BACKGROUND: Allergic Rhinitis Control Test (ARCT) has been validated in the allergic rhinitis (AR) step-up pharmacotherapy management approach. OBJECTIVE: The aim of our study was to evaluate the potential of ARCT in AR step-down pharmacotherapy. METHODS: In an open-labeled randomized controlled study, patients with AR controlled with intranasal corticosteroid (INS) plus antihistamine (step 4) were included and randomized into an ARCT or a control group. In the ARCT group, the patients were followed up every 15 days; if the ARCT score was >= 20 (controlled AR), the patient would step down to step 3 (INS), step 2 (daily antihistamine), step 1 (antihistamine as needed), and step 0 (no medication) consecutively; if the ARCT score was strictly <20, the treatment would not be adjusted. In the control group, patients would be treated with step 4 medications during the whole study. Rhinitis Quality-of-Life Questionnaire (RQLQ), Morisky Questionnaire, and Brief Illness Perception Questionnaire (B-IPQ) were completed at baseline and the end of the study. Medication use and side effects were recorded. RESULTS: A total of 255 patients with AR were enrolled into the study; 27 patients dropped out. The control rates at day 45 were 77.8% in the ARCT group and 85.8% in the control group (P>.05). The ARCT group had less mean medication use than the control group (INS 1.27 vs 2.22 bottle, antihistamines 35.9 vs 61.4 tablets) (P<.05). RQLQ, Morisky, and B-IPQ score were significantly improved in both groups after treatment (P<.05). CONCLUSIONS: Stepping down AR medications in controlled patients led to similar clinical outcomes at reduced cost compared with those who maintained their current treatment level. ARCT is an optimal tool for evaluating the step-down eligibility. (C) 2019 American Academy of Allergy, Asthma & Immunology