Current Allergy and Asthma Reports

, Volume 13, Issue 2, pp 142–151 | Cite as

Comparative Analysis of Allergic Rhinitis in Children and Adults

  • Adriana Izquierdo-Domínguez
  • Antonio L. Valero
  • Joaquim Mullol
RHINITIS (JN BARANIUK AND JJ OPPENHEIMER, SECTION EDITORS)

Abstract

Allergic rhinitis (AR) is a worldwide health problem that generates a significant healthcare burden in adults, adolescents, and children. Epidemiological studies have indicated that the prevalence of AR has progressively increased over the last three decades in developed and industrialized countries. AR currently affects up to 40 % of the worldwide population, with differences between adults and children and different countries of the World. Although not life-threatening, AR symptoms are frequently bothersome, adversely affecting work and quality of life of the affected patients, and causing a significant burden on both the individual and society. The symptoms have the potential to lead to both physical and mental complications, with sleep-disordered breathing in childhood and adolescence being associated with disorders in learning performance, behavior, and attention. Clinical features and comorbidities are very important for the “allergic march”, and in both adults and children there is some evidence of association between AR and asthma. ARIA classifications of both symptom duration (intermittent, persistent) and severity (mild, moderate, severe) have been validated in both adult and pediatric populations. Based on the duration and severity of patient’s disease, an appropriate treatment strategy has been issued for both adults and children, which consists of patient’s education, allergen avoidance, and pharmacological as well as allergen-specific immunotherapy treatment. The present review will attempt to compare the characteristics of AR between children and adults, either in the epidemiology, clinical features, impact on QOL, and management of the disease.

Keywords

Allergic rhinitis Adults Children Epidemiology Quality of life Management Clinical features Comparative analysis Prevalence Classification Clinical features Management Immunotherapy 

Notes

Disclosure

Dr. Valero has served on boards for Stallergenes, Meda Pharmaceuticals, FAES, and ESTEVE; has received grant support from Uriach; and has received payment for development of educational presentations (including service on speakers bureaus) from FAES, Stallergenes, Novartis, and Pfizer.

Dr. Mullol has served on boards for Uriach, Meda Pharmaceuticals, Johnson & Johnson, FAES, and Hartington Pharma; has received grant support from GlaxoSmithKline, Uriach, FAES, and Merck Sharp & Dohme; and has received payment for development of educational presentations (including lectures and service on speakers bureaus) from Uriach, Hartington Pharma, FAES, Novartis, Boehringer-Ingelheim, ESTEVE, Merck Sharp & Dohme, and PIERRE-FABRE.

