Allergic rhinitis in children: a modern view of therapy

In recent decades, there has been an increase in the prevalence of allergic diseases around the world. In industrialized countries, the prevalence of allergic rhinitis reaches up to 40%. Symptoms of allergic rhinitis can have a negative impact on patients’ quality of life, disturb sleep, and contribute to poor school performance. In allergic rhinitis, characteristic changes of the nasal mucous membrane epithelium are noted: metaplasia of goblet cells; exfoliation of the epithelium; decrease in number of cells with mobile cilia; loss of cilia by epithelial cells; infiltration of mucous membrane by inflammatory cells; thickening of basal membrane. Symptoms of allergic rhinitis include rhinorrhoea, obstructed nasal breathing, itching and sneezing. Modern classifications of allergic rhinitis take into account the etiology, duration and severity of symptoms and pathophysiological changes. Allergic rhinitis often debut in children under 6, which is often preceded by sensitization. The algorithm of management of patients with allergic rhinitis has four main methods that are necessary simultaneously: training of patients, including children and their parents, elimination of allergens, pharmacotherapy, immunotherapy. Elimination measures are very important for patients with allergic rhinitis, but it is not always possible to completely eliminate contact with the causal allergen. The choice of drug therapy depends on the form and clinical severity of the disease, the age of the patient (age restriction of the drug), the availability of the drug in pharmacies and its price, as well as the acceptability and satisfaction of the patient with the specific treatment method. Intranasal antihistamines have been shown to be highly effective in reducing symptoms such as sneezing, rhinorrhoea, itching, and to a lesser extent - nasal congestion. Intranasal antihistamines also have faster onset than oral antihistamines. Nasal congestion is most effectively facilitated by decongestants.

1. Belov V.A. Basic principles of allergic rhinitis therapy in paediatric practice. Meditsinskiy sovet = Medical Council. 2017;(9):103-107. (In Russ.) doi: 10.21518/2079-701X-2017-9-103-107.

2. Klimek L., Pfaar O., Bousquet J., Senti G., Kundig T. Allergen immunotherapy in allergic rhinitis: current use and future trends. Expert Rev Clin Immunol. 2017;(13):897-906. doi: 10.1080/1744666X.2017.1333423.

3. von Kobyletzki L.B., Bornehag C.G., Hasselgren M., Larsson M., Lindstrom C.B., Svensson A. Eczema in early childhood is strongly associated with the development of asthma and rhinitis in a prospective cohort. BMC Dermatol. 2012;(12):11. doi: 10.1186/1471-5945-12-11.

4. Shokouhi Shoormasti R., Pourpak Z., Fazlollahi M.R., Kazemnejad A., Nadali F., Ebadi Z., Tayebi B., Moslemi M., Karimi A., Valmohammadi S., Nazemi A.M., Mari A., Moin M. The Prevalence of Allergic Rhinitis, Allergic Conjunctivitis, Atopic Dermatitis and Asthma among Adults of Tehran. Iran J Public Health. 2018;47(11):1749-1755. doi: 10.1186/1471-5945-12-11.

5. Yang P.C. Investigation of the nasal mucosa in perennial allergic rhinitis with SEM and TEM. Zhonghua Er Bi Yan Hou Ke Za Zhi. 1990;25(2):95-96,126.

6. Ozerskaya I.V., Geppe N.A., Malyavina U.S. Osobennosti respiratornogo ehpiteliya u detey s bronkhial'noy astmoy i allergicheskim rinitom. Doktor.Ru. 2018;(11):50-56. (In Russ.) doi: 10.31550/1727-2378-2018-155-11-50-56.

7. Brozek J.L., Bousquet J., Agache I., Agarwal A., Bachert C., Bosnic-Anticevich S., et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950-958. doi: 10.1016/j.jaci.2017.03.050.

8. Linneberg A., Dam Petersen K., Hahn-Pedersen J., Hammerby E., Serup-Hansen N. and Boxall N. Burden of allergic respiratory disease: a systematic review. Clin Mol Allergy. 2016;(14):12. doi: 10.1186/s12948-016-0049-9.

9. MeLtzer E.O., Gross G.N., KatiaL R. and Storms W.W. Allergic rhinitis substantially impacts patient quaLity of Life: findings from the NasaL Allergy Survey Assessing Limitations. J Fam Pract. 2012;(61):5—10. Available at: https://www.ncbi.nLm.nih.gov/pubmed/22312622.

10. Smith M., Cecchi L., Skjoth C.A., et aL. Common ragweed: a threat to environmentaL heaLth in Europe. Environ Int. 2013;(61):115-126. doi: 10.1016/j.envint.2013.08.005.

