Allergic rhinitis — the one that isn't a cold

About this guide

Allergic rhinitis — allergic inflammation of the lining of the nose — is probably the most under-diagnosed common condition we see in Singapore. Studies put local prevalence at around 30%, yet a recent local study estimated that roughly 85% of people with allergic rhinitis are undiagnosed and 73% are untreated — many of them with symptoms that would count as moderate-to-severe. Most patients have simply learned to live with it, having assumed for years that they “always catch colds” or have a “sensitive nose.”

It’s one of the three conditions that make up the classic atopic triad — alongside eczema and asthma. If you have one of these, the odds of having or developing the other two are meaningfully higher.

This guide covers:

• How to tell allergic rhinitis apart from recurrent colds — and from other kinds of rhinitis
• What’s actually triggering it in Singapore’s climate
• What you get back from treating it properly — probably more than you expect
• The three main classes of medication, and what we generally don’t recommend
• Whether there’s a “cure” — and the realistic role of allergen immunotherapy
• Practical steps at home, including correct nasal-spray technique and dust-mite reduction

Everything below applies to adults and children — we’ve flagged paediatric-specific points where they matter.

What is allergic rhinitis?

Allergic rhinitis is an IgE-mediated inflammation of the nasal lining in response to an allergen — most often, in Singapore, house dust mite. Breathing in the allergen triggers cells in the nasal lining to release histamine and other inflammatory mediators, which produce the familiar cluster: runny nose, blocked nose, sneezing, and itchy nose. Many patients also get itchy, watery, red eyes — that’s allergic conjunctivitis, a close cousin that often travels with allergic rhinitis; we cover it in its own guide.

Allergic rhinitis is classified two ways:

• Perennial — year-round symptoms, driven by indoor allergens (dust mites, pet dander, moulds). This is the dominant form in Singapore.
• Seasonal — pollen-driven; common in temperate countries, uncommon locally.

And by how intrusive it is:

• Intermittent (fewer than 4 days a week, or fewer than 4 consecutive weeks) vs persistent (≥4 days a week and ≥4 consecutive weeks)
• Mild (not troublesome) vs moderate-severe (affecting sleep, daily activity, leisure or sport, school or work)

The important point: it is not a cold, even though the symptoms overlap. That confusion — plus the “it’s just how my nose is” assumption — is the biggest single reason so many Singaporean patients go untreated for years.

What’s triggering it in Singapore — the dust mite connection

Singapore’s warm, humid climate is the ideal condition for house dust mites (HDM) to thrive. Over 80% of people with allergic airway disease in Singapore are sensitised to dust mites, and three species dominate:

• Dermatophagoides pteronyssinus (European house dust mite)
• Dermatophagoides farinae (American house dust mite)
• Blomia tropicalis — particularly abundant in tropical climates, and an important local allergen that isn’t routinely tested in many overseas labs

Dust mites themselves are harmless microscopic creatures. What actually triggers symptoms is a protein in their droppings (and to a lesser extent their body fragments). They live wherever humans shed skin cells — mattresses, pillows, bolsters, sheets, sofas, soft toys, carpets — and flourish where humidity sits above 50%.

Other indoor triggers to consider if symptoms persist:

• Pet dander (cat, dog, rabbit, hamster)
• Cockroach allergen — more common in older buildings
• Mould spores — damp bathrooms, air-conditioning condensate, poorly ventilated corners

Pollen-driven seasonal AR is uncommon in Singapore, though we occasionally see patients who became sensitised while living in a temperate country.

Allergic rhinitis vs “always catching a cold”

Patients often come in having spent years assuming they simply pick up colds easily. A few features usually separate the two:

If your “colds” keep coming back, last for months, itch constantly, and settle with an antihistamine — they aren’t colds.

