Treatment Of Pediatric Allergic Rhinitis Research Articles

Efficacy and safety of sublingual versus subcutaneous immunotherapy in children with allergic rhinitis: a systematic review and meta-analysis.

To systematically compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with allergic rhinitis (AR). PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to March 2, 2023. Outcomes included symptom scores (SSs), medication scores (MSs), symptom and medication scores (SMSs), new sensitizations, development of asthma, improvement, and treatment-related adverse events (TRAEs). The quality of the included studies was assessed by the modified Jadad scale and Newcastle-Ottawa scale (NOS). Meta-regression was carried out to explore the source of heterogeneity. Subgroup analysis was further conducted in terms of study design [randomized controlled trials (RCTs), cohort studies], allergen [house dust mites (HDMs), grass pollen], treatment duration (≥ 24, 12-23 or < 12 months), allergen immunotherapy (AIT) modality (drops or tablets), and AIT protocol [continuous, pre-seasonal, co-seasonal, or after the grass pollen season (GPS)]. Sensitivity analysis was conducted for all outcomes. A Bayesian framework and a Monte Carlo Markov Chain (MCMC) model were developed for indirect comparison. Totally 50 studies with 10813 AR children were included, with 4122 treated with SLIT, 1852 treated with SCIT, and 4839 treated with non-SLIT or non-SCIT therapy. For direct comparison, the SLIT group had a similar SS to the SCIT group [pooled standardized mean difference (SMD): 0.41, 95% confidence interval (CI): -0.46, 1.28, P = 0.353]. Comparable MSs were observed in the SLIT and SCIT groups (pooled SMD: 0.82, 95%CI: -0.88, 2.53, P = 0.344). For indirect comparison, no significant differences were found in SSs (pooled SMD: 1.20, 95% credibility interval (CrI): -1.70, 4.10), MSs (pooled SMD: 0.57, 95%CrI: -1.20, 2.30), SMSs (pooled SMD: 1.80, 95%CrI: -0.005, 3.60), new sensitizations [pooled relative risk (RR): 0.34, 95%CrI: 0.03, 3.58], and development of asthma (pooled RR: 0.68, 95%CrI: 0.01, 26.33) between the SLIT and SCIT groups; the SLIT group illustrated a significantly lower incidence of TRAEs than the SCIT group (pooled RR: 0.17, 95%CrI: 0.11, 0.26). Considering both efficacy and safety, SLIT might be a more favorable AIT than SCIT in the treatment of pediatric AR, which may serve as a decision-making reference for clinicians. PROSPERO (CRD42023460693).

Chinese expert consensus on stepwise treatment of pediatric allergic rhinitis

Allergic rhinitis (AR) is one of the most common allergic diseases in children. Stepwise approach targeting to minimize impact of disease with optimized treatment should be the most practical approach, whilst there have been neither systematic and detailed recommendations for the stepwise treatment of AR nor related consensus documents to provide guidance for its specific application in clinical practice. Thus, the expert panel draft the consensus through literature review and two rounds of Delphi voting, which selects and focuses on the critical clinical questions in stepwise treatment, provides targeted therapeutic regimen basing on symptom type and severity of AR as well as assessment recommendations, and discusses key issues including the time point and criteria for assessment and step-up/down regimen. This consensus aims to provide a specific and practical guidance for the general practitioners, specialists, pharmacists and nurses, and promote the standardization of AR treatment in pediatric population.

Guideline for diagnosis and treatment of pediatric allergic rhinitis (2022, revision)

Guideline for diagnosis and treatment of pediatric allergic rhinitis (2022, revision)

Yu ping feng san for pediatric allergic rhinitis: A systematic review and meta-analysis of randomized controlled trials.

