Introduction

Abstract

The prevalence of allergic rhinitis in childhood has increased throughout most of the world over the past few decades, causing substantial morbidity in children and increased health care costs. Recent studies have shown that 20% of children are affected by allergic rhinitis by age 3 years, and about 40% of all children have symptoms of allergic rhinitis by age 6 years. These trends have created the need for the development of intervention strategies to prevent, treat, and potentially modify the course of allergic rhinitis in children.Several risk factors have been identified for allergic rhinitis; these include a family history of atopic disorders, a serum IgE of greater than 100 IU/mL before age 6, a higher socioeconomic class, and exposure to indoor allergens. Often allergic rhinitis goes undiagnosed, most likely because symptoms are either overlooked or are attributed to respiratory infections.Treatment strategies for pediatric allergic rhinitis are changing, particularly as new, more effective and safe therapies become available. Antihistamines, which had been widely used, are not effective for nasal congestion, and even the “nonsedating” compounds have been shown to be sedating. In addition, few antihistamines other than loratadine are indicated for children under age 12 years. Decongestants are effective for nasal decongestion, but when used long-term have been shown to cause tachyphylaxis and rebound nasal congestion. The intranasal corticosteroids are the most effective medications for the spectrum of allergic rhinitis symptoms and have been used in children. The newer intranasal corticosteroids have the advantage of greater efficacy with far fewer side effects than has been associated with their predecessors.A workshop was recently convened in Barcelona, Spain, to review and discuss the latest information in pediatric allergic rhinitis and its treatment. This supplement is based on the discussions at that workshop; its purpose is to provide clinicians with a comprehensive summary of the important aspects of pediatric allergic rhinitis and the use of intranasal corticosteroids, in particular, as a treatment. It is designed to provoke thought and stimulate further research in this important area. Topics addressed include the epidemiology, pathophysiology, and diagnosis of allergic rhinitis; treatment options; the modes of action and the pharmacokinetics of intranasal corticosteroids, with a consideration of hypothalamic pituitary axis data; and the safety and efficacy of mometasone furoate, a new intranasal corticosteroid indicated for use in children with allergic rhinitis. The prevalence of allergic rhinitis in childhood has increased throughout most of the world over the past few decades, causing substantial morbidity in children and increased health care costs. Recent studies have shown that 20% of children are affected by allergic rhinitis by age 3 years, and about 40% of all children have symptoms of allergic rhinitis by age 6 years. These trends have created the need for the development of intervention strategies to prevent, treat, and potentially modify the course of allergic rhinitis in children. Several risk factors have been identified for allergic rhinitis; these include a family history of atopic disorders, a serum IgE of greater than 100 IU/mL before age 6, a higher socioeconomic class, and exposure to indoor allergens. Often allergic rhinitis goes undiagnosed, most likely because symptoms are either overlooked or are attributed to respiratory infections. Treatment strategies for pediatric allergic rhinitis are changing, particularly as new, more effective and safe therapies become available. Antihistamines, which had been widely used, are not effective for nasal congestion, and even the “nonsedating” compounds have been shown to be sedating. In addition, few antihistamines other than loratadine are indicated for children under age 12 years. Decongestants are effective for nasal decongestion, but when used long-term have been shown to cause tachyphylaxis and rebound nasal congestion. The intranasal corticosteroids are the most effective medications for the spectrum of allergic rhinitis symptoms and have been used in children. The newer intranasal corticosteroids have the advantage of greater efficacy with far fewer side effects than has been associated with their predecessors. A workshop was recently convened in Barcelona, Spain, to review and discuss the latest information in pediatric allergic rhinitis and its treatment. This supplement is based on the discussions at that workshop; its purpose is to provide clinicians with a comprehensive summary of the important aspects of pediatric allergic rhinitis and the use of intranasal corticosteroids, in particular, as a treatment. It is designed to provoke thought and stimulate further research in this important area. Topics addressed include the epidemiology, pathophysiology, and diagnosis of allergic rhinitis; treatment options; the modes of action and the pharmacokinetics of intranasal corticosteroids, with a consideration of hypothalamic pituitary axis data; and the safety and efficacy of mometasone furoate, a new intranasal corticosteroid indicated for use in children with allergic rhinitis.