The use of evidence-based guidelines for AR therapy results in improved disease control. Current management is based on avoidance of triggering allergen(s), non-sedative anti-histamines for mild disease, and use of non-systemically bioavailable nasal steroids for moderate/severe disease. The use of an intranasal combined preparation of fluticasone propionate and azelastine for those unresponsive to these measures is under investigation. Allergen-specific immunotherapy, currently recommended for severe cases, is the only treatment modality potentially able to alter long term not only disease severity, but also progression. Immunotherapy is often unavailable to deserving patients and concern regarding risk/benefit and acceptability can hamper its use in children. Evidence on efficacy and safety of the more child-friendly sublingual route of administration is emerging, however further well-designed paediatric studies are needed. Education of patients, carers and of practitioners in the nature of AR, the possible need for long term concordance with therapy and the optimal use of this is a vital part of disease management.