Dr. Izquierdo-Dominguez reported no potential conflicts of interest relevant to this article.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC. A survey of the burden of allergic rhinitis in Europe. Allergy. 2007;62 Suppl 5:17–25.PubMedCrossRefGoogle Scholar
  2. 2.
    Nathan RA. The burden of allergic rhinitis. Allergy Asthma Proc. 2007;28:3–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Morais-Almeida M, Gaspar A, Pires G, Prates S, Rosado Pinto J. Risk factors for asthma symptoms at school age: an 8-year prospective study. Allergy Asthma Proc. 2007;28:183–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Annesi-Maesano I, Hulin M, Lavaud F, et al. Poor air quality in classrooms related to asthma and rhinitis in primary schoolchildren of the French 6 cities study. Thorax. 2012;67:682–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008. Allergy. 2008;63 Suppl 86:8–160.PubMedCrossRefGoogle Scholar
  6. 6.
    Valero A, Ferrer M, Sastre J, et al. A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the allergic rhinitis and its impact on asthma severity items. J Allergy Clin Immunol. 2007;120:359–65.PubMedCrossRefGoogle Scholar
  7. 7.
    Valero A, Ferrer M, Baró E, et al. Discrimination between moderate and severe disease may be used in patients witheither treated or untreated allergic rhinitis. Allergy. 2010;65(12):1609–13.PubMedCrossRefGoogle Scholar
  8. 8.
    • Jáuregui I, Dávila I, Sastre J, et al. Validation of ARIA (Allergic Rhinitis and its Impact on Asthma) classification in a pediatric population: the PEDRIAL study. Pediatr Allergy Immunol. 2011;22:388–92. This article shows the validation of ARIA classification in children with allergic rhinitis.PubMedCrossRefGoogle Scholar
  9. 9.
    • Montoro J, Del Cuvillo A, Mullol J, et al. Validation of the modified allergic rhinitis and its impact on asthma (ARIA) severity classification in allergic rhinitis children: the PEDRIAL study. Allergy. 2012;67(11):1437–42. This article shows the validation of the modified ARIA severity classification in children with allergic rhinitis which discriminates moderate from severe disease among untreated patients.PubMedCrossRefGoogle Scholar
  10. 10.
    Bousquet J, Bodez T, Gehano P, et al. Implementation of guidelines for allergic rhinitis in specialist practices. A randomized pragmatic controlled trial. Int Arch Allergy Immunol. 2009;150(1):75–82.PubMedCrossRefGoogle Scholar
  11. 11.
    Bachert C, van Cauwenberge P, Olbrecht J, van Schoor J. Prevalence, classification and perception of allergic and non allergic rhinitis in Belgium. Allergy. 2006;61:693–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004;24:758–64.PubMedCrossRefGoogle Scholar
  13. 13.
    Nathan RA, Meltzer EO, Derebery J, et al. The prevalence of nasal symptoms attributed to allergies in the United States: findings from the burden of rhinitis in an America survey. Allergy Asthma Proc. 2008;29:600–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Jessen M, Malm L. Definition, prevalence and development of nasal obstruction. Allergy. 1997;52 Suppl 40:3–6.PubMedCrossRefGoogle Scholar
  15. 15.
    • Katelaris CH, Lee BW, Potter PC, et al. Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America. Clin Exp Allergy. 2012;42:186–207. This manuscript presents the latest prevalences of allergic rhinitis in developed countries and in both children and adults.PubMedCrossRefGoogle Scholar
  16. 16.
    Asher MI, Keil U, Anderson HR, et al. International study of asthma and allergies in childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8:483–91.PubMedCrossRefGoogle Scholar
  17. 17.
    Weiland SK, Björksten B, Brunekreef B, et al. Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods. Eur Respir J. 2004;24:406–12.PubMedCrossRefGoogle Scholar
  18. 18.
    Ellwood P, Asher MI, Beasley R, Clayton TO, Stewart AW, the ISAAC Steering Committee. The International Study of Asthma and Allergies in childhood (ISAAC): phase three rationale and methods. Int J Tuberc Lung Dis. 2005;9:10–6.PubMedGoogle Scholar
  19. 19.
    Ait-khaled N, Odhiambo J, Pearce N, et al. Prevalence of symptoms of asthma, rhinitis and eczema in 13- to 14- year- old children in Africa: the International Study of Asthma and Allergies in Childhood Phase III. Allergy. 2007;62:247–58.PubMedCrossRefGoogle Scholar
