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Allergic rhinitis is the most common childhood condition caused by sensitization to outdoor allergens. It is a major risk factor for developing asthma with a high symptom burden among children.
The prevalence of asthma and allergic rhinitis has been increasing over the years both in developed and developing countries.
The burden of allergic rhinitis in children-Global and India
Allergic rhinitis affects about 10 percent to 30 percent of adults and 40 percent of children worldwide, seriously impacting daily life and causing severe burden among children and parents. A worldwide study revealed that that the average prevalence of rhinoconjunctivitis symptoms in children between 6 to 8 years was 8,5 percent and 14.6 percent in 13 to 14 years of children.
In India, the burden of allergic rhinitis is high with a substantial overlap with asthma.
Classification of allergic rhinitis
1.Intermittent: up to 4 days /week or up to consecutive 4 weeks.
2. Persistent: More than 4 days /week or more than 4 consecutive weeks
Clinical presentation of allergic rhinitis
Main symptoms include runny nose, blocked nose, itching of the palate, nose, ears, or eyes, or sneezing and may develop as early as 18 months of age.
Moderate to severe atopic disease in children is usually associated with a risk of developing asthma, allergic rhinitis, and food allergies.
Allergic rhinitis and quality of life
Allergic symptoms frequently interfere with a child’s ability to participate in daily activities and disrupt normal sleeping patterns, causing emotional distress and impacting negatively learning and cognition.
Other findings include poor school performance and school absences due to destruction, fatigue, irritability, poor interaction, isolation, and low self-esteem.
Treatment of allergic rhinitis
Diagnosis of allergic rhinitis based on types of symptoms
Intermittent symptoms: If mild, then oral or intranasal antihistamine and or decongestant or LTRA(leukotriene receptor antagonist)
If symptoms moderate to severe then oral or intranasal antihistamine and or decongestant or fluticasone plus azelastine in intranasal combination or chromone if responding after 2-4 weeks.
persistent symptoms:
If mild then oral or intranasal antihistamine and or decongestant or fluticasone plus azelastine in intranasal combination or chromone if responding after 2-4 weeks.
If moderate to severe then
First option: Fluticasone plus Azelastine in intranasal combination
Second option: Intranasal GC ( glucocoticoid)plus oral antihistamine or LTRA
follow up after 2-4 weeks, if responding step down, if not increase the dose of GC or review diagnosis or refer to a specialist.
Role of antihistaminics in allergic rhinitis in children
Oral antihistamines are the mainstay of treatment of allergic rhinitis in children.
Antihistamines are classified as first and second-generation on their effects on the central nervous system.
First-generation antihistamines cross the blood-brain barrier and interact with the brain’s H1 receptor, leading to disturbed rapid eye movement, sleep, and cognitive functions.
Second-generation oral antihistamines are now the first-line treatment recommended for all patients of allergic rhinitis.
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