Pediatric allergic rhinitis: Treatment

Allergic rhinitis is a common disease of childhood that must be diagnosed and treated effectively to prevent complications and impaired quality of life frequently seen in children. The first step in treatment is allergen avoidance when appropriate. It may be difficult to eliminate all offending allergens effectively to reduce symptoms, so medications are often required. Antihistamines are effective in treating immediate symptoms of sneezing, pruritus, watery eyes, and rhinorrhea. SGAs are the preferred antihistamines because of their superior side-effect profile. The only antihistamine moderately effective for nasal congestion is nasal azelastine. Thus, decongestants are commonly used with oral antihistamines. Intranasal corticosteroids are the most effective therapy for AR, but concern about potential growth retardation (especially in older preparations) has limited their use. Montelukast may be as effective as antihistamines in treating AR symptoms. Nasal cromolyn is an option for mild disease when used prophylactically, and ipratropium bromide is effective when rhinorrhea is the predominant feature. When avoidance measures and medications are not effective, allergy immunotherapy is an effective alternative. Because of improved understanding of the pathogenesis of allergic diseases, new and better therapies, such as anti-IgE antibody therapy, may be forthcoming. The effective treatment of AR in children will reduce symptoms and will improve overall health and quality of life, making a happier, healthier child.