Other kinds of rhinitis — and why the diagnosis matters

Not every runny or blocked nose is allergic. Before treating, we try to distinguish between:

• Infective rhinitis — viral upper respiratory tract infection (see Colds, coughs and sore throats); shorter, often systemic, discharge frequently turns purulent.
• Vasomotor (non-allergic) rhinitis — the nose over-reacts to non-allergic triggers: temperature changes (e.g. entering an air-conditioned room from outside), strong smells, spicy food, alcohol, smoke. Itch is usually mild or absent and there’s no eye involvement. Antihistamines tend to be less effective; treatment often involves avoiding triggers, saline rinses, and sometimes an intranasal corticosteroid or anticholinergic spray.
• Hormonal rhinitis — pregnancy is the classic example; symptoms settle after delivery.
• Drug-induced rhinitis — chronic use of topical decongestant sprays (oxymetazoline — Iliadin; xylometazoline — Otrivin) beyond a few days causes rebound congestion (rhinitis medicamentosa). ACE inhibitors, some beta-blockers, and NSAIDs can also cause nasal symptoms in some patients.
• Occupational rhinitis — triggered by something at work (flour in bakers, latex, cleaning agents, chemicals); typically better on weekends and holidays.
• Structural causes — deviated septum, nasal polyps, adenoid hypertrophy in children — these produce blockage without the allergic features.

Getting the diagnosis right matters because the treatment pathways differ. Vasomotor rhinitis responds less well to antihistamines; rhinitis medicamentosa needs the offending spray stopped; nasal polyps may need specialist assessment.

Figuring out your triggers

Even when dust-mite sensitisation is the dominant story, patients differ in what reliably sets them off. A short mental audit often helps:

• When are symptoms worst? First thing on waking (a strong dust-mite signal — your face has been on the pillow for hours), right after making the bed (stirring up mite droppings), entering an air-conditioned car or room (temperature change), at a friend’s house with pets, at a specific workplace, during cleaning?
• When do they ease? On a holiday abroad? After a night away from home? At the beach or pool?
• Specific settings that reliably worsen you: pet homes, old bookshops, dusty storage rooms, carpeted hotel rooms, libraries, construction sites.
• Non-allergic irritants that aren’t allergens but reliably make things worse: cigarette smoke, strong perfumes, incense, vehicle exhaust, scented cleaning products.

A short symptom diary over 2–3 weeks — when symptoms flare, where you were, what you did — is often more useful than any blood test.

How we diagnose it

Allergic rhinitis is usually diagnosed from history and physical examination; formal testing is not routinely required.

We look for a characteristic symptom pattern: at least two of runny nose, blocked nose, itchy nose, or sneezing; present for at least two consecutive days; lasting more than an hour on most days. Eye symptoms (itchy, red, watery eyes) often accompany it.

On examination we may see:

• “Allergic salute” crease — a transverse line across the lower nose from frequent upward rubbing; particularly common in children
• Allergic shiners — darker discolouration under the eyes
• Habitual mouth-breathing posture
• Pale, boggy nasal lining with clear watery discharge (rather than the red, inflamed appearance of a viral infection)
• Middle-ear fluid or retracted eardrum — more often in children
• Conjunctival redness or swelling

A personal or family history of eczema, asthma, or food allergy strengthens the suspicion — these conditions cluster together because they share an underlying allergic tendency.

A note on young children — the “atopic march”

Allergies in children tend to develop in a predictable sequence:

1. Atopic dermatitis (eczema) — often in the first year of life
2. Food allergy — may follow
3. Allergic rhinitis — typically from around 2 years of age
4. Asthma — may develop in the preschool years or later

This sequence — the atopic march — means that a child under 2 with persistent runny or blocked nose is much more likely to have something other than allergic rhinitis: a run of viral infections, adenoid hypertrophy, non-allergic rhinitis, or a structural cause. Sensitisation takes time to develop, so true AR before 2 is uncommon.

If your young child has persistent nasal symptoms, it’s worth a consultation to sort out what’s actually going on — not just a reflex script for an antihistamine.

Red flags — when the pattern isn’t quite right

A few features should prompt a different line of assessment rather than assuming AR:

• One-sided nasal blockage or discharge
• Recurrent nosebleeds, particularly if severe or one-sided
• Purulent or foul-smelling discharge
• Recurrent sinus infections
• Facial pain, orbital pain, swelling, or visual changes
• Progressive worsening despite optimised treatment

These can point to structural issues (deviated septum, polyps), chronic rhinosinusitis, a foreign body in a child, or rarer diagnoses that warrant ENT assessment.