Background:The potential treatment effects and safety of Yu ping feng san (YPFS) for pediatric allergic rhinitis (PAR) patients have yet to be studied systematically.Objectives:To assess the effects and safety of YPFS for treat pediatric patients, allergic rhinitis.Methods:We systematically searched PubMed, EMBASE (Excerpta Medical Database), Cochrane library, Chinese Cochrane Centre's Controlled Trials Register platform, Wanfang Chinese Digital Periodical and Conference Database, China National Knowledge Infrastructure Database, and VIP Chinese Science, from inception dates to November 1, 2019. Randomized controlled trials (RCTs) were included. The risk of bias in the trials was assessed in accordance with the Cochrane Handbook, version 5.1.0. RevMan 5.3 software was used to perform a meta-analysis. Grading of Recommendations Assessment, Development and Evaluation methodology was applied to evaluate the evidence quality for each outcome. The quality of evidence for each outcome measurement was low for 4 outcomes and very low for 5 outcomes.Results:A total of 10 RCTs involving 1069 participants (3–15 years old) fulfilled the inclusion criteria. After exclusion, 8 RCTs were pooled for efficacy assessment. The overall efficacy evaluation result did not show benefit for the experimental group (relative risk 0.32, CI 95% 0.24–0.45; P = .98;) Investigation of variation of serum IgA, immunoglobulin E, IgG in three studies in 2 groups returned no statistical significance. YPFS gave relatively better safety (relative risk 0.29, CI 95% 0.14–0.58; P = .0005; Fig. S8 and lower recurrence rates than did Western medical therapy.Conclusions:Current evidence cannot support the routine use of YPFS for treatment of PAR. This may be due to poor-quality study-design limitations of the included YPFS studies. Our data showed that the use of YPFS for PAR is relatively safe compared to Western medical therapy, but a conclusion could not be drawn because only 5 studies were analyzed. Every study suffered from some methodological limitation. Therefore, further large, rigorously-designed studies are necessary to determine conclusively the utility of YPFS in PAR.

Efficacy of Sublingual Administration of Dermatophagoides Farinae Drops for Treatment of Pediatric Allergic Rhinitis Accompanied by Adenoid Hypertrophy and Improvement of Immune Function.

BackgroundThe aim of this study was to determine the efficacy of sublingual administration of Dermatophagoides farinae drops for the treatment of allergic rhinitis (AR) accompanied by adenoid hypertrophy and the effect on immune function in children.Material/MethodsEosinophil counts in peripheral blood before and after treatment were determined; serum levels of immunoglobulin E (IgE), total IgE (T-IgE), immunoglobulin G4 (IgG4), interleukin-2 (IL-2), and interleukin-6 (IL-6) before and after treatment were detected by enzyme-linked immunosorbent assay.ResultsThe total effective rate in the study group was significantly higher than that in the control group (P<0.05). In both the study and control groups, symptom scores, medication scores, eosinophil counts in the peripheral blood, and serum levels of IgE, T-IgE, and IL-6 were significantly lower than those before treatment (P<0.05), while the serum levels of IgG4 and IL-2 were significantly higher than those before treatment (P<0.05). After treatment, symptom scores, medication scores, eosinophil counts in the peripheral blood, and serum levels of IgE, T-IgE, and IL-6 in the study group were significantly lower than those in the control group (P<0.05), while the serum levels of IgG4 and IL-2 were significantly higher in the study group than those in the control group (P<0.05).ConclusionsSublingual administration of D. farinae drops improved the clinical symptoms of pediatric AR caused by Dermatophagoides mites and improved the immune functions in children.

Epidemiological investigation of allergic rhinitis in Ningxia

Objective: To investigate the epidemiological characteristics of allergic rhinitis (AR) in Ningxia and to analyze its related factors. Methods: From March to September of 2013, a multi-stage and cluster sampling method was used to investigate the diagnosis and treatment of AR in Ningxia Area (3 years and above). Guidelines for diagnosis and treatment of allergic rhinitis (2009, Wuyishan) was used as the basis for the diagnosis of adult AR, while Guidelines for diagnosis and treatment of pediatric allergic rhinitis (2010, Chongqing) was used as the basis for children. SPSS 16.0 software was used to complete the statistical analysis. Results: The total number of questionnaires was 6 000, and the number of effective questionnaire was 5 236, the recovery rate was 87.27%. With 684 cases diagnosed of AR, the prevalence of AR in Ningxia was 13.06% (684/5 236), including 13.40% (325/2 425) of males, 12.77% (359/2 811) of females. The difference was not statistically significant (χ(2)=0.456, P>0.05). There was significant difference in the prevalence between Hui and Han [14.35% (452/3 150) vs 11.12% (232/2 086), χ(2)=11.51, P<0.05]. According to ARIA criteria, persistent AR was 27.63% (189/684), intermittent AR was 72.37% (495/684). The month with highest incidence of AR in Ningxia Area was September, accounting for 71.78% (491/684). The prevalence of urban population was 14.54%, with the prevalence of rural population was 11.90%, and the difference was significant between urban and rural residents (χ(2)=7.90, P<0.05). The age group with highest prevalence rate was 21~30 years old. The main inhalation allergens were mugwort (68.42%), weeds (58.48%) and ragweed (55.56%). The main dietary allergens were wheat flour (14.33%), peanut (13.74%) and walnut kernel (11.99%). The most common complication was allergic conjunctivitis [82.02% (561/684)]. Conclusion: The epidemiology of AR in Ningxia Area is preliminarily understood, which will provide the epidemiological evidence for the prevention and treatment of AR and the formulation of public health policy.

