Update on Allergic Rhinitis

Abstract

1. Todd A. Mahr, MD* 2. Ketan Sheth, MD, MBA† 1. *Clinical Professor of Pediatrics, University of Wisconsin Medical School, Department of Pediatric Allergy/Immunology, Gundersen Clinic, La Crosse, Wisc 2. †Assistant Clinical Professor of Pediatrics, Indiana University School of Medicine, Lafayette Allergy & Asthma Clinic, Lafayette, Ind After completing this article, readers should be able to: 1. Recognize the various signs and symptoms of allergic rhinitis (AR) in children. 2. Understand the impact of AR on pediatric patients. 3. Discuss the treatment of AR in children. 4. Describe the systemic effects of antihistamines in infants and young children. 5. Understand the roles of topical and oral corticosteroids in the treatment of AR. Allergic rhinitis (AR) is the most common chronic disease in children, affecting up to 40%. However, the disease frequently is overlooked and undertreated because it often is mistaken for recurrent upper respiratory tract infections in children who cannot adequately communicate the impact of their symptoms. AR generally is not considered to be a life-threatening disease, yet it is one of the major reasons for visits to pediatricians. In 1998, the Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology defined rhinitis as “inflammation of the membrane lining the nose, characterized by nasal congestion, rhinorrhea, sneezing, itching of the nose and/or postnasal drainage.” AR is a hypersensitivity reaction to specific allergens occurring in sensitized patients that is mediated by immunoglobulin (Ig)E antibodies and results in inflammation. Traditionally, AR is classified as seasonal or perennial and as either mild, moderate, or severe. Mild AR involves no sleep interruption, no impairment of daily activities, and no troublesome symptoms. Moderate-to-severe AR involves one or more of those factors. A newer classification system specifies that AR be characterized as intermittent or persistent. Intermittent disease involves symptoms for fewer than 4 days per week or for a duration of fewer than 4 weeks. Persistent disease involves symptoms that occur more than 4 days per week and are present for longer than 4 weeks (Bousquet, 2001). Because approximately 50 million Americans have AR, almost all primary care physicians encounter the disease. In one study, 42% …