Background: allergic rhinitis (AR) is a common health challenge and its prevalence is rising. Many medications were used for treatment. Aim of the work: to compare the effects of monotherapy with topical steroid, Botulinum Toxin-A (BTX-A) or Fexofenadine hydrochloride in treatment of AR. Patients and Methods: one hundred and fifty patients with AR were included. They were divided into three equal groups; the first treated with a single dose intranasal injection of BTX-A, the second treated with Fexofenadine (once/day), and the third treated with intranasal steroid spray (Triamcinolone, once/day). All patients were evaluated before treatment for nasal symptoms and each symptom was scored by severity. In addition, patients were administered the rhinoconjunctivitis quality of life (RQoL) questionnaire. All patients were followed-up each two weeks till the end of the third month and data was evaluated in each visit. Results: at baseline, groups were comparable regarding symptom severity and quality of life (QoL). At 2 weeks, all groups showed improvement in symptom severity and QoL. Regarding symptom severity, the lower was Triamcinolone followed by Fexofenadine and then BTX-A group, but QoL was significantly improvement in BTX-A, Fexofenadine and Triamcinolone respectively. At the end, there was significant reduction of symptom severity scores for obstruction, rhinorrhea, sneezing, itching, eye irritation, total nasal symptoms' score (TNSS) and QoL scores. Conclusion: BTX-A may be a suitable alternative therapy for AR treatment. Otherwise, the treatment with second generation antihistamine or corticosteroids is effective.