000942 - Surveys on Real-World Practice Patterns in the Pharmacological Treatment of Allergic Rhinitis

Real-world pharmacologic management of allergic rhinitis (AR) may differ from guideline-based recommendations, influenced by symptom presentation, physician judgment, and patient preference. This study aimed to investigate current prescribing patterns for AR in Korea, focusing on treatment selection, escalation strategies, combination therapy, and management in special clinical settings.

A cross-sectional questionnaire was developed using a three-round Delphi process. The survey assessed real-world pharmacologic management of AR according to symptom severity and nasal congestion, next-step treatment strategies for uncontrolled disease, patterns of combination therapy, prescribing practices and safety considerations for leukotriene receptor antagonists (LTRAs), and management approaches in special clinical settings, including pollen-induced seasonal AR, pregnancy, and lactation.

Seventy-seven clinicians completed the survey. Treatment strategies shifted from as-needed to regular therapy with increasing symptom severity; however, approximately 20% of physicians reported prescribing primarily based on patient preference regardless of disease severity. Nasal congestion was a key determinant of medication choice: intranasal corticosteroids (INCS) were preferred for mild AR with congestion, whereas INCS/intranasal antihistamine combinations predominated in moderate-to-severe disease. In the absence of nasal congestion, oral antihistamines were favored for mild AR and INCS for moderate-to-severe AR. When initial therapy was inadequate, physicians consistently preferred add-on strategies rather than treatment switching, most commonly adding INCS to existing therapy. LTRAs were frequently prescribed in patients with concomitant asthma, although counseling regarding potential neuropsychiatric adverse effects was limited. Pre-seasonal pharmacotherapy was commonly initiated 1–3 weeks before pollen exposure. In pregnant and lactating patients, non-systemic therapies and oral antihistamines were preferred, with increased use of INCS in later pregnancy and during lactation.

Real-world pharmacologic management of allergic rhinitis in Korea shows partial concordance with current guidelines, with treatment decisions often influenced by physician judgment and patient preference, underscoring the need for more implementation-oriented, patient-centered guidance.