  20. 20.
    Strachan D, Sibbald B, Weiland S, et al. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: The International Study of Asthma and Allergies in Childhood (ISAAC). Paediatr Allergy Immunol. 1997;8:161–76.CrossRefGoogle Scholar
  21. 21.
    Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol. 1999;103:125–38.PubMedCrossRefGoogle Scholar
  22. 22.
    Asher MI, Montefort S, Bjorksten B, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis and eczema in childhood: ISAAC phases one and three repeat multicountry cross-sectional surveys. Lancet. 2006;368:733–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Björksten B, Clayton T, Ellwood P, Stewart A, Strachan D, the ISAAC Phase Three Study Group. Worldwide time trends for symptoms of rhinitis and conjunctivitis: Phase III of the International Study of Asthma and Allergies in Childhood. Pediatr Allergy Immunol. 2008;19:110–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Ait-Khaled A, Pearce N, Anderson HR, Ellwood P, Montefort S, Shah J, ISAAC Phase Three Study Group. Global map of the prevalence of symptoms of rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC) phase three. Allergy. 2009;64(1):123–48.PubMedCrossRefGoogle Scholar
  25. 25.
    Lødrup Carlsen KC, Söderström L, Mowinckel P, et al. Asthma prediction in school children; the value of combined IgE antibodies and obstructive airways disease severity score. Allergy. 2010;65:1134–40.PubMedGoogle Scholar
  26. 26.
    Hopper JL, Jenkins MA, Carlin JB, Giles GG. Increase in the self-reported prevalence of asthma and hay fever in adults over the last generation: a matched parent-offspring study. Aust J Public Health. 1995;19:120–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Bauchau V, Durham SR. Epidemiological characterization of the intermittent and persistent types of allergic rhinitis. Allergy. 2005;60:350–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Cingi C, Topuz B, Songu M, et al. Prevalence of allergic rhinitis among the adult population in Turkey. Acta Otolaryngol. 2010;130:600–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Zhang L, Han D, Huang D, et al. Prevalence of self-reported allergic rhinitis in eleven major cities in China. Int Arch Allergy Immunol. 2009;149:47–57.PubMedCrossRefGoogle Scholar
  30. 30.
    Neffen H, Mello JF, Sole D, et al. Nasal allergies in the Latin American population: results from the Allergies in Latin America survey. Allergy Asthma Proc. 2010;31 Suppl 1:S9–S23.PubMedCrossRefGoogle Scholar
  31. 31.
    Settipane RA, Charnock DR. Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol. 2007;19:23–34.PubMedGoogle Scholar
  32. 32.
    Del Cuvillo A, Montoro J, Bartra J, et al. Validation of ARIA duration and severity classifications in Spanish allergic rhinitis patients−the ADRIAL cohort study. Rhinology. 2010;48(2):201–5.PubMedGoogle Scholar
  33. 33.
    Guilemany JM, Garcia-Piñeiro A, Alobid I, et al. Persistent allergic rhinitis has a moderate impact on the sense of smell, depending on both nasal congestion and inflammation. Laryngoscope. 2009;119(2):233–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Hadley JA, Schaefer SD. Clinical evaluation of rhinosinusitis: history and physical examination. Otolaryngol Head Neck Surg. 1997;117:S8–S11.PubMedCrossRefGoogle Scholar
  35. 35.
    Irwin RS. Silencing chronic cough [see comments]. Hosp Pract. 1999;34:53–60. quiz 129–30.5.CrossRefGoogle Scholar
  36. 36.
    Kulig M, Klettke U, Wahn V, Forster J, Bauer CP, Wahn U. Development of seasonal allergic rhinitis during the first 7 years of life. J Allergy Clin Immunol. 2000;106:832–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Selnes A, Nystad W, Bolle R, Lund E. Diverging prevalence trends of atopic disorders in Norwegian children. Results from three cross sectional studies. Allergy. 2005;60:894–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Berger WE. Allergic rhinitis in children: diagnosis and management strategies. Paediatr Drugs. 2004;6:233–50.PubMedCrossRefGoogle Scholar
  39. 39.
    Steele RW. Rhinosinusitis in children. Curr Allergy Asthma Rep. 2006;6:508–12.PubMedCrossRefGoogle Scholar
