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Symptom Assessment of Patients with Allergic Rhinitis Using an Allergen Exposure Chamber
Published on: March 3, 2023
A control model to evaluate pharmacotherapy for allergic rhinitis in children
Gary Rachelefsky1, Judith Rosen Farrar
1Executive Care Center for Asthma, Allergy, and Respiratory Diseases, Geffen School of Medicine at the University of California, Los Angeles, 1131 Wilshire Blvd, Ste 202, Santa Monica, CA 90401, USA.
Insights
Treating pediatric allergic rhinitis (AR) with medications, especially intranasal steroids, improves disease control by reducing impairment and risks. Further research with standardized measures is needed for better comparisons.
Area of Science:
- Pediatric Allergy and Immunology
- Pharmacotherapy Research
- Clinical Trial Analysis
Background:
- Pediatric allergic rhinitis (AR) management is crucial for disease control.
- Evaluating treatment efficacy using an impairment-risk model is an important consideration.
- Existing models for asthma management offer a potential framework for AR.
Purpose of the Study:
- To systematically review the application of an impairment-risk control model in pediatric allergic rhinitis pharmacotherapy.
- To assess how different pharmacologic treatments impact disease control domains of impairment and risk in children with AR.
- To evaluate the utility of this model for guiding treatment decisions in pediatric AR.
Main Methods:
- Systematic review of controlled clinical trials in children (aged 2-18) with AR.
- Searched MEDLINE and EMBASE databases (January 1996 - May 2012).
- Included studies of at least 2 weeks duration assessing impairment and/or risk of comorbidities.
Main Results:
- Sixteen trials involving over 3000 children met criteria.
- All studied medication classes improved AR-related impairment.
- Intranasal steroids showed benefits for asthma and obstructive sleep apnea risks; oral antihistamines had potential effects on asthma and sleep-disordered breathing.
Conclusions:
- Pharmacotherapy for pediatric AR, particularly intranasal steroids, effectively improves disease control by reducing impairment and associated risks.
- While most AR medications likely improve impairment, standardized outcome measures are needed for robust comparisons.
- Intranasal steroids may decrease the risk of comorbidities, supporting current treatment guidelines.
Importance:
Although the question of whether early diagnosis and treatment of pediatric allergic rhinitis (AR) improve disease control is important, a more crucial question is whether we can evaluate the effect of treatment on disease control using an impairment-risk model.
Objective:
To conduct a systematic review evaluating application of a control model based on domains of impairment and risk (similar to that used for asthma) in pharmacotherapy for children with AR.
Evidence Acquisition:
We searched the MEDLINE and EMBASE databases (January 1, 1996, through May 31, 2012) for controlled studies lasting 2 weeks or longer in children with confirmed diagnoses of AR, including measures assessing impairment and/or risk of comorbid conditions.
Results:
Sixteen controlled clinical trials, including more than 3000 children (aged 2-18 years) with AR (seasonal, n = 2290; perennial, n = 800), met the study criteria. All medication classes improved impairment related to AR, but between-treatment comparisons were limited because of different assessments. Intranasal steroids improved risk outcomes associated with asthma and obstructive sleep apnea. Small single studies suggested possible effects of oral antihistamines on asthma and sleep-disordered breathing. No risk data were available for nasal antihistamines or montelukast sodium.
Conclusions:
Treatment of AR, particularly with intranasal steroids, improves disease control in children by reducing disease-associated impairment and risk. All AR medications with proved efficacy probably improve impairment, paralleling symptom reduction. Intranasal steroids may reduce the likelihood of comorbidities that increase health care use. These observations, although limited by different protocols and outcomes measures among studies, support current practice recommendations. Studies that use standardized measures of impairment to permit better comparison and appropriate protocols for risk evaluation are needed.
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