Treatment of Allergic Rhinitis in Children

Abstract

Allergic rhinitis is an inflammatory disease of nasal mucosa mediated by IgE-associated response to indoor and outdoor environmental allergens. The treatment of allergic rhinitis involves three main categories: avoidance of allergen, pharmacologic management and immunotherapy. The first therapeutic approach in allergic rhinitis is prevention, which is done by avoidance of causal allergens. This helps reduce the symptoms and the need for medications for allergic rhinitis. But allergen-avoidance measures should be considered before or in association with pharmacologic treatment. The intranasal steroids produce significant relief of all nasal symptoms of allergic rhinitis, including nasal congestion, sneezing, rhinorrhea, and itching. They are the first choice drugs in allergic rhinitis except mild intermittent rhinitis. In mild intermittent allergic rhinitis suggested initial treatment consists of an oral antihistaminic, an intranasal antihistaminic, and/or an oral or intranasal decongestant. Montelukast can be used in children as young as 6 months and it is approved by FDA for treatment of allergic rhinitis, in which it has shown clinical efficacy in both seasonal and perennial AR. Multiple randomized, double-blind, placebo controlled studies have shown efficacy of omalizumab (anti-IgE) in seasonal and perennial allergic rhinitis. However, the application of omalizumab in the treatment of allergic rhinitis in the absence of other atopic diseases will likely be restricted to a narrowly defined set of circumstances due to its cost. Specific immunotherapy should be considered when patients fail to respond to avoidance of allergens and pharmacotherapy or experience side effects, or when it is not cost effective.

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…Current treatment algorithms for children 2199,2200 and adult patients 182,1005 with moderate to severe AR with insufficient symptom control or treatment failure with INCS monotherapy uniformly recommend adding nasal IPB to the established INCS therapy if one of the main symptoms is predominant or refractory rhinorrhea. Although most guidelines recommend the combined use of both INCS and IPB in those patients, only one study assessed the effectiveness of this combination therapy in AR patients.…”