Update on pediatric allergic rhinitis: narrative review based on guideline updates

Pediatric allergic rhinitis, among the most common chronic allergic diseases in children and adolescents, represents a significant public health burden in Korea and other countries. Allergic rhinitis in childhood is closely associated with asthma and should be considered a unified airway disease requiring integrated management. Recent Allergic Rhinitis and its Impact on Asthma and Korean Academy of Asthma, Allergy and Clinical Immunology guidelines advocate an evidence-based control-oriented stepwise treatment strategy that incorporates a patient-centered approach that is supported by both randomized trial data and real-world evidence. Intranasal corticosteroids (INCS) remain the first-line treatment for moderate to severe pediatric allergic rhinitis, whereas INCS plus intranasal antihistamine (INAH) combination therapy is recommended when symptom control is inadequate with INCS alone. Oral antihistamines (OAH) and INAH are recommended for children with mild disease or when rapid symptom relief is required. However, the addition of OAH to INCS therapy does not confer clinically meaningful additional benefits compared with INCS monotherapy in most patients with allergic rhinitis; therefore, routine combination therapy is not recommended. Leukotriene receptor antagonists are not recommended as first-line therapy for allergic rhinitis and are mainly used as add-on therapy in patients with concomitant asthma. In patients with predictable seasonal allergic rhinitis, INCS may be initiated 1-2 weeks before the anticipated pollen season to optimize symptom control. Pediatric management requires special consideration of age-specific clinical features, treatment adherence, safety, and caregiver education. The early diagnosis and guideline-based treatment of allergic rhinitis in children may improve their quality of life and reduce long-term respiratory morbidity.