Testing — usually not needed, sometimes helpful

Allergy testing is not routinely required to diagnose AR. It’s most useful when:

• The diagnosis is genuinely unclear after history and examination
• Symptoms persist or remain severe despite properly-used first-line treatment
• We’re considering allergen immunotherapy (which needs a specific trigger identified)
• Multiple atopic conditions coexist and allergen identification would change management

Two tests are commonly used:

• Skin prick test (SPT) — a small drop of allergen extract is pricked onto the forearm; a raised, itchy bump appears within 15–20 minutes for what you’re sensitised to. Fast, cheap per allergen, and can test many allergens in one sitting — but you must be off antihistamines for several days beforehand, and it needs healthy skin (not suitable during an eczema flare). Systemic reactions are very rare but possible.
• Specific IgE blood test (sIgE) — a blood sample measures allergen-specific antibodies. You don’t need to stop antihistamines, it can be done during a skin flare, and it’s safer — but results take a few days, it costs more, and sensitivity is slightly lower.

Both tests measure sensitisation, not necessarily clinical allergy. A positive result has to match the clinical history to mean something. Broad-panel testing is rarely useful in Singapore because dust mite dominates by such a wide margin — we usually focus on the specific allergens a patient’s history suggests.

Why treat it — what you get back

Patients often ask us whether treatment is really worth it, given that allergic rhinitis is “not serious.” It isn’t life-threatening, but uncontrolled AR carries a larger daily cost than most people realise. When treatment works, here’s what commonly returns:

• Sleep. Nasal congestion disrupts sleep architecture. Treated AR usually means falling asleep faster, fewer night-time awakenings, less snoring, and — for many patients — a striking reduction in daytime fatigue.
• Breathing through the nose again. Chronic mouth-breathing dries the mouth, worsens dental plaque, contributes to sore throats, and in children can affect facial growth and dental alignment. Reversing it matters more than it sounds.
• Sense of smell and taste. Chronic congestion dulls smell, and taste is largely driven by smell. Many patients don’t realise how much they’ve lost until it comes back after a few weeks of good treatment.
• Performance in sport and at school or work. Children with poorly-controlled AR have measurably worse school performance, worse sports stamina, and more daytime drowsiness — a mix of disrupted sleep and chronic congestion. Adults describe similar gains in concentration and energy.
• Better control of other atopic conditions. Good AR control often improves asthma, reduces sinus infections, and reduces the rate of middle-ear problems in children.
• Headache and facial pressure. Often misattributed to sinusitis, these frequently settle when the underlying rhinitis is treated well.
• Less social embarrassment. Chronic sniffing, sneezing, and throat-clearing carry a social cost that patients rarely mention. Many say this is the biggest gain once it’s gone.

If you’ve been putting up with AR for years, it’s easy to underestimate how much better you can feel.

Treatment — three main options

Three classes of medication are first-line. Which one fits best depends on your symptom pattern, how quickly you need relief, whether you prefer oral or spray, and cost.

Intranasal corticosteroid spray (INCS)

A small dose of corticosteroid delivered directly to the nasal lining. This is the most effective single treatment for allergic rhinitis, particularly for the congestion component. Common options in Singapore:

• Fluticasone propionate — Flixonase
• Fluticasone furoate — Avamys
• Mometasone — Nasonex (subsidised under government schemes)
• Beclomethasone — Beconase
• Budesonide — Rhinocort
• Triamcinolone — Nasacort

Onset and time to full effect. Some improvement within 6–12 hours, but full benefit takes 1–2 weeks of daily, consistent use. A patient who tries a spray for three days and gives up often concludes it “didn’t work” — when in fact they stopped before it started working.

Safety. INCS is much safer than oral steroids — the dose reaching the bloodstream is tiny, and the safety record over decades of use is well established, including in children. The main side effects are local: mild nasal irritation or dryness, occasional light bleeds from the nose (usually improved by correcting technique, see below).