  40. 40.
    Noone PG, Leigh MW, Sannuti A, et al. Primary ciliar dyskinesia: diagnostic and phenotypic features. Am J Respir Crit Care Med. 2004;169:459–67.PubMedCrossRefGoogle Scholar
  41. 41.
    Zureik M, Neukirch C, Leynaert B, Liard R, Bousquet J, Neukirch F. Sensitisation to airborne moulds and severity of asthma: cross sectional study from European community respiratory health survey. BMJ. 2002;325:411–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Rosenstreich DL, Eggleston P, Kattan M, et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma [see comments]. N Engl J Med. 1997;336:1356–63.PubMedCrossRefGoogle Scholar
  43. 43.
    Lewis SA, Weiss ST, Platts-Mills TA, Burge H, Gold DR. The role of indoor allergen sensitization and exposure in causing morbidity in women with asthma. Am J Respir Crit Care Med. 2002;165:961–6.PubMedGoogle Scholar
  44. 44.
    Chen WY, Tseng HI, Wu MT, et al. Synergistic effect of multiple indoor allergen sources on atopic symptoms in primary school children. Environ Res. 2003;93:1–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Shaaban R, Zureik M, Soussan D, et al. Allergic rhinitis and onset of bronchial hyperresponsiveness: a population-based study. Am J Respir Crit Care Med. 2007;176:659–66.PubMedCrossRefGoogle Scholar
  46. 46.
    Rochat MK, Illi S, Ege MJ, et al. Allergic rhinitis as a predictor for wheezing onset in school-aged children. J Allergy Clin Immunol. 2010;126:1170–5–e2.CrossRefGoogle Scholar
  47. 47.
    Shaaban R, Zureik M, Soussan D, et al. Rhinitis and onset of asthma: a longitudinal population-based study. Lancet. 2008;372:1049–57.PubMedCrossRefGoogle Scholar
  48. 48.
    Camelo-Nunes I, Sole D. Allergic rhinitis: indicators of quality of life. J Bras Pneumol. 2010;36(1):124–33.PubMedCrossRefGoogle Scholar
  49. 49.
    Gentile D, Shapiro G, Sloner D. Allergic rhinitis. In: Leung D, Sampson H, Geha R, Szefler S, editors. Pediatric allergy. Principles and practice. St. Louis: Mosby; 2003. p. 287–97.Google Scholar
  50. 50.
    Hallstrand TS, Curtis JR, Aitken ML, Sullivan SD. Quality of life in adolescents with mild asthma. Pediatr Pulmonol. 2003;36:536–43.PubMedCrossRefGoogle Scholar
  51. 51.
    Roberts G, Mylonopoulou M, Hurley C, Lack G. Impairment in quality of life is directly related to the level of allergen exposure and allergic airway inflammation. Clin Exp Allergy. 2005;35:1295–300.PubMedCrossRefGoogle Scholar
  52. 52.
    Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case–control study. J Allergy Clin Immunol. 2007;120:381–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Meltzer EO, Blaiss MS, Derebery MJ, et al. Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol. 2009;124:S43–70.PubMedCrossRefGoogle Scholar
  54. 54.
    Juniper EF, Guyatt GH, Dolovich J. Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol. 1994;93(2):413–23.PubMedCrossRefGoogle Scholar
  55. 55.
    Juniper EF, Howland WC, Roberts NB. Measuring quality of life in children with rhinoconjunctivitis. J Allergy Clin Immunol. 1998;101:163–70.PubMedCrossRefGoogle Scholar
  56. 56.
    Juniper EF, Guyatt GH. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy. 1991;21:77–83.PubMedCrossRefGoogle Scholar
  57. 57.
    Juniper EF, Thompson AK, Ferrie PJ, Roberts JN. Development and validation of the mini rhinoconjunctivitis quality of life questionnaire. Clin Exp Allergy. 2000;30(1):132–40.PubMedCrossRefGoogle Scholar
  58. 58.
    Juniper E, Rohrbaugh T, Meltzer EO. A questionnaire to measure quality of life in and adults with nocturnal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2003;111:484–90.PubMedCrossRefGoogle Scholar
  59. 59.
    Valero A, Alonso J, Antepara I, et al. Development and validation of a new Spanish instrument to measure health-related quality of life in patients with allergic rhinitis: the ESPRINT questionnaire. Val Health. 2007;10(6):466–77.CrossRefGoogle Scholar
  60. 60.
    Valero A, Alonso J, Antépara I, et al. Health-related quality of life in allergic rhinitis: comparing the short form ESPRINT-15 and MiniRQLQ questionnaires. Allergy. 2007;62(12):1372–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Valero A, Baró E, Sastre J, et al. Reference values for facilitating the interpretation of the ESPRINT-15 questionnaire (Spanish version). J Investig Allergol Clin Immunol. 2009;19(5):396–403.PubMedGoogle Scholar
