Allergic rhinitis in children

Abstract

Allergic rhinitis affects up to 40% of children but is commonly undiagnosed. Careful assessment of nasal symptoms allows for the most appropriate therapeutic options to be chosen. Allergen avoidance is often difficult in practice. Antihistamines are of limited benefit in allergic rhinitis caused by house dust mite and other perennial allergens, where symptoms, predominantly nasal obstruction, are not histamine mediated. In contrast, symptoms triggered by pollen, such as nasal itch, rhinorrhoea and sneezing, are relieved by antihistamines. Intranasal steroids are the treatment of choice for persistent moderate–severe allergic rhinitis and are more effective than antihistamines for relief of nasal obstruction. Failure to respond to intranasal medications is often caused by poor compliance or inefficient use of nasal sprays. Immunotherapy may be a useful, if expensive, option, particularly where symptoms are because of a specific pollen. The benefits of immunotherapy in house dust mite‐induced rhinitis and asthma remain controversial.

A Before-after Assessment of the Efficacy of Narivent® in the Treatment of Symptoms Associated with Allergic Rhinitis in a Paediatric Population

“…On the contrary, perennial rhinitis with the prominent symptom of nasal blockage is more common in primary and preschool age children and allergens usually implicated include the house dust mite (HDM) (e.g. Dermatophagoides pteronyssinus and Dermatophagoides farinaeae) and animal dander [4]. The pattern of rhinitis (seasonal or perennial) also depends by the climatic environment (temperate or tropical) [6].…”

“…AR is often considered as a mild disorder. It may be in fact regarded by parents as an irritation rather than as a significant disease and consequently to be ignored, underdiagnosed, misdiagnosed (with symptoms frequently attributed to a recurrent cold) and mistreated [4].…”

“…Its prevalence in children is estimated to be 10-40% and appears to be increasing throughout the world [3,4]. AR is often considered as a mild disorder.…”

“…AR is characterized by symptoms of sneezing and nasal itching with obstruction and mucosal discharge, caused by an IgE-mediated reaction, and traditionally is classified as either perennial (PAR) or seasonal ('hay fever'), dependent on whether symptoms occur throughout the year or in relation to seasonal exposure to allergen [4,6].…”

Intranasal Triamcinolone and Growth Velocity

“…[1][2][3][4] Intranasal corticosteroids (INCs) are the most efficacious treatment option in relieving nasal congestion and controlling frequent symptoms and are the treatment of choice for persistent AR. 5,6 Nasacort (Sanofiaventis, Bridgewater, NJ; microcrystalline suspension of triamcinolone acetonide aqueous nasal spray [TAA-AQ]) has been marketed in the United States for nearly 2 decades and is approved for treating nasal symptoms of both perennial AR (PAR) and seasonal AR in adults and children. Double-blind, placebo-controlled studies have shown that TAA-AQ is effective and well tolerated in children.…”