11. Ziska L., KnowLton K., Rogers C., et aL. Recent warming by Latitude associated with increased Length of ragweed poLLen season in centraL North America. Proc Natl Acad Sci U S A. 2011;108(10):4248-4251. doi: 10.1073/pnas.1014107108.

12. WaLLace D.V., Dykewicz M.S., Bernstein D.I., et aL. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(2 suppL.):1-84. doi: 10.1016/j.jaci.2008.06.003.

13. Bousquet J., KhaLtaev N., Cruz A.A., et aL. ALLergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in coLLaboration with the WorLd HeaLth Organization, GA2LEN and ALLer Gen). Allergy. 2008;63(suppL. 86):8-160. doi: 10.1111/j.1398-9995.2007.01620.x.

14. Emeryk A., Emeryk-Maksymiuk J., Janeczek K. New guideLines for the treatment of seasonaL aLLergic rhinitis. Postepy Dermatol Alergol. 2019;36(3):255-260. doi: 10.5114/ada.2018.75749.

15. PapadopouLos N.G., Bernstein J.A., DemoLy P., et aL. Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report. Allergy. 2015;70(5):474-494. doi: 10.1111/aLL.12573.

16. Roberts G., XatzipsaLti M., Borrego L.M., Custovic A., HaLken S., HeLLings P.W., PapadopouLos N.G., Rotiroti G., Scadding G., Timmermans F., VaLovirta E. Paediatric rhinitis: position paper of the European Academy of ALLergy and CLinicaL ImmunoLogy. Allergy. 2013;68(9):1102-1116. doi: 10.1111/aLL.12235.

17. Westman M., Stjarne P., Asarnoj A., et aL. NaturaL course and comorbidities of aLLergic and nonaLLergic rhinitis in chiLdren. J Allergy Clin Immunol. 2012;129(2):403-408. doi: 10.1016/j.jaci.2011.09.036.

18. PoLs D.H., Wartna J.B., Moed H., van ALphen E.I., Bohnen A.M., BindeLs PJ. Atopic dermatitis, asthma and aLLergic rhinitis in generaL practice and the open popuLation: a systematic review. Scand J Prim Health Care. 2016;34(2):143-150. doi: 10.3109/02813432.2016.1160629.

19. HiLL DA., Grundmeier R.W., Ram G. and SpergeL J.M. The epidemioLogic characteristics of heaLthcare provider-diagnosed eczema, asthma, aLLergic rhinitis, and food aLLergy in chiLdren: retrospective cohort study. BMC Pediatr. 2016;(16):133. doi: 10.1186/s12887-016-0673-z.

20. Kim J.L., Brisman J., AL Aberg M. Trends in the prevaLence of asthma, rhinitis and eczema in 15 year oLd adoLescents over an 8 year period. Respir Med. 2014;(108):701-708. doi: 10.1016/j.rmed.2014.02.011.

21. Head K., Snidvongs K., Hopkins C. et aL. SaLine irrigation for aLLergic rhinitis. Cochrane Database Syst Rev. 2018;(6):CD012597. doi: 10.1002/14651858.CD012597.pub2.

22. MeLtzer E.O. Pharmacotherapeutic strategies for aLLergic rhinitis: matching treatment to symptoms, disease progression, and associated conditions. Allergy Asthma Proc. 2013;(34):301-311. doi: 10.2500/aap.2013.34.3676.

23. Hoyte F.C.L., NeLson H.S. Recent advances in aLLergic rhinitis. Version 1. F1000Res. 2018;(7):F1000 FacuLty Rev-1333. doi: 10.12688/f1000research.15367.1.

24. KaLiner M.A., Storms W., TiLLes S., et aL. Comparison of oLopatadine 0.6% nasaL spray versus fLuticasone propionate 50 microg in the treatment of seasonaL aLLergic rhinitis. Allergy Asthma Proc. 2009;30(3):255-262. doi: 10.2500/aap.2009.30.3232.

25. Garaschenko T.I., Boikova N.E. Impaired nasaL breathing and aLLergic rhinitis in chiLdren. Meditsinskiy sovet = Medical Council. 2015;(6):72-78. (In Russ.) doi: 10.21518/2079-701X-2015-6-72-78.

26. HeLLings P.W., DobbeLs F., Denhaerynck K., et aL. ExpLorative study on patient's perceived knowLedge LeveL, expectations, preferences and fear of side effects for treatment for aLLergic rhinitis. Clin Transl Allergy. 2012;(2):9. doi: 10.1186/2045-7022-2-9.

27. Nurmatov U., Dhami S., Arasi S., et aL. ALLergen immunotherapy for aLLergic rhinoconjunctivitis: A systematic overview of systematic reviews. Clin Transl Allergy. 2017;(7):24. doi: 10.1186/s13601-017-0159-6.