  62. 62.
    Valero A, Izquierdo I, Giralt J, et al. Rupatadine improves nasal symptoms, quality of life (ESPRINT-15) and severity in a subanalysis of a cohort of Spanish allergic rhinitis patients. J Investig Allergol Clin Immunol. 2011;21(3):229–35.PubMedGoogle Scholar
  63. 63.
    Valero A, Muñoz-Cano R, Sastre J, et al. The impact of allergic rhinitis on symptoms, and quality of life using the new criterion of ARIA severity classification. Rhinology. 2012;50(1):33–6.PubMedGoogle Scholar
  64. 64.
    Sardana N, Craig T. Congestion and sleep impairment in allergic rhinitis. Asian Pac J Allergy Immunol. 2011;29:297–306.PubMedGoogle Scholar
  65. 65.
    Derebery J, Meltzer E, Nathan RA, et al. Rhinitis symptoms and comorbidities in the United States: Burden of rhinitis in America survey. Otolaryngol Head Neck Surg. 2008;139:198–205.PubMedCrossRefGoogle Scholar
  66. 66.
    Mullol J. A survey of the burden allergic rhinitis in Spain. J Investig Allergol Clin Immunol. 2009;19(1):27–34.PubMedGoogle Scholar
  67. 67.
    Marinho S, Simpson A, Custovic A. Allergen avoidance in the secondary and tertiary prevention of allergic diseases: does it work? Prim Care Respir J. 2006;15:152–8.PubMedCrossRefGoogle Scholar
  68. 68.
    Filon FL, Radman G. Latex allergy: a follow up study of 1040 healthcare workers. Occup Environ Med. 2006;63:121–5.PubMedCrossRefGoogle Scholar
  69. 69.
    Fink RS, Pierre LN, Daley Yates PT, Richards DH, Gibson A, Honour JW. Hypothalamic-pituitaryadrenal axis function after inhaled corticosteroids: unreliability of urinary free cortisol estimation. J Clin Endocrinol Metab. 2002;87:4541–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Sastre J, Mosges R. Local and systemic safety of intranasal corticosteroids. J Investig Allergol Clin Immunol. 2012;22(1):1–12.PubMedGoogle Scholar
  71. 71.
    •• Brozek JL, Bousquet J, Baena-Cagnani CE, Global Allergy and Asthma European Network, Grading of Recommendations Assessment, Development and Evaluation Working Group, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466–76. This manuscript shows the GRADE-based ARIA recommendations on the prevention and treatment of adults and children with allergic rhinitis, with and without comorbid asthma.PubMedCrossRefGoogle Scholar
  72. 72.
    Schünemann HS, Jaeschke R, Cook DJ, et al. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med. 2006;174:605–14.PubMedCrossRefGoogle Scholar
  73. 73.
    Brozek JL, Baena-Cagnani CE, Bonini S, et al. Methodology for development of the Allergic Rhinitis and its Impact on Asthma guideline 2008 update. Allergy. 2008;63:38–46.PubMedCrossRefGoogle Scholar
  74. 74.
    Calderon M, Gerth van Wijk R, Eichler I, et al. Perspectives on allergen-specific immunotherapy in childhood: An EAACI position statement. Pediatr Allergy Immunol. 2012;23:300–6.PubMedCrossRefGoogle Scholar
  75. 75.
    European Declaration on Immunotherapy: Combating Allergy Beyond Symptoms.http://eaaci.net/eaacimedia/1663-eaacipresents-theeuropean-declaration-onallergen-immunotherapy.
  76. 76.
    Calderon M, Cardona V, Demoly P, on behalf of the EAACI 100 Years of Immunotherapy Experts Panel. One hundred years of allergen immunotherapy European Academy of Allergy and Clinical Immunology celebration: review of unanswered questions. Allergy. 2012;67:462–76.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Adriana Izquierdo-Domínguez
    • 1
  • Antonio L. Valero
    • 2
  • Joaquim Mullol
    • 3
    • 4
  1. 1.Department of AllergologyHospital QuirónBarcelonaSpain
  2. 2.Department of Pneumology and Respiratory Allergy, ICT, Hospital Clínic i UniversitariInstitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); and CIBER de Enfermedades Respiratorias (CIBERES)BarcelonaSpain
  3. 3.Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i UniversitariInstitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); and CIBER de Enfermedades Respiratorias (CIBERES)BarcelonaSpain
  4. 4.Rhinology Unit & Smell Clinic, Department of OtorhinolaryngologyHospital Clínic, IDIBAPSBarcelonaSpain

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