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Paediatric issues relating to the pharmacotherapy of allergic rhinitis
1Valley Clinical Research Center, 3729 Easton-Nazareth Highway, Ste 202, Easton, Pennsylvania 18045, USA.
Insights
Allergic rhinitis in children is increasing, often alongside asthma. Topical nasal steroids or non-sedating antihistamines are recommended treatments, with steroids generally offering better symptom control.
Area of Science:
- Pediatric Allergy and Immunology
- Otorhinolaryngology
- Pharmacology
Background:
- Allergic rhinitis prevalence in children has surged in recent decades, paralleling increases in asthma, suggesting shared inflammatory pathways.
- Environmental and genetic factors contribute to these comorbidities, highlighting potential for targeted pharmacological interventions.
- Understanding these shared mechanisms is crucial for effective pediatric respiratory and nasal condition management.
Purpose of the Study:
- To review current pharmacotherapy options for pediatric allergic rhinitis.
- To compare the efficacy and safety profiles of different treatment classes.
- To provide guidance on selecting appropriate treatments based on clinical evidence.
Main Methods:
- Literature review of clinical trials and pharmacological studies on pediatric allergic rhinitis treatments.
- Comparative analysis of topical nasal corticosteroids, second-generation antihistamines, and other agents.
- Evaluation of efficacy, safety, tolerability, and long-term effects in pediatric populations.
Main Results:
- Intranasal corticosteroids demonstrate superior symptom control compared to second-generation antihistamines.
- While efficacy is comparable within classes, safety and tolerability guide agent selection.
- Second-generation antihistamines can improve learning in children with rhinitis; nasal decongestants offer short-term relief but risk rebound.
- Chromones are safe but require frequent dosing; ipratropium bromide targets rhinorrhea.
Conclusions:
- Pharmacotherapy for pediatric allergic rhinitis is indicated when allergen avoidance is insufficient.
- Topical intranasal steroids or second-generation antihistamines are the preferred first-line treatments.
- Treatment choice should prioritize local efficacy, systemic safety, and tolerability in children.
Abstract:
The prevalence of allergic rhinitis in children has risen significantly over the last two decades. Important comorbidities like asthma have grown in parallel due to a complex mix of environmental and genetic factors. These conditions have similar allergic inflammatory mechanisms, which raises the possibility of treating both conditions by targeting shared inflammatory mediators pharmacologically. The first line treatment for paediatric allergic rhinitis is a topical nasal corticosteroid or a non-sedating antihistamine. Available intranasal corticosteroids show superior symptom control to second-generation antihistamines. However, most topical steroids and non-sedating antihistamines have equivalent clinical efficacy within their respective classes, so the choice of agent depends on safety and tolerability. Ideally, topical nasal steroids should exhibit high local receptor binding affinity and low systemic bioavailability, allied with a lack of long-term growth suppression in children and adolescents. Regular use of topical steroids is advisable, but intermittent and prophylactic use is also effective. Second-generation antihistamines are effective and some have no adverse cardiac or sedative effects. Non-sedating antihistamine treatment can ameliorate rhinitis-induced decrements in learning. alpha-Adrenergic nasal decongestants provide short-term benefit, but topical agents can cause rebound symptoms. Prophylactic treatment with chromones is safe and effective, but multiple daily dosing is needed. Ipratroprium bromide nasal spray is useful as an intermittent therapy for mild disease or as add-on treatment, but its effect is limited to the control of rhinorrhoea. Children with allergic rhinitis should receive pharmacotherapy if allergen avoidance measures are ineffective, ideally with a topical intranasal steroid or a second-generation antihistamine.