Purpose of Review <p>Allergic rhinitis (AR) is a very common and troubling disorder that severely affects patients’ quality of life. There is an urgent need to understand the immunopathologic factors behind the disease. Acetylcholine is a neurotransmitter that has emerged as one of the critical regulators of AR pathogenesis.</p> Recent Findings <p>The elevation of cholinergic transmitters and their muscarinic receptors is a major driver of nasal hypersensitivity and excessive nasal secretion in AR pathogenesis. In addition to inducing extensive mucus secretions, the relevant research data for acetylcholine in immune regulation and airway remodeling remain fragmented. The immunopathological mechanisms underlying acetylcholine signaling pathways associated with AR may provide clinical practitioners with novel insights for medication selection in controlling patients’ symptoms.</p> Summary <p>We highlight the roles of acetylcholine in AR pathogenesis and the findings of clinical trials on intranasal anticholinergics use in AR, and hope to provide a reference for patients’ management.</p>