Second-generation oral antihistamines

Taken as a tablet or syrup, usually once a day. Faster than INCS (effect within 1–3 hours) and good for sneezing, itch, and runny nose — but less effective for congestion than INCS. Commonly used in Singapore:

• Cetirizine — Zyrtec, Alerid (subsidised)
• Loratadine — Clarityn (subsidised)
• Desloratadine — Aerius
• Levocetirizine — Xyzal
• Fexofenadine — Telfast
• Bilastine — Bilaxten (a newer third-generation option, with minimal sedation)

These are generally well-tolerated. Compared to the older first-generation antihistamines (below), they cause much less drowsiness, though some individual variation exists — cetirizine and levocetirizine have a slightly higher chance of sedation in some people; loratadine, desloratadine, fexofenadine, and bilastine tend to be the least sedating.

Combined intranasal corticosteroid + antihistamine spray (INCS+INAH)

A single spray that combines both. Fastest-acting of the three options (effect within 30 minutes, maximal over 2–3 days) and the most effective for moderate-to-severe symptoms. Commonly used in Singapore:

• Fluticasone + azelastine — Dymista
• Mometasone + olopatadine — Ryaltris

Used as a step-up when INCS monotherapy isn’t quite enough, or as a first-line option when severe symptoms need fast relief. The main drawbacks are cost (not currently subsidised) and a transient bitter aftertaste from the azelastine component, which is usually manageable with correct spray technique.

Switching, stepping up, stepping down

Pharmacotherapy continues until symptoms settle, after which we discuss stepping down rather than stopping abruptly. If AR returns, restart at the previously-effective dose. If initial treatment doesn’t achieve good control despite consistent, correct use, we usually consider:

• Oral antihistamine → INCS
• INCS → INCS+INAH combination
• Adding adjuncts (saline rinses, short-course topical decongestant)

What we generally don’t recommend

Some treatments that used to be commonly prescribed are no longer first-line for AR:

• First-generation oral antihistamines — chlorpheniramine (Piriton), hydroxyzine, promethazine (Phenergan), ketotifen. These cross into the brain and cause meaningful sedation and anticholinergic side effects (dry mouth, constipation, urinary retention, blurred vision). They impair driving and school performance, and in older adults are associated with confusion and falls. They still have legitimate uses in specific situations (acute urticaria, some allergic reactions, short-term sedation), but not for chronic allergic rhinitis.
• Montelukast (Singulair) as routine AR treatment — less effective than INCS and OAH for AR alone, and the Health Sciences Authority has an advisory regarding the risk of neuropsychiatric side effects (mood change, agitation, sleep disturbance, rarely suicidal thoughts). It has a specific role as an add-on in patients with AR plus coexisting asthma, and in that setting we weigh risks and discuss them openly.
• Long-term oral corticosteroids — the wrong trade-off for a chronic condition; long-term side effects (blood pressure, blood glucose, bone, cataracts, weight gain) outweigh benefit when good alternatives exist.
• Oral decongestants on their own (pseudoephedrine, phenylephrine) — limited benefit for AR beyond nasal congestion, with a side-effect burden (raised blood pressure, palpitations, insomnia, urinary retention). A short-course combination with an antihistamine has a role for a few days of severe congestion, but shouldn’t be used chronically.

A conversation about steroids

Many patients feel uncomfortable using a “steroid” spray, often because they’ve heard concerns about oral steroid side effects or seen older family members on long-term prednisolone. It’s a reasonable question — and one worth discussing rather than dismissing.

A few points of framing:

• Intranasal and oral corticosteroids aren’t the same drug in the same dose in the same place. The amount of corticosteroid in a daily nasal spray is roughly 1/50th to 1/100th of a typical oral prednisolone dose, and it’s delivered directly to the nasal lining rather than circulated through the bloodstream.
• Long-term, recommended-dose INCS has a well-established safety record across decades of use, including in children followed for growth.
• The main local side effects — mild dryness and occasional spotting of blood — are usually down to spray technique (aiming at the septum rather than away from it). They’re manageable.
• The realistic alternative to well-treated AR isn’t “no treatment” — it’s years of chronic symptoms, poor sleep, and sometimes worsening asthma or sinus disease.

