Therapeutic approaches to allergic rhinitis: Treating the child

Allergic rhinitis is currently the most common of all chronic diseases in c hildren. However, children frequently lack the ability to verbalize their s ymptoms, with the result that the condition may go undiagnosed and untreate d. Unfortunately, untreated allergic rhinitis not only detrimentally affect s children's physical and psychosocial well-being, quality of life, and cap acity to function and learn, but it is also associated with and may contrib ute to potentially serious sequelae, including asthma, sinusitis, and otiti s media. Because children may not accurately describe their symptoms, the c lassic signs of allergic rhinitis in the pediatric population, including th e allergic shiner, the allergic crease, and the allergic salute, are partic ularly important in enabling the clinician to recognize those children who may have this condition; other significant signs include mouth breathing, s noring, chronic cough, and continual throat clearing. The options for treat ing allergic rhinitis in the child are the same as those for the adult, and the clinician can expect the same level of efficacy, Environmental control for allergen avoidance is an important goal, but the clinician must prescr ibe it within the context of the family's lifestyle to obtain compliance. C omplete avoidance of inhalant allergens is not always-feasible, and medicat ions are necessary. Oral antihistamines remain the mainstay of initial trea tment for allergies. Given evidence of the significant deleterious effects of the sedating antihistamines on learning, the clinician should prescribe nonsedating second-generation agents whenever possible, Decongestants may b e needed. Intranasal corticosteroids are a most effective option, and these agents lack the systemic side effects associated with orally administered steroids. In persistent disease, allergen immunotherapy injections may be c onsidered, In all cases, the clinician should consider issues that are like ly to influence compliance in the pediatric population.