It has been suggested that intranasal phototherapy represents an alternative choice in the treatment of seasonal allergic rhinitis (SAR). Our aim was to compare the efficacy of intranasal phototherapy with that of azelastine in patients with SAR.Seventy seven patients were randomly assigned to the two treatment groups: Group A (phototherapy) and Group B (azelastine). Subjective and objective outcomes were represented by changes in Total Nasal Symptom Score (TNSS), Quality of life scores (Rhinoconjunctivitis Quality of Life Questionnaire – RQLQ), and nasal resistance.The study demonstrated that both azelastine and intranasal phototherapy are able to significantly improve TNSS, including individual nasal symptoms. Nevertheless, phototherapy reduced nasal obstruction better than azelastine (p=0.038). Both treatments were highly effective in improving RQLQ scores overall and in seven separate domains.Whether intranasal phototheraphy will be a standard treatment of SAR or not should be appraised in future studies and clinical trials.