Skip to main content

Advertisement

SpringerLink
Log in

Pediatric Allergic Rhinitis: the Stepwise Treatment Approach

  • Pediatric Allergy (F Baroody, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Opinion Statement

Treatment of allergic rhinitis in children requires a thoughtful, stepwise approach. Before considering medication for rhinitis, possibly chronic medication, you must (1) confirm disease based on symptoms or testing for offending allergens, (2) implement environmental controls when possible, (3) understand how allergy medication will affect children, and (4) recognize the need to use the minimum amount of medicine necessary to treat symptoms. Special attention to the impact of medication on school performance and social interactions is important when treating children. For intermittent symptoms, an oral antihistamine should be tried first. Chronic symptoms will respond best to a topical nasal steroid spray. Spending the time to figure out what most troubles the child will focus therapy (such as an antihistamine eye drop when ocular itching is a primary symptom) and prevent use of unnecessary medication. Moving past medication to immunotherapy is an important next step as we look for ways to change the natural course of atopic disease. There are now multiple approved forms of immunotherapy in the USA; this should allow a tailored approach to treating symptoms that have progressed beyond pharmacologic therapy. These layers of therapy, environmental control, pharmacologic management focused on bothersome symptoms, and immunotherapy, naturally allow for escalation of treatment with increasing symptoms. Working with the parents is imperative to fully understand the impact symptoms are having on the child and to achieve compliance with medications. This combined, stepwise approach will lead to good relief for the child and satisfaction among both parents and treating physician.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

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

  1. CDC. CDC National Health Interview Survey. 2014.

  2. Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, 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 (London, England). 2006;368(9537):733–43.

    Article  Google Scholar 

  3. 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(2):381–7.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  CAS  PubMed  Google Scholar 

  5. Weller FR, Weller MS, Jansen HM, de Monchy JG. Effect of local allergen priming on early, late, delayed-phase, and epicutaneous skin reactions. Allergy. 1996;51(12):883–6.

    Article  CAS  PubMed  Google Scholar 

  6. Solomon WR, Burge HA, Boise JR. Exclusion of particulate allergens by window air conditioners. J Allergy Clin Immunol. 1980;65(4):305–8.

    Article  CAS  PubMed  Google Scholar 

  7. Wallace DV, Dykewicz M, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122:s1–84.

    Article  PubMed  Google Scholar 

  8. Jones AM, Harrison RM. The effects of meteorological factors on atmospheric bioaerosol concentrations—a review. Sci Total Environ. 2004;326(1):151–80.

    Article  CAS  PubMed  Google Scholar 

  9. Kenney P Hilberg O, Sigsgaard T. Clinical Application of Nasal Filters: An Observational Study on the Usability of Nasal Filters in Managing Seasonal Allergic Rhinitis J. Allergy Clin Immunol Prac. 2016.

  10. Comert S Karakaya G, Kalyoncu AF. Wraparound eyeglasses improve symptoms and quality of life in patients with seasonal allergic rhinoconjuntivitis. International Forum of Allergy and Rhinology. 2016.

  11. Arbes SJ, Sever M, Mehta J, Collette N, Thomas B, Zeldin DC. Exposure to indoor allergens in day-care facilities: results from 2 North Carolina counties. J Allergy Clin Immunol. 2005;116(1):133–9.

    Article  PubMed  Google Scholar 

  12. Arbes SJ, Cohn RD, Yin M, Muilenburg ML, Burge HA, Friedman W, Zeldin DC. House dust mite allergen in US beds: results from the first national survey of lead and allergens in housing. J Allergy Clin Immunol. 2003;111(2):408–14.

    Article  PubMed  Google Scholar 

  13. Arbes SJ, Cohn RD, Yin M, Muilenburg ML, Burge HA, Friedman W, Zeldin DC. Dog allergen (can f 1) and cat allergen (Fel d 1) in US homes: results from the National Survey of lead and allergens in housing. J Allergy Clin Immunol. 2004;114(1):111–7.

    Article  PubMed  Google Scholar 

  14. Egmar AC, Almqvist C, Emenius G, Lilja G, Wickman M. Deposition of cat (Fel d 1), dog (can f 1), and horse allergen over time in public environments—a model of dispersion. Allergy. 1998;53(10):957–61.