If you have concerns, bring them up. For some patients the right answer is INCS plus an oral antihistamine; for others it’s antihistamine alone; for a few, immunotherapy is the better long-term path.

How to use a nasal spray correctly

Technique is a surprisingly large determinant of whether a spray works. Most patients have never been shown properly, and instructions on packaging can be unclear.

1. Blow your nose first to clear it.
2. Shake the bottle.
3. Prime a new bottle — a few test sprays into the air until a fine mist appears (follow the instructions for your product).
4. Tilt your head slightly forward, not back. This is the opposite of what many people assume.
5. Use the opposite hand to the nostril you’re spraying — left hand for right nostril, right hand for left. This angles the nozzle away from the septum (the middle wall of the nose), which is the most sensitive area and the usual source of nosebleeds from sprays.
6. Aim outward — toward the outer corner of the eye on the same side, not straight up.
7. Breathe in gently through the nose as you press down. A soft sniff, not a hard one — hard sniffing sends the medication straight down the throat.
8. Don’t blow your nose for 15 minutes after.

A bitter taste at the back of the throat usually means the spray has run down the back of the nose rather than coating the lining. Adjust the angle and the force of your sniff.

Saline nasal rinses

Plain salt-water rinses — from a squeezable bottle (NeilMed Sinus Rinse) or a small spray (FESS, Sterimar, Sinugas) — are a safe, inexpensive adjunct. They help wash out allergens, thin secretions, and improve symptom control, and they pair well with any of the pharmacological treatments. Particularly useful:

• Before an INCS spray — clears the lining so the spray coats better
• During a viral URTI on top of AR — when congestion spikes
• In children who tolerate small sprays better than large-volume rinses
• In pregnancy, when we want to minimise medication

For a large-volume rinse, use distilled, previously boiled, or sterile water — not tap water, because of a rare but serious risk of nasal infection. Proper buffered-salt sachets are inexpensive and widely available.

Topical nasal decongestant sprays — short-term tool only

Topical decongestants — oxymetazoline (Iliadin) and xylometazoline (Otrivin) — work within minutes by shrinking swollen nasal blood vessels. They’re genuinely useful for a few days of severe congestion — for example during a viral infection on top of AR, to help you sleep, or to let an INCS spray actually reach the nasal lining.

The critical rule: use for a maximum of 5 consecutive days. Beyond that, the nose becomes “dependent” on the spray — congestion rebounds worse than before every time the effect wears off, creating a cycle called rhinitis medicamentosa. We regularly see patients who’ve been using these sprays several times a day for years; breaking the cycle takes weeks and often needs an INCS spray to cover the transition.

Iliadin is sold in three age-specific strengths in Singapore:

• Iliadin Baby 0.01% — up to 1 year old
• Iliadin Children 0.025% — 1 to 6 years
• Iliadin Adult 0.05% — 6 years and up

The 5-day rule applies to all of them.

Reducing house dust mite exposure

A realistic framing first: dust-mite avoidance measures on their own are unlikely to control moderate-to-severe AR. The research evidence for avoidance is modest, and most patients need pharmacotherapy as the backbone of treatment. But the measures below are cheap, low-risk, and can give meaningful incremental benefit — particularly for sleep, since most dust-mite exposure happens while you’re in bed.

Worth doing:

• Encase the mattress, pillow, and bolster in tightly-woven dust-mite-proof covers (pore size below 10 microns). Widely available in Singapore — look for certified brands rather than generic claims.
• Wash bedding weekly in hot water (above 60°C), or use a hot dryer cycle where hot-water washing isn’t practical.
• Remove carpets and rugs from bedrooms where feasible. Hard floors are easier to keep dust-free.
• Reduce soft toys, cushions, and fabric wall hangings in bedrooms. A favourite soft toy sealed in a bag in the freezer overnight, once a week, kills mites.
• Vacuum weekly with a HEPA-filter vacuum. The settled allergen re-suspends for about 20 minutes after vacuuming or bed-making, so avoid exercising in the same space during that window if you’re sensitive.
• Humidity. Mites thrive above 50% humidity; air-conditioned bedrooms typically drop below that, which helps. Dedicated dehumidifiers are rarely necessary in practice.

