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Author Spotlight: Advancing Allergic Rhinitis Research with Multicolor Immunofluorescence
Published on: September 22, 2023
Optimal management of allergic rhinitis
Insights
Allergic rhinitis (AR) in children is common, undertreated, and impacts asthma development. Effective management includes allergen avoidance, pharmacotherapy, and potentially allergen-specific immunotherapy for improved long-term outcomes.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Clinical Otolaryngology
Background:
- Allergic rhinitis (AR) is the most prevalent chronic childhood disease, frequently misdiagnosed or inadequately treated.
- Undertreated AR significantly diminishes quality of life, worsens asthma control, and is a key factor in asthma development.
- AR affects nasal passages and connected organs, presenting diverse symptoms requiring comprehensive management strategies.
Purpose of the Study:
- To review current evidence-based guidelines and management strategies for pediatric allergic rhinitis.
- To highlight the importance of accurate diagnosis, allergen avoidance, and appropriate pharmacotherapy.
- To discuss the role and emerging evidence for allergen-specific immunotherapy in children.
Main Methods:
- Review of recently published European Academy of Allergy and Clinical Immunology (EAACI) pediatric AR guidelines.
- Inclusion of patient care pathway information from the Royal College of Paediatrics and Child Health for AR and asthma.
- Analysis of pharmacotherapeutic options, including saline sprays, antihistamines, intranasal corticosteroids, and antileukotrienes.
- Evaluation of allergen-specific immunotherapy (subcutaneous and sublingual) efficacy and safety in pediatric populations.
Main Results:
- Evidence-based guidelines are crucial for improving AR disease control in children.
- Pharmacotherapy for AR ranges from saline sprays to intranasal corticosteroids and antihistamines, tailored to disease severity.
- Sublingual immunotherapy demonstrates efficacy and safety for grass pollen allergy in children; further research is needed for other allergens.
- Subcutaneous immunotherapy use in children is limited by safety and acceptability concerns regarding injections.
Conclusions:
- Comprehensive management of pediatric AR involves accurate diagnosis, allergen avoidance, and tailored pharmacotherapy.
- Allergen-specific immunotherapy offers a unique potential to modify long-term disease trajectory, with sublingual immunotherapy showing promise.
- Patient, caregiver, and practitioner education is essential for effective AR management and improved health outcomes.
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.
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