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Update on the treatment of allergic rhinitis in children
Eleni Anastasiou1, Paraskevi Xepapadaki1, Julijana Asllani2
1Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
Insights
Allergic rhinitis (AR) in children is common and impacts quality of life, but is often underdiagnosed. Effective treatments include nasal steroids and antihistamines, with immunotherapy offering disease modification.
Area of Science:
- Pediatric Allergy and Immunology
- Otolaryngology
- Pharmacology
Background:
- Allergic rhinitis (AR) is a prevalent chronic condition affecting children and adults, significantly impacting quality of life, academic performance, and healthcare utilization.
- Pediatric AR is frequently underdiagnosed and undertreated, leading to adverse physical, emotional, and cognitive developmental outcomes.
Purpose of the Study:
- To review current evidence on pediatric allergic rhinitis treatment strategies.
- To highlight age-specific challenges and evolving treatment paradigms for childhood AR.
- To inform clinical practice and future research directions in pediatric allergic rhinitis management.
Main Methods:
- Narrative review of recent scientific literature on pediatric allergic rhinitis treatment.
- Analysis of international guidelines, particularly ARIA (Allergic Rhinitis and its Impact on Asthma) recommendations.
- Synthesis of evidence on pharmacotherapy, immunotherapy, and adjunctive measures.
Main Results:
- Intranasal corticosteroids are foundational for moderate-to-severe pediatric AR; second-generation and intranasal antihistamines are effective for milder symptoms.
- Fixed-dose intranasal steroid-antihistamine combinations offer enhanced efficacy for severe or uncontrolled cases.
- Allergen immunotherapy is the sole disease-modifying treatment, while biologics and novel immunotherapies show promise in specific scenarios.
Conclusions:
- A stepwise, patient-centered approach is recommended for pediatric AR, prioritizing symptom control, safety, and long-term outcomes.
- Pharmacotherapy, allergen immunotherapy, patient education, and environmental control are crucial for sustained disease management.
- Further research, including age-adapted algorithms and long-term studies, is needed to address evidence gaps in pediatric AR, particularly for early intervention and disease modification.
Abstract:
Allergic rhinitis (AR) is the most common chronic condition from childhood to adulthood and remains a major, often underestimated, contributor to impaired quality of life, school performance, and healthcare use. Although symptoms frequently begin early in life, pediatric AR is still underdiagnosed and inadequately treated, with important consequences for physical, emotional, and cognitive development. In this narrative review, we summarize recent evidence on the treatment of AR in children, highlighting age-specific challenges and evolving treatment concepts. International recommendations, particularly those from ARIA, support a stepwise, patient-centred approach focused on symptom control, safety, and long-term outcomes. Intranasal corticosteroids remain the cornerstone of therapy for moderate-to-severe disease, while second-generation antihistamines and intranasal antihistamines provide effective options for milder or intermittent symptoms. Fixed-dose intranasal steroid-antihistamine combinations are highly effective, providing options for children with more severe or uncontrolled AR. Allergen immunotherapy is the only disease-modifying intervention. Emerging strategies, including biologics and novel immunotherapy approaches, are promising but currently limited to specific contexts. Alongside pharmacotherapy, education, adherence support, and pragmatic environmental measures are essential to achieve sustained disease control. Ongoing gaps in the pediatric evidence-base highlight the need for age-adapted algorithms and long-term studies focusing on early intervention and disease modification.
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