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Abstract Background. Allergic rhinitis (AR) remains underdiagnosed and insufficiently controlled, markedly impairing patients’ quality of life, including in pediatrics. In real-world practice, poor adherence, symptom variability, differences between national and international algorithms, and factors limiting intranasal drug delivery (including anatomical barriers) hinder optimal control.Objective. To provide multidisciplinary consensus proposals to optimize AR management by harmonizing national clinical guidance with ARIA 2024 principles, focusing on symptom control and adherence.Methods. A multidisciplinary expert council (allergology/immunology, otorhinolaryngology, pediatrics) meeting was held. National and international guidelines, systematic reviews, clinical trials, and real-world evidence were analyzed regarding control assessment (VAS), monotherapy vs combination therapy—including fixed-dose INCS/INAH combinations—and the impact of anatomical factors on intranasal treatment effectiveness.Results. The VAS was endorsed as a simple validated tool to monitor control. ARIA 2024 allows initiating any pharmacological option at the first assessment based on VAS-defined control and patient preferences. Evidence suggests that monotherapy fails to achieve adequate control in a substantial proportion of patients; fixed-dose INCS/INAH combinations offer practical advantages (enhanced efficacy, simplified regimen, improved adherence) and are recommended as initial therapy in persistent disease with VAS ≥5, especially with prominent nasal congestion. ENT evaluation is important when anatomical barriers compromise intranasal drug deposition.Conclusion. An updated VAS-driven algorithm was proposed, enabling initiation at any step; early use of fixed-dose INCS/INAH combinations is appropriate in patients with marked nasal congestion.