Pediatric Allergic Rhinitis: Treatment

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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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