    Article  CAS  PubMed  Google Scholar 

  15. Avner DB, Perzanowski MS, Platts-Mills TA, Woodfolk JA. Evaluation of different techniques for washing cats: quantitation of allergen removed from the cat and the effect on airborne Fel d 1. J Allergy Clin Immunol. 1997;100(3):307–12.

    Article  CAS  PubMed  Google Scholar 

  16. Wood RA, Johnson EF, Van Natta ML, Chen PH, Eggleston PA. A placebo-controlled trial of a HEPA air cleaner in the treatment of cat allergy. Am J Respir Crit Care Med Med. 158(1):115–20.

  17. Wilson J, Dixon SL, Breysse P, Jacobs D, Adamkiewicz G, Chew GL, Dearborn D, Krieger J, Sandel M, Spanier A. Housing and allergens: a pooled analysis of nine US studies. Environ Res. 2010;110(2):189–98.

    Article  CAS  PubMed  Google Scholar 

  18. Morgan WJ, Crain EF, Gruchalla RS, O’Connor GT, Kattan M, Evans R, Stout J, Malindzak G, Smartt E, Plaut M, Walter M, Vaughn B, Mitchell H. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004;351:1068–80.

    Article  CAS  PubMed  Google Scholar 

  19. Luczynska C, Tredwell E, Smeeton N, Burney P. A randomized controlled trial of mite allergen-impermeable bed covers in adult mite-sensitized asthmatics. Clin Exp Allergy. 2003;33(12):1648–53.

    Article  CAS  PubMed  Google Scholar 

  20. Calderon M, Kleine-Tebbe J, Linneberg A, DeBlay F, de Rojas DHF, Virchow JC, Demoly P. House dust mite respiratory allergy: an overview of current therapeutic strategies. J Allergy Clin Immunol Prac. 2015;3(6):843–55. Current review of dust mite allergy and therapeutic strategies.

    Article  Google Scholar 

  21. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, van Wijk RG, Ohta K, Zuberbier T, Schünemann HJ. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2010;126(3):466–76.

    Article  PubMed  Google Scholar 

  22. Reddel HK Bateman ED, Becker A et al. Global strategy for asthma management and prevention. Updated 2015. Available from http://ginasthmaorg/wp-content/uploads/2016/01/GINA_Report_2015_Aug11-1pdf. Updated 2015.

  23. Nurmatov U, van Schayck CP, Hurwitz B, Sheikh A. House dust mit avoidance measures for periennial allergic rhinitis: an updated Cochrane systematic review. Allergy. 2012;67:158–65.

    Article  CAS  PubMed  Google Scholar 

  24. Pingitore G, Pinter E. Environmental interventions for mite-induced asthma: a journey between systematic reviews, contrasting evidence and clinical practice. Eur Ann Allergy Clin Immunol. 2013;45(3):74–7.

    CAS  PubMed  Google Scholar 

  25. Platts-Mills TA. Allergen avoidance in the treatment of asthma: problems with the meta-analyses. J Allergy Clin Immunol. 2008;122:694–6.

    Article  PubMed  Google Scholar 

  26. Schad CA, Skoner DP. Antihistamines in the pediatric population: achieving optimal outcomes when treating seasonal allergic rhinitis and chronic urticaria. Allergy Asthma Proc. 2008;29(1):7–13.

    Article  CAS  PubMed  Google Scholar 

  27. Meltzer EO. Allergic rhinitis: managing the pediatric spectrum. Allergy Asthma Proc. 2006;27(1):2–8.

    CAS  PubMed  Google Scholar 

  28. Blaiss MS. Antihistamines: treatment selection criteria for pediatric seasonal allergic rhinitis. Allergy Asthma Proc. 2005;26(2):95–102.

    CAS  PubMed  Google Scholar 

  29. Vuurman EF, van Veggel LM, Sanders RL, Muntjewerff ND, O’Hanlon JF. Effects of semprex-D and diphenhydramine on learning in young adults with seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 1996;76(3):247–52.

    Article  CAS  PubMed  Google Scholar 

  30. Bender B, Milgrom H. Neuropsychiatric effects of medications for allergic diseases. J Allergy Clin Immunol. 1995;95(2):523–8.