Usually not worth the money: expensive “allergy” air purifiers (limited evidence for rhinitis specifically), chemical anti-mite sprays (short-lived effect, potentially irritating), and wholesale furniture replacement.

Is there a cure? — allergen immunotherapy

“Is there a cure?” is the most common question we get, usually after a few years of tablets and sprays that help but don’t solve the underlying problem.

The honest answer: standard pharmacological treatment controls allergic rhinitis but doesn’t cure it. The closest thing to a disease-modifying treatment is allergen immunotherapy — and it’s worth a careful conversation.

What it is

Allergen immunotherapy (AIT) is a gradual re-education of the immune system. Over a prolonged period, you’re given progressively increasing doses of the specific allergen you’re sensitised to, until the immune system’s exaggerated response becomes smaller. Two main delivery routes:

• Subcutaneous immunotherapy (SCIT) — small injections under the skin; initially weekly at a specialist clinic during a build-up phase (3–6 months), then monthly maintenance injections.
• Sublingual immunotherapy (SLIT) — a tablet or drops placed under the tongue daily at home. For house dust mite, SLIT tablets registered in many countries include Acarizax (SQ HDM) and Actair; availability and registration status in Singapore changes over time and your specialist will advise.

Realistic expectations

• Commitment: 3 years at minimum, often 3–5 years, for a durable effect. This is the part most patients don’t anticipate. It is a long course, not a short treatment.
• Effect size. For well-selected patients with dust-mite-driven AR, immunotherapy produces meaningful symptom reduction in most patients, with many able to reduce or stop other medications. It’s not guaranteed, and a minority get limited benefit.
• Persistence after stopping. Unlike tablets and sprays — which work only while you take them — the benefit of immunotherapy can persist for years after the course is completed. This is what makes it the closest thing to a “cure.”
• Side effects. SCIT carries a small risk of systemic allergic reaction, which is why injections are given in a specialist clinic with observation afterwards. SLIT is safer in that respect; most side effects are local (itching or slight swelling under the tongue) and usually settle as treatment continues.

Who should think about it

Worth considering if:

• You have persistent moderate-to-severe AR despite well-used first-line treatment
• You have an identified specific allergen — usually confirmed by SPT or sIgE — that matches your clinical picture
• You can commit to the multi-year schedule
• You have coexisting mild asthma driven by the same allergen (immunotherapy may help both)

Less suitable if:

• Symptoms are already well-controlled on minimal medication
• Asthma is poorly controlled (relative contraindication for SCIT)
• You’re pregnant (maintenance is often continued if already established and safe, but starting during pregnancy is usually deferred)
• Certain immune or cardiovascular conditions — specialist assessment is needed

The pathway

Immunotherapy is a specialist-led treatment. If we think it’s worth exploring, we usually:

1. Confirm the dominant allergen with SPT or sIgE testing
2. Optimise standard pharmacotherapy first to establish a baseline
3. Refer to an allergy, immunology, or ENT specialist experienced in immunotherapy for assessment and initiation
4. Continue to see you for general primary care follow-up in parallel — we don’t disappear from the picture

We’re happy to have this conversation at any stage, including early, so you know the option exists.

When we’d consider specialist referral

Most allergic rhinitis can be managed well in primary care. The situations where ENT, allergy, or immunology referral adds value:

• Symptoms persist or remain severe despite optimised pharmacotherapy, particularly with significant impact on sleep, school, or work
• Nasal polyps suspected, or visible on examination
• Chronic rhinosinusitis not settling with appropriate treatment
• Structural issues — significant septal deviation, adenoid hypertrophy in children
• Red flags — unilateral symptoms, recurrent epistaxis, facial pain, visual changes
• Considering allergen immunotherapy
• Coexisting poorly-controlled asthma — sometimes worth a joint review

