Current Allergy and Asthma Reports

, Volume 1, Issue 6, pp 515–522 | Cite as

Allergic rhinitis and asthma in children: Disease management and outcomes

  • Carlos E. Baena-Cagnani


Antihistamines and inhaled glucocorticoids, which can be targeted toward multiple points in the "allergic cascade" underlying allergic rhinitis and asthma, extend the promise of enhanced outcomes in children with allergic rhinitis, asthma, or both. Antihistamine therapy confers significant relief of subjective ratings of seasonal and perennial allergic symptoms (eg, rhinorrhea, congestion, sneezing, pruritus), whereas topical steroids alleviate such discomfort while also improving objective anatomic and functional indices of nasal patency (eg, nasal peak inspiratory flow). Youngsters with asthma also experience substantial clinical benefits from inhaled steroids, which improve objective measures of pulmonary function and reduce rescue b2-agonists for symptom management and quality-of-life enhancement. This paper reviews recent clinical findings on the role of antihistamines and topical corticosteroids in pediatric allergy and asthma management, as well as the favorable effects of these medications on both objective and subjective health outcomes.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Togias A: Unique mechanistic features of allergic rhinitis. J Allergy Clin Immunol 2000, 105:S599-S604.PubMedCrossRefGoogle Scholar
  2. 2.
    Jordana G, Dolovich J, Briscoe MP, et al.: Intranasal fluticasone propionate versus loratadine in the treatment of adolescent patients with seasonal allergic rhinitis. J Allergy Clin Immunol 1996, 97:588–595.PubMedCrossRefGoogle Scholar
  3. 3.
    The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet 1998, 351:1225–1232.CrossRefGoogle Scholar
  4. 4.
    Genovese A, Patella V, De Crescenzo G, et al.: Loratadine and desethoxylcarbonyl-loratadine inhibit the immunological release of mediators from human Fc epsilon RI+ cells. Clin Exp Allergy. 1997, 27:559–567.PubMedCrossRefGoogle Scholar
  5. 5.
    Lippert U, Kruger-Krasagakes S, Moller A, et al.: Pharmacological modulation of IL-6 and IL-8 secretion by the H1-antagonist decarboethoxy-loratadine and dexamethasone by human mast and basophilic cell lines. Exp Dermatol 1995, 4:272–276.PubMedCrossRefGoogle Scholar
  6. 6.
    Kalayci O, Saraclar Y, Adalioglu G, et al.: The effect of cetirizine on sulfidoleukotriene production by blood leukocytes in children with allergic rhinitis. Allergy 1995, 50:964–969.PubMedCrossRefGoogle Scholar
  7. 7.
    Abdelaziz MM, Devalia JL, Khair OA, et al.: Effect of fexofenadine on eosinophil-induced changes in epithelial permeability and cytokine release from nasal epithelial cells of patients with seasonal allergic rhinitis. J Allergy Clin Immunol 1998, 101:410–420.PubMedCrossRefGoogle Scholar
  8. 8.
    John M, Lim S, Seybold J, et al.: Inhaled corticosteroids increase interleukin-10 but reduce macrophage inflammatory protein-1alpha, granulocyte-macrophage colony-stimulating factor, and interferon-gamma release from alveolar macrophages in asthma. Am J Respir Crit Care Med 1998, 157:256–262.PubMedGoogle Scholar
  9. 9.
    Austin CE, Foreman JC: Acoustic rhinometry compared with posterior rhinomanometry in the measurement of histamine-and bradykinin-induced changes in nasal airway patency. Br J Clin Pharmacol 1994, 37:33–37.PubMedGoogle Scholar
  10. 10.
    Hynes B, Cole P, Forte V, et al.: The evaluation of intranasal topical beclomethasone spray in the treatment of children with non-purulent rhinitis using rhinometric, cytologic and symptomatologic assessment. J Otolaryngol 1989, 18:151–154.PubMedGoogle Scholar
  11. 11.
    Pearlman DS, Lumry WR, Winder JA, Noonan MJ: Once-daily cetirizine effective in the treatment of seasonal allergic rhinitis in children aged 6 to 11 years: a randomized, doubleblind, placebo-controlled study. Clin Pediatr (Phila) 1997, 36:209–215.Over a 4-week treatment interval, once-daily therapy with cetirizine at 10 mg significantly reduced total and individual rhinitis symptom scores, including ocular itching and oral/nasal itching, from baseline in 209 children aged 6 to 11 with seasonal allergic rhinitis. As compared with placebo, a lower cetirizine dose (5 mg/day) did not decrease symptoms from baseline.CrossRefGoogle Scholar
