If you've got a stuffy, drippy or itchy nose from allergies, figuring out which remedies help best can be tough.

New guidelines from the Academy of Otolaryngology should make it easier for people and their doctors to choose the treatments that will help the most, from over-the-counter remedies like antihistamines to more serious interventions like allergy shots and even surgery.

And because allergic rhinitis affects 1 in 6 Americans, that's a lot of stuffy drippy misery potentially avoided.

We talked with Dr. Sandra Lin, an associate professor of otolaryngology at the Johns Hopkins School of Medicine and a guideline author, to find out what's new. Here goes:

  • Sublingual immunotherapy for grass allergies lets people with those allergies get the benefits of allergy shots without the shots. It was approved by the Food and Drug Administration in 2014.
  • Surgery is an option for people with persistent symptoms and obstructed nasal passages. But other, less invasive treatments should be tried first.
  • Acupuncture may help relieve symptoms and improve quality of life for people with perennial allergic rhinitis, and may help with seasonal allergies. too, according to several studies. Thus it could be an option for people looking for nonpharmaceutical treatments.
  • There's not enough evidence that traditional Chinese herbal remedies help, largely because there are so many different remedies and very little testing for safety and effectiveness.

The recommendation of acupuncture seems surprising, but Lin says, "I'm telling you there is some evidence base for it."
That and the question of traditional herbal remedies made for a lot of discussion "in a good way," Lin adds. The committee included not just ENTs but primary care doctors and patients.

The guidelines also provide a road map for treating allergic rhinitis, with over-the-counter medications and managing the environment as the first line of defense.

"There's so much available over the counter," Lin notes. But because there are so many options, it can be hard to match the drug with the symptoms, she says.

Antihistamines don't help for stuffiness, for instance, but they do help with sneezing and itch. Decongestants are good for stuffiness and drippy noses. One steroid nasal spray, triamcinolone (Nasacort), is now available over the counter. That and prescription steroid nasal sprays are good for treating stuffiness and mucus.

"One of the things I think is useful is to see your primary care physician and let them look at you so they can make the decision if you have environmental allergies," Lin says. "Sometimes what people think are allergies are not allergies."

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