A brief note on pregnancy

AR often worsens in pregnancy, partly from hormonal effects on the nasal lining and partly because perennial AR doesn’t pause just because you’re pregnant. Our usual approach:

• Saline rinses first — safe throughout pregnancy
• Intranasal corticosteroid if needed — budesonide has the most accumulated safety data and is our usual first choice
• Second-generation oral antihistamines — loratadine and cetirizine have the most reassuring safety data and are generally acceptable; we use the lowest effective dose
• Avoid oral decongestants (pseudoephedrine), especially in the first trimester
• Avoid first-generation antihistamines as a rule
• Topical decongestants briefly, if at all

Pregnancy is also a good time to reassess triggers in the home — dust-mite measures taken now may help both your symptoms and your baby’s future nasal and asthma trajectory.

The Singapore context — schemes that help

• Healthier SG Chronic Tier — patients enrolled with us can access chronic-disease medications (including some INCS and OAH preparations) at prices similar to polyclinic prices.
• Community Health Assist Scheme (CHAS) — means-tested subsidies for consultations and selected medications at participating GP clinics. More at chas.sg.
• MediSave — usable for chronic disease consultations and selected medications, up to the annual withdrawal limit (currently $500, rising to $700 / $1,000 from January 2027).
• Primary Care Networks (PCN) — KTMC is part of Class PCN, which supports nurse counselling and chronic disease registry tracking.

Get in touch

Joo Chiat — 172 Joo Chiat Road, #01-01, Singapore 427443 · Tel 6920 1952

Punggol — 658 Punggol East, #01-04, Singapore 820658 · Tel 6312 4589

Email — admin@ktmc.sg

References

Guidelines

• Agency for Care Effectiveness (ACE). Allergic rhinitis: diagnosis and management. ACE Clinical Guideline, Ministry of Health, Singapore. 2026. ace-hta.gov.sg
• Bousquet J, Schünemann HJ, Togias A, et al. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2020;145(1):70-80.
• Wise SK, Damask C, Roland LT, et al. International consensus statement on allergy and rhinology: Allergic rhinitis — 2023. Int Forum Allergy Rhinol. 2023;13(4):293–859.

Singapore epidemiology and dust mite sensitisation

• Wang XS, Tan TN, Shek LP, et al. The prevalence of asthma and allergies in Singapore; data from two ISAAC surveys seven years apart. Arch Dis Child. 2004;89:423–426.
• Chew FT, Lim SH, Goh DY, Lee BW. Sensitization to local dust-mite fauna in Singapore. Allergy. 1999;54:1150–1159.
• Andiappan AK, Puan KJ, Lee B, et al. Allergic airway diseases in a tropical urban environment are driven by dominant mono-specific sensitization against house dust mites. Allergy. 2014;69:501–509.

Pharmacotherapy

• Penagos M, Compalati E, Tarantini F, et al. Efficacy of mometasone furoate nasal spray in the treatment of allergic rhinitis. Meta-analysis of randomized, double-blind, placebo-controlled clinical trials. Allergy. 2008;63:1280–1291.
• Meltzer EO, LaForce C, Ratner P, et al. MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) in the treatment of seasonal allergic rhinitis. Allergy Asthma Proc. 2012;33:324–332.
• Health Sciences Authority, Singapore. Drug Safety Information — advisory on montelukast and neuropsychiatric effects. hsa.gov.sg

Allergen immunotherapy

• Dhami S, Nurmatov U, Arasi S, et al. Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic review and meta-analysis. Allergy. 2017;72:1597–1631.
• Demoly P, Emminger W, Rehm D, et al. Effective treatment of house dust mite-induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: results from a randomized, double-blind, placebo-controlled phase III trial. J Allergy Clin Immunol. 2016;137(2):444–451.

National programmes

• Ministry of Health, Singapore. Healthier SG and Chronic Tier information. healthiersg.gov.sg
• Community Health Assist Scheme. chas.sg

This information is for general education only and is not a substitute for medical advice. Allergic rhinitis management must be individualised to your symptom pattern, triggers, and response to treatment — please speak with our team about what’s right for you. v1.0 · April 2026 · Review due April 2028.