  12. 12.
    Sienra-Monge JJ, Gazca-Aguilar A, Rio-Navarro B: Doubleblind comparison of cetirizine and loratadine in children ages 2 to 6 years with perennial allergic rhinitis. Am J Ther 1999, 6:149–155.PubMedCrossRefGoogle Scholar
  13. 13.
    Day JH, Andersson CB, Briscoe MP: Efficacy and safety of intranasal budesonide in the treatment of perennial rhinitis in adults and children. Ann Allergy 1990, 64:445–450.PubMedGoogle Scholar
  14. 14.
    Banov CH, Silvers WS, Green AW, et al.: Placebo-controlled, double-blind study of the efficacy and safety of triamcinolone acetonide aerosol nasal inhaler in pediatric patients with seasonal allergic rhinitis. Clin Ther 1996, 18:265–272.PubMedCrossRefGoogle Scholar
  15. 15.
    Meltzer EO, Casale TB, Nathan RA, Thompson AK: Once-daily fexofenadine HCl improves quality of life and reduces work and activity impairment in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 1999, 83:311–317.PubMedGoogle Scholar
  16. 16.
    Van Cauwenberge P, Juniper EF: Comparison of the efficacy, safety and quality of life provided by fexofenadine hydrochloride 120 mg, loratadine 10 mg and placebo administered once daily for the treatment of seasonal allergic rhinitis. Clin Exp Allergy 2000, 30:891–899.PubMedCrossRefGoogle Scholar
  17. 17.
    Rowe-Jones JM: The link between the nose and lung, perennial rhinitis and asthma-is it the same disease? Allergy 1997, 52:20–28.PubMedGoogle Scholar
  18. 18.
    Pedersen W, Hjuler I, Bisgaard H, Mygind N: Nasal inhalation of budesonide from a spacer in children with perennial rhinitis and asthma. Allergy 1998, 53:383–387.PubMedCrossRefGoogle Scholar
  19. 19.
    The Childhood Asthma Management Program Research Group:Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med 2000, 343:1054–1063.This long-term, placebo-controlled follow-up study involving 1041 children with mild to moderate asthma demonstrated that budesonide therapy (200 ώg bid) significantly diminished hospitalizations, urgent caregiver visits, and albuterol use from baseline while increasing proportions of episode-free days and exhibiting an oral steroidsparing effect as compared with placebo. Although changes in most postbronchodilator spirometric variables were not different in budesonide-treated patients as compared with a control group, therapy with the inhaled corticosteroid did significantly attenuate airway responsiveness to methacholine.CrossRefGoogle Scholar
  20. 20.
    Reddel H, Jenkins C, Woolcock A: Diurnal variability-time to change asthma guidelines? BMJ 1999, 319:45–47.PubMedGoogle Scholar
  21. 21.
    Shapiro G, Bronsky EA, LaForce CF, et al.: Dose-related efficacy of budesonide administered via a dry powder inhaler in the treatment of children with moderate to severe persistent asthma. J Pediatr 1998, 132:976–982.PubMedCrossRefGoogle Scholar
  22. 22.
    Pedersen S, Hansen OR: Budesonide treatment of moderate and severe asthma in children: a dose-response study. J Allergy Clin Immunol 1995, 95:29–33.PubMedCrossRefGoogle Scholar
  23. 23.
    Henriksen JM, Dahl R: Effects of inhaled budesonide alone and in combination with low-dose terbutaline in children with exercise-induced asthma. Am Rev Respir Disease 1983, 128:993–997.Google Scholar
  24. 24.
    Waalkens HJ, Essen-Zandvliet EE, Gerritsen J, et al.: The effect of an inhaled corticosteroid (budesonide) on exerciseinduced asthma in children. Dutch CNSLD Study Group. Eur Respir J 1993, 6:652–656.PubMedGoogle Scholar
  25. 25.
    Jonasson G, Carlsen KH, Jonasson C, Mowinckel P: Low-dose inhaled budesonide once or twice daily for 27 months in children with mild asthma. Allergy 2000, 55:740–748.PubMedCrossRefGoogle Scholar
  26. 26.
    Mellon M, Leflein J, Walton-Bowen K, et al.: Comparable efficacy of administration with face mask or mouthpiece of nebulized budesonide inhalation suspension for infants and young children with persistent asthma. Am J Respir Crit Care Med 2000, 162:593–598.PubMedGoogle Scholar
  27. 27.
    Baker JW, Mellon M, Wald J, et al.: A multiple-dosing, placebocontrolled study of budesonide inhalation suspension given once or twice daily for treatment of persistent asthma in young children and infants. Pediatrics 1999, 103:414–421.PubMedCrossRefGoogle Scholar