Sublingual immunotherapy for pediatric allergic rhinitis: The clinical evidence.

Allergic rhinitis is estimated to affect 10%-20% of pediatric population and it is caused by the IgE-sensitization to environmental allergens, most importantly grass pollens and house dust mites. Allergic rhinitis can influence patient's daily activity severely and may precede the development of asthma, especially if it is not diagnosed and treated correctly. In addition to subcutaneous immunotherapy, sublingual immunotherapy (SLIT) represents the only treatment being potentially able to cure allergic respiratory diseases, by modulating the immune system activity. This review clearly summarizes and analyzes the available randomized, double-blinded, placebo-controlled trials, which aimed at evaluating the effectiveness and the safety of grass pollen and house dust mite SLIT for the specific treatment of pediatric allergic rhinitis. Our analysis demonstrates the good evidence supporting the efficacy of SLIT for allergic rhinitis to grass pollens in children, whereas trials regarding pediatric allergic rhinitis to house dust mites present lower quality, although several studies supported its usefulness.

Cost-effectiveness analysis of mometasone furoate versus beclomethasone dipropionate for the treatment of pediatric allergic rhinitis in Colombia.

IntroductionAllergic rhinitis (AR) is one of the most common chronic respiratory diseases observed in the pediatric population, producing a significant morbidity, and an economic burden due to direct medical costs and indirect costs. Despite the high prevalence of AR in children and the importance of the use of topical intranasal corticosteroids for its treatment, comparative analyses of alternative treatments in pediatric patients, in terms of both cost and effectiveness are lacking.MethodsA decision-analysis model was developed to estimate the cost-effectiveness of mometasone furoate nasal spray (MFNS) compared to beclomethasone dipropionate nasal spray (BDNS) for treating pediatric patients with AR over a 12-month period. Effectiveness parameters were obtained from a published study in which authors performed a systematic review of the literature. Cost data were obtained from a hospital´s bills and from the national manual of drug prices. The study assumed the perspective of the national healthcare in Colombia. The outcomes were three effectiveness measures summarized in a therapeutic index (TIX).ResultsFor the base-case analysis, the model showed that compared to BDNS, therapy with MFNS was associated with lower costs (US$229.78 vs. 289.74 average cost per patient over 12 months) and a greater improvement in TIX score (0.9724 vs. 0.8712 score points on average per patient over 12 months), thus leading to dominance.ConclusionThe present analysis shows that in Colombia, compared with BDNS, therapy with MFNS for treating pediatric patients with AR is a dominant strategy because it showed a greater improvement in a TIX reflecting both efficacy and safety, at lower total treatment costs.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0192-6) contains supplementary material, which is available to authorized users.

Treatment on 28 cases of pediatric allergic rhinitis by combining Tuina and Chinese herbal medicine

ObjectiveTo discuss the clinical efficacy of treating pediatric allergic rhinitis by combining Tuina with Chinese herbal medicines. MethodsTwenty-eight cases of pediatric allergic rhinitis were treated by combining pediatric Tuina and oral administration of Yupingfeng powder (▪) combined with Guizhi decoction (▪). The clinical efficacy was observed after 6 treatments. ResultsThe treatment of pediatric allergic rhinitis by combining Tuina and Chinese herbal medicines had an overall effectivness rate of 85.71%. ConclusionCombined treatment using pediatric Tuina and an herbal mixture of Yupingfeng powder (▪) and Guizhi decoction (▪) has positive therapeutic efficacy for treatment of pediatric allergic rhinitis, and should be considered as a treatment for this condition.

