Allergic Sensitization and Rhinitis in Children: What Is New?

Abstract

Allergic rhinitis I Pediatric I House dust mite I Pollens I Skin prick test I Immunotherapy Opinion statement In children with nasal symptoms during several months, oftentimes with a chronically relapsing course, allergic rhinitis is one of the most probable diagnoses. This is often complicated with recurrent respiratory infections, as there is a circular causal loop between allergic rhinitis that increases the frequency of respiratory infections and the infections that exacerbate the allergic disease. As a consequence, in these children, the physician should intentionally search for allergic sensitization, in serologic specific IgE testing and/or with skin prick testing. If a possible allergic diathesis is further suspected because of a personal (atopic dermatitis) or a family history of allergic diseases, the search for allergic sensitization should begin at an even earlier age; in several cases, allergic sensitization can already be shown even before the age of two. In my opinion, in highly atopic children as soon as a specific allergic sensitization can be documented that coincide with the presence of symptoms on possible exposure, as obtained from the detailed history, allergen immunotherapy should be offered as an integral part of the treatment. It is very well plausible that the earlier in the development of the allergic disease, we can redirect the immune system, the better the results. However, in these young allergic children, I only choose sublingual immunotherapy (SLIT), being the option with the best safety profile. In our clinic, we have looked for several ways to improve adherence, which is an issue especially in SLIT. Among the several strategies we implemented are written information on the treatment and the administration schedule with a 20 min explanation by a specialized nurse at start, a flexible, 1-month up-dosing phase to reduce the frequency and intensity of local side effects and reduce the frequently seen flare in nasal symptoms, morning dosing, up-dosing under the cover of an antihistamine and a topical corticosteroid in the evening for 6 weeks, a close follow-up of the children by phone contacts, and an initial follow-up visit at 6 weeks.