Keeping up with clinical trials: 
ARISE for allergic rhinitis

Researchers at the NACE state that a lack of patient education leads to improper use and misconceptions about intranasal medications, compromising adherence and resulting in poor AR symptom control.^9,11 The ARISE trial will therefore provide young Australians living with AR with a specifically designed education package alongside their daily intranasal corticosteroid spray, with an aim to evaluate the impact and effectiveness of education in reducing symptoms and improving quality of life.^9,11

Recruitment is currently underway at 17 general practices and allergy clinics across every state and territory in Australia, with completion of the study expected in May 2026.^9,11

Guidelines advise that treatment of allergic rhinitis should be tailored to symptom severity and frequency, with non-sedating oral or intranasal antihistamines recommended first-line for mild intermittent symptoms, and the addition of intranasal corticosteroids recommended for persistent or moderate-to-severe symptoms.^12,13 Importantly, it is recommended that a treatment is trialled for at least 4 weeks before assessing efficacy, and adherence and spray technique checked before escalating therapy.^12,13

Nasal saline is also recommended as a well-tolerated and effective adjunct treatment to pharmacotherapy across the spectrum of allergic rhinitis presentations.¹² Specifically, pretreatment with nasal saline may help improve effectiveness of medicated nasal sprays in adults,¹⁴ with saline recommended to be used 10 minutes before administration of a medicated nasal spray to clear the nasal passages.¹³ A systematic review and meta-analysis of randomised controlled trials found adjunct use of nasal saline in both adults and children resulted in 31.2% faster mucociliary clearance, 27.7% improvement in nasal symptom scores and 27.9% improvement in quality of life.^*15

For both medicated sprays and nasal saline sprays, correct technique is essential for effective and safe use.¹³ Patients need to be advised to aim outwards towards the outer wall of the nose and the ear, so that the spray can reach the highly vascularised turbinate region of the nasal cavity.^12,13,16 Instructions for correct administration are incorporated in the ASCIA Treatment Plan for Allergic Rhinitis, and patient videos are also available to demonstrate correct use of nasal saline sprays and washes.

Australia has one of the highest prevalences of AR in the world, as well as some of the highest rates of allergic sensitisation to common aeroallergens.^2,3 This makes Australians vulnerable to the adverse impacts of climate change on allergens and allergic disease.²

Climate strongly influences airborne pollen in Australia, with climate change expected to increase pollen production, allergenicity and season duration, elevating the risk of prolonged and unpredictable exposure.^2-6 Indeed, incidence of respiratory diseases in Australia has increased over the last decades due to a higher prevalence of airborne allergens.³ An increase in weather extremes can also heighten the risk of asthma exacerbations, as was seen in the world’s worst case of epidemic thunderstorm asthma that occurred in Melbourne in November 2016.^2,3

With these evolving environmental challenges, trials like ARISE are more important than ever to accelerate allergy research and support patients with evidence-based allergy care.