Allergic Rhinitis

A 28-year-old woman presents to the ENT clinic with a 3-year history of nasal congestion, rhinorrhoea, and sneezing that worsens during the monsoon season. She reports itching of the nose and palate. Examination reveals pale, boggy nasal mucosa with clear nasal discharge. Nasal smear shows predominance of eosinophils (>5%). She has tried intranasal saline rinses with minimal relief. What is the most appropriate first-line pharmacological treatment for this patient?

A 32-year-old male software engineer from Bangalore presents with a 6-month history of bilateral nasal obstruction, clear rhinorrhoea, and postnasal drip. Symptoms are worse in the morning and during air-conditioned office hours. He denies fever, facial pain, or anosmia. Nasal endoscopy shows bilateral pale, edematous nasal mucosa with clear secretions; no polyps or deviated septum. Skin prick testing is positive for dust mite and mold allergens. He has tried saline rinses and a 2-week course of intranasal fluticasone but reports only 25% symptom improvement. What is the most appropriate next step in management?