Allergic rhinitis (AR) is a prevalent condition characterized by increased sensitivity to otherwise benign allergens, resulting in a range of adverse effects on an individual’s quality of life. Some more persistent AR effects include disrupted sleep, reduced vitality, lowered mood, limited frustration tolerance, impaired focus, and decreased academic and professional performance, significantly stressing healthcare systems’ clinical and financial aspects1. In the United States, approximately 20–40% of the population is affected by AR, further underscoring the significance of this issue2.

The link between AR and asthma, another inflammatory airway condition, is becoming increasingly evident owing to the comorbid nature of these entities, ranging from 10% to 25%3. Although our understanding of the link between AR and asthma has advanced over the last few years, there is consensus to suggest that the upper and lower airways are a unified morphological and functional unit in health and disease3. In support of the abovementioned notion, the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines, initially published in 2001, highlight the importance of appropriate management of AR in patients with asthma4,5. Moreover, recent research has shed light on the potential benefits of Allergen Immunotherapy (AIT) in alleviating AR symptoms, possibly leading to long-term resolution of the condition and a reduction in asthma exacerbations and incidence of pneumonia6. Interestingly, AIT appears to confer advantages that persist even after treatment cessation. In this vein, analyzing cost-effectiveness data from a Florida Medicaid population, it is apparent that the total average healthcare cost over 18 months can be reduced by 38% for patients receiving AIT compared to those receiving standard care or $6637 versus $10,644 USD, respectively with reductions that were observed in both adult (30%) and pediatric (42%) groups7.

The current primary healthcare landscape presents challenges in providing optimal care to AR patients. To complicate matters, there is a shortage of allergists and immunologists, limiting the availability of specialized care for the increasing number of patients who could benefit from AIT8. Primary care practitioners often encounter and treat patients with allergies initially. However, gaps in their training and a lack of clear guidance have hindered the effective management of persistent symptoms, resulting in inefficient resource utilization. Accordingly, there is a critical need to equip primary care providers with the corresponding training. This commentary proposes a lucid, comprehensive workflow model for primary care practitioners to address the challenges of treating mild to moderate respiratory allergies and using AIT to manage patients when appropriate. The model aims to guide practitioners through critical steps in patient assessment, pharmacotherapy approaches, and initiating or continuing AIT. Additionally, the paper emphasizes the importance of developing medical education programs and bridging the gap between primary care and allergy-related treatment, which seeks to provide more effective and efficient care for AR patients.