New developments in the treatment of pediatric allergic rhinitis and conjunctivitis.

The primary care physician is the first line of treatment for allergic rhinitis, which affects approximately one-fourth of children in the United States. There is an increasing trend toward self-management by patients or parents due to high-deductible insurance plans and the over-the-counter availability of allergy medications. The primary care physician can offer guidance on appropriate selection of medications and potential adverse effects. Vitamin D deficiency has been proposed as a potential contributing factor in patients with allergic diseases, and studies are underway to determine whether supplementation with vitamin D is helpful for these conditions. Sublingual immunotherapy has recently received US Food and Drug Administration approval for grass and ragweed allergens; many children will be interested in this alternative to allergy shots. The relative advantages and disadvantages of sublingual vs subcutaneous immunotherapy are discussed.

Treatment of pediatric allergic rhinitis complicated with upper airway cough syndrome.

上气道咳嗽综合征（upper airway cough syndrome，UACS）是指与各种鼻炎（变应性及非变应性）、鼻窦炎、慢性咽炎、慢性扁桃体炎、鼻息肉、腺样体肥大等上气道疾病相关的慢性咳嗽，既往曾诊断为鼻后滴漏（流）综合征（postnasal drainage syndrome，PNDS）。2006年美国胸科医师协会（American College of Chest Physicians，ACCP）修订咳嗽指南时提出，

Diagnosis and treatment of pediatric allergic rhinitis with comorbid diseases except asthma and upper airway cough syndrome

变应性鼻炎（AR）经常与其他一些疾病同时存在，如伴发支气管哮喘、上气道咳嗽综合征、分泌性中耳炎、睡眠呼吸障碍、复发性和（或）慢性鼻一鼻窦炎、过敏性咽炎和喉炎、异位性皮炎等，因此，应当将AR看作是全身变态反应在鼻部的表现。现将几种常见的并发疾病的诊治情况简述如下。

Guidelines for diagnosis and treatment of pediatric allergic rhinitis (2010, Chongqing)

儿童变应性鼻炎也称儿童过敏性鼻炎（allergic rhinitis，AR）在我国的患病率约为10%，且呈继续增加趋势。由于儿童变应性鼻炎对下呼吸道炎性疾病（如支气管哮喘）的发生发展、严重程度及临床转归均有重要影响，因此制订本诊断和治疗指南，对规范临床诊疗及哮喘防控均具有重要意义。本指南适用于2～14岁的儿童患者。

72 Real Life Attitudes toward Treatment of Pediatric Allergic Rhinitis

72 Real Life Attitudes toward Treatment of Pediatric Allergic Rhinitis

Corticosteroids in the treatment of pediatric allergic rhinitis

The goal of treatment in pediatric allergic rhinitis is to provide effective prevention of or relief from allergic rhinitis symptoms as safely and effectively as possible. Removing or avoiding allergens is always advised; however, pharmacotherapy is often necessity. Pharmacologic options include systemic decongestants, which are associated with irritability and insomnia, particularly in children. Antihistamines are widely used; however, first-generation antihistamines are known to cause dry mouth and sedation. Oral corticosteroids are very effective but can have unwanted systemic effects. Over the past decade, intranasal corticosteroids have been shown to be the most effective form of pharmacologic treatment for allergic rhinitis. Data support the use of intranasal corticosteroids as first-line therapy over oral antihistamines; nonetheless, some clinicians have been reluctant to prescribe these agents, particularly for children, because of concerns for systemic effects. Overall, the newer corticosteroids, including mometasone furoate (MF), beclomethasone dipropionate, and budesonide have an improved risk-benefit ratio compared with older cortico-steroids and are now considered the drug of choice for pediatric allergic rhinitis. A good deal of evidence exists that confirms the lack of systemic effects from intranasal cortico-steroids. However, reports of decreased bone growth in children receiving intranasal budesonide short-term and beclomethasone dipropionate long-term have heightened concerns that some of these drugs may have systemic effects. A new intranasal corticosteroid, MF nasal spray, has been studied in children 3 to 12 years of age and has been shown to be effective. Intranasal MF is available with once-daily dosing, which has the potential to decrease systemic side effects. (J Allergy Clin Immunol 2001;108:S59-64.)