe or not controlled — preferred over a steroid spray alone)

First visit

• No routine tests — Clinical diagnosis from typical symptoms and triggers.

Only if indicated

• Skin prick test or specific IgE — Uncertain diagnosis, or before allergen immunotherapy.
• Absolute eosinophil count — Not needed routinely.
• Nasal endoscopy — One-sided symptoms, bleeding or polyps.