The Journal of Allergy and Clinical Immunology: In Practice
Volume 1, Issue 3 , Pages 214-226, May 2013

Current and Future Directions in Pediatric Allergic Rhinitis

• Deborah Gentile, MD
, 
• Ashton Bartholow, BS
, 
• Erkka Valovirta, MD, PhD
, 
• Glenis Scadding, MD
, 
• David Skoner, MD

Received 8 January 2013; received in revised form 22 March 2013; accepted 23 March 2013.

• Abstract
• Full Text
• PDF
• Images
• References

Article Outline

• Background
• Epidemiology
• Comorbidities and complications
• Pathophysiology
• Current treatment strategies
  • Allergen avoidance
  • Pharmacotherapy
    • Oral or intranasal antihistamines
    • Intranasal corticosteroids
    • Systemic corticosteroids
    • Leukotriene receptor antagonists
    • Intranasal anticholinergics
    • Intranasal decongestants
    • Intranasal cromolyn
    • Anti-IgE
  • Specific immunotherapy
    • Subcutaneous immunotherapy
    • Sublingual immunotherapy
  • Surgery
  • Partnership
• Future directions
  • Diagnosis
  • Guidelines
  • Potential effect of health care reform
  • New/future therapies
  • Influence of generics/OTC switches
• References
• Copyright

Background

Allergic rhinitis (AR) is a common pediatric problem that significantly affects sleep, learning, performance, and quality of life. In addition, it is associated with significant comorbidities and complications.

Objective

The aim was to provide an update on the epidemiology, comorbidities, pathophysiology, current treatment, and future direction of pediatric AR.

Methods

Literature reviews in each of these areas were conducted, and the results were incorporated.

Results

The prevalence of AR is increasing in the pediatric population and is associated with significant morbidity, comorbidities, and complications. The mainstay of current treatment strategies includes allergen avoidance, pharmacotherapy, and allergen specific immunotherapy.

Conclusions

In the future, diagnosis will be improved by microarrayed recombinant allergen testing and therapy will be expanded to include emerging treatments such as sublingual immunotherapy and combination products.

Key words: Allergic rhinitis, Pediatrics, Specific immunotherapy, Intranasal corticosteroids, Antihistamines, Leukotriene modifiers

Abbreviations used: ADHD, Attention deficit hyperactivity disorder, AH, Antihistamines, AR, Allergic rhinitis, CRD, Component-resolved diagnostics, DC, Dendritic cell, FDA, Food and Drug Administration, FEIA, Fluorescent enzyme immunoassay, HCP, Health care provider,ICS, Inhaled corticosteroid, INCS, Intranasal corticosteroids, OCS, Oral corticosteroids, OME, Otitis media with effusion, OR, Odds ratio,OSA, Obstructive sleep apnea, OTC, Over-the-counter, PAA, Pediatric Allergies in America, QoL, Quality of life, SCIT, Subcutaneous immunotherapy, SIT, Specific immunotherapy, SLIT, Sublingual immunotherapy, Treg, Regulatory T [cell]