Optimal management of allergic rhinitis

Abstract

Allergic rhinitis (AR), the most common chronic disease in childhood is often ignored, misdiagnosed and/or mistreated. Undertreated AR impairs quality of life, exacerbates asthma and is a major factor in asthma development. It can involve the nose itself, as well as the organs connected with the nose manifesting a variety of symptoms. Evidence-based guidelines for AR therapy improve disease control. Recently, paediatric AR guidelines have been published by the European Academy of Allergy and Clinical Immunology and are available online, as are a patient care pathway for children with AR and asthma from the Royal College of Paediatrics and Child Health. Management involves diagnosis, followed by avoidance of relevant allergens, with additional pharmacotherapy needed for most sufferers. This ranges, according to severity, from saline sprays, through non-sedating antihistamines, oral or topical, with minimally bioavailable intranasal corticosteroids for moderate/severe disease, possibly plus additional antihistamine or antileukotriene. The concept of rhinitis control is emerging, but there is no universally accepted definition. Where pharmacotherapy fails, allergen-specific immunotherapy, which is uniquely able to alter long-term disease outcomes, should be considered. The subcutaneous form (subcutaneous immunotherapy) in children has been underused because of concerns regarding safety and acceptability of injections. Sublingual immunotherapy is both efficacious and safe for grass pollen allergy. Further studies on other allergens in children are needed. Patient, carer and practitioner education into AR and its treatment are a vital part of management.

Resolving the etiology of atopic disorders by using genetic analysis of racial ancestry

“…158 Preschool children and young adults with untreated AR are at threefold increased risk of asthma later in life. 159,160 Evidence regarding the heritability of AR came from twin studies. 161 Though MZ twins were 45–60% concordant, the concordance rate in DZ twins was not more than 25%, with the calculated heritability ranging between 33% and 91%.…”

Applications and mechanisms of immunotherapy in allergic rhinitis and asthma

“…Allergen avoidance and pharmacotherapy such as antihistamines and local corticosteroids are the first line treatment management for controlling symptoms in AR [Bousquet et al 2012;Braido et al 2014;Jutel, 2014;Scadding, 2015;Wheatley and Togias, 2015]. For asthma control, long acting bronchodilators (LABAs) and inhaled corticosteroids (ICSs) are recommended by current guidelines [Reddel et al 2015a[Reddel et al , 2015b.…”

Pooled efficacy and safety data for house dust mite sublingual immunotherapy tablets in adolescents

“…20,21 Further, not well-controlled allergic rhinitis reduces sleep quality impairing concentration, school attendance and performance, 22 highlighting the importance of treating allergic rhinitis effectively in adolescents.…”