Pediatric Allergic Rhinitis: Treatment
Section snippets
Quality of life and comorbid disorders
AR can have a profound and significant effect on a child's quality of life including psychosocial aspects and daily functioning. Children with AR are more inclined than their peers without AR to demonstrate shyness, depression, anxiety, fearfulness, and fatigue [11]. In fact, AR affected classroom/work productivity and ability to perform daily activities in more than 90% the children evaluated, leading to absenteeism in 23% [12]. In addition, children were commonly embarrassed and felt
Pathophysiology
Prolonged exposure to allergens such as dust mite, cockroach, cat, dog, or pollen leads to allergen-specific IgE production. Re-exposure to the allergens triggers a cascade of events including early- and late-phase responses resulting in the symptoms of AR [16], [17].
The early-phase response develops within minutes after re-exposure to the offending allergen. The allergen binds to cell surface–bound allergen-specific IgE, which activates mast cells and basophils. This activation results in the
Signs and symptoms of allergic rhinitis
Because some children are unable to verbalize their symptoms, it is important to be familiar with the signs and symptoms associated with AR to diagnose these children properly and to treat them early. Classic symptoms of AR include paroxysms of sneezing, nasal and palatal pruritus, nasal congestion, and rhinorrhea, with or without ocular symptoms. Other symptoms include postnasal drainage, headaches, nocturnal cough, and snoring. Irritability and fatigue may be present, sometimes to a
Diagnosis
The diagnosis of AR begins with a careful documentation of the patient's symptoms and any seasonal or other exposure pattern, as well as a detailed medical and environmental history. In pediatrics, the individual providing the history is usually the parent or caretaker [19]. The demonstration of allergen-specific IgE corresponding to allergen exposure and symptomatic periods confirms the diagnosis of AR. Specific IgE can be measured using radioallergosorbent testing or ELISA, but skin testing
Treatment
Management options for a child with allergic rhinitis include environmental control for allergen avoidance, pharmacotherapy, and allergen immunotherapy. The goal of treatment is to control the symptoms, improve the child's ability to function, and prevent the complications of allergic rhinitis [18].
Summary
Allergic rhinitis is a common disease of childhood that must be diagnosed and treated effectively to prevent complications and impaired quality of life frequently seen in children. The first step in treatment is allergen avoidance when appropriate. It may be difficult to eliminate all offending allergens effectively to reduce symptoms, so medications are often required. Antihistamines are effective in treating immediate symptoms of sneezing, pruritus, watery eyes, and rhinorrhea. SGAs are the
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2020, Considering the Patient in Pediatric Drug Development: How Good Intentions Turned Into HarmRisk effects of high and low relative humidity on allergic rhinitis: Time series study
2019, Environmental ResearchCitation Excerpt :Allergic rhinitis (AR) is one of the most common allergic disorders (Casale TB and MS., 2004; Feng et al., 2017), a chronic inflammatory reaction of the nasal mucosa, often accompanied by sneezing, flowing nose, nasal itching and nasal congestion (Lai et al., 2005).
Reply
2010, Journal of Allergy and Clinical ImmunologyBurden of allergic rhinitis: Results from the Pediatric Allergies in America survey
2009, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Adults also reported that spring, followed by fall, was the worst time of year for allergy symptoms. AR is characterized by nasal congestion, rhinorrhea, repeated sneezing, and nasal itching, common symptoms brought on by the body's immunologic inflammatory response to allergen exposure.19-22 Ocular symptoms, such as eye itching, tearing, redness, and lid puffiness, collectively referred to as allergic conjunctivitis, are also common symptoms of AR.23
Mometasone furoate nasal spray is safe and effective for 1-year treatment of children with perennial allergic rhinitis
2009, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :In addition to asthma [32–35], common comorbidities of pediatric AR include otitis media with effusion, adenoidal hypertrophy, and Eustachian tube dysfunction [5,32,36–38]. Failure to adequately treat AR can lead to an increase in these comorbidities as well as in sinusitis, nasal polyp recurrence, sleep disturbances, orthodontic malocclusions, and behavioral and educational problems [32,39–41]. Among children with chronic otitis media, anywhere from 24% to 30% have been found to have concomitant AR [36,37].
Quantitative assessment of allergic shiners in children with allergic rhinitis
2009, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Whether allergic shiners correlated with the severities of symptoms of allergic rhinitis has never been investigated. This relationship seems to be logical because the pathogenesis of allergic shiners is believed to be related to venous stasis resulting from nasal congestion.1,4 To solve this puzzle, we designed this study and found in the prospective follow-up visits that frequent allergic rhinitis symptoms above certain thresholds were associated with either darker or larger allergic shiners.