  28. 28.
    Kemp JP, Skoner DP, Szefler SJ, et al.: Once-daily budesonide inhalation suspension for the treatment of persistent asthma in infants and young children. Ann Allergy Asthma Immunol 1999, 83:231–239.PubMedGoogle Scholar
  29. 29.
    MacKenzie CA, Weinberg EG, Tabachnik E, et al.: A placebo controlled trial of fluticasone propionate in asthmatic children. Eur J Pediatr 1993, 152:856–860.PubMedCrossRefGoogle Scholar
  30. 30.
    LaForce CF, Pearlman DS, Ruff ME, et al.: Efficacy and safety of dry powder fluticasone propionate in children with persistent asthma. Ann Allergy Asthma Immunol 2000, 85:407–415.CrossRefGoogle Scholar
  31. 31.
    Peden DB, Berger WE, Noonan MJ, et al.: Inhaled fluticasone propionate delivered by means of two different multidose powder inhalers is effective and safe in a large pediatric population with persistent asthma. J Allergy Clin Immunol 1998, 102:32–38.PubMedCrossRefGoogle Scholar
  32. 32.
    Simons FE: A comparison of beclomethasone, salmeterol, and placebo in children with asthma. Canadian Beclomethasone Dipropionate-Salmeterol Xinafoate Study Group. N Engl J Med 1997, 337:1659–1665.PubMedCrossRefGoogle Scholar
  33. 33.
    Juniper EF: How important is quality of life in pediatric asthma? Pediatr Pulmonol Suppl 1997, 15:17–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Bisgaard H, Gillies J, Groenewald M, Maden C: The effect of inhaled fluticasone propionate in the treatment of young asthmatic children: a dose comparison study. Am J Respir Crit Care Med 1999, 160:126–131.PubMedGoogle Scholar
  35. 35.
    Nelson HS, Busse WW, deBoisblanc BP, et al.: Fluticasone propionate powder: oral corticosteroid-sparing effect and improved lung function and quality of life in patients with severe chronic asthma. J Allergy Clin Immunol 1999, 103:267–275.PubMedCrossRefGoogle Scholar
  36. 36.
    Mahajan P, Pearlman D, Okamoto L: The effect of fluticasone propionate on functional status and sleep in children with asthma and on the quality of life of their parents. J Allergy Clin Immunol 1998, 102:19–23.Long-term therapy with inhaled fluticasone propionate (50 to 100 ώg twice daily) for 24 to 52 weeks not only significantly enhanced quality of life and functional status of children with mild to moderate asthma, diminishing sleep disturbances; consistent with these findings, parents of actively treated children (vs controls) also reported a significantly lower burden on a quality-of-life instrument.PubMedCrossRefGoogle Scholar
  37. 37.
    Tinkelman DG, Reed CE, Nelson HS, Offord KP: Aerosol beclomethasone dipropionate compared with theophylline as primary treatment of chronic, mild to moderately severe asthma in children. Pediatrics 1993, 92:64–77.PubMedGoogle Scholar
  38. 38.
    Global Initiative for Asthma: Global strategy for asthma management and prevention report. Bethesda, MD: National Institutes of Health; 1995. [NIH publication no. 96-3659A, NHLBI].Google Scholar
  39. 39.
    Rabe KF, Vermeire PA, Soriano JB, Maier WC: Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J 2000, 16:802–807.Although consensus guidelines for the treatment of moderate to severe or persistent asthma in children warrant the use of medications that attenuate or reverse inflammation, this Western European household survey determined that most respondents had used prescription "quick-relief" medications (63%) rather than inhaled corticosteroids (23%). By either objective (eg, lung function) or subjective (eg, symptom control) standards, the data suggested that current asthma care falls decidedly short of consensus goals.PubMedCrossRefGoogle Scholar
  40. 40.
    Coutts JA, Gibson NA, Paton JY: Measuring compliance with inhaled medication in asthma. Arch Dis Child 1992, 67:332–333.PubMedGoogle Scholar
  41. 41.
    Williams H, Jones ER, Sibert JR: Twice daily versus four times daily treatment with beclomethasone dipropionate in the control of mild childhood asthma. Thorax 1986, 41:602–605.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2001

Authors and Affiliations

  • Carlos E. Baena-Cagnani
    • 1
  1. 1.Division of Immunology and Respiratory MedicineInfantile HospitalCórdobaArgentina

Personalised recommendations