    Article  CAS  PubMed  Google Scholar 

  31. Milgrom H, Bender B. Adverse effects of medications for rhinitis. Ann Allergy Asthma Immunol. 1997;78(5):439–44.

    Article  CAS  PubMed  Google Scholar 

  32. Diphenhydramine Hydrochloride. MicroMedex Pharmaceutical Database. Accessed 3/31/2016. Last Updated: 4/26/2016.

  33. Clemastine. MicroMedex Pharmaceutical Database. Accessed 3/31/2016. Last Updated: 4/26/2016.

  34. Brompheniramine. MicroMedex Pharmaceutical Database. Accessed 3/31/2016. Last Updated: 4/26/2016.

  35. Lee CF, Sun HL, Lu KH, Ku MS, Lue KH. The comparison of cetirizine, levocetirizine and placebo for the treatment of childhood perennial allergic rhinitis. Pediatr Allergy Immunol. 2009;20(5):493–9.

    Article  CAS  PubMed  Google Scholar 

  36. Tzanetos DB, Fahrenholz JM, Scott T, Buchholz K. Comparison of the sedating effects of levocetirizine and cetirizine: a randomized, double-blind, placebo-controlled trial. Ann Allergy Asthma Immunol. 2011;107(6):517–22.

    Article  CAS  PubMed  Google Scholar 

  37. Gentile D, Bartholow A, Valovirta E, Scadding G, Skoner D. Current and future directions in pedaiatric allergic rhinitis J. Allergy Clin Immunol Prac. 2013;1(3):214–26.

    Article  Google Scholar 

  38. Meltzer EO, Blaiss M, Fairchild CJ. Comprehensive report of olopatadine 0.6 % nasal spray as treatment for children with seasonal allergic rhinitis. Allergy Asthma Proc. 2011;32(3):213–20.

    Article  CAS  PubMed  Google Scholar 

  39. Berger WE, Shah S, Lieberman P, Hadley J, Price D, Munzel U, et al. Long-term, randomized safety study of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in an advanced delivery system) in subjects with chronic rhinitis. J Allergy Clin Immunol Pract. 2014;2(2):179–85.

    Article  PubMed  Google Scholar 

  40. Herman D, Garay R, Le Gal M. A randomized double-blind placebo controlled study of azelastine nasal spray in children with perennial rhinitis. Int J Pediatr Otorhinolaryngol. 1997;39(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  41. Bielory LBB, Wagner R. Allergic and immunologic eye disease. Pediatric allergy: principles and practice. 3rd ed 2015. p. 482–97.

  42. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ (Clinical research ed). 1998;317(7173):1624–9. Review aticle looking at nasal steroid sprays and efficacy compared with oral antihistamines.

    Article  CAS  Google Scholar 

  43. Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S, Hellings PW, et al. Paediatric rhinitis: position paper of the European academy of allergy and clinical immunology. Allergy. 2013;68(9):1102–16.

    CAS  PubMed  Google Scholar 

  44. Schenkel EJ, Skoner DP, Bronsky EA, Miller SD, Pearlman DS, Rooklin A, et al. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics. 2000;105(2):E22.

    Article  CAS  PubMed  Google Scholar 

  45. Skoner JD, Schaffner TJ, Schad CA, Kwon AY, Skoner DP. Addressing steroid phobia: improving the risk-benefit ratio with new agents. Allergy Asthma Proc. 2008;29(4):358–64.

    Article  CAS  PubMed  Google Scholar 

  46. Meltzer EO, Baena-Cagnani CE, Gates D, Teper A. Relieving nasal congestion in children with seasonal and perennial allergic rhinitis: efficacy and safety studies of mometasone furoate nasal spray. World Allergy Org J. 2013;6(1):5.

    Article  Google Scholar 

  47. Skoner DP, Rachelefsky GS, Meltzer EO, Chervinsky P, Morris RM, Seltzer JM, et al. Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate. Pediatrics. 2000;105(2):E23.

    Article  CAS  PubMed  Google Scholar 

  48. Storms WW, Segall N, Mansfield LE, Amar NJ, Kelley L, Ding Y, et al. Efficacy and safety of beclomethasone dipropionate nasal aerosol in pediatric patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2013;111(5):408–14.e1.

    Article  CAS  PubMed  Google Scholar 

  49. Berger WE, Prenner B, Turner R, EO M. A patient preference and satisfaction study of ciclesonide nasal aerosol and mometasone furoate aqueous nasal spray in patients with perennial allergic rhinitis. Allergy Asthma Proc. 2013;34(6):542–50.

    Article  PubMed  Google Scholar 

  50. Can D, Tanac R, Demir E, Gulen F, Veral A. Is the usage of intranasal glucocorticosteroids alone in allergic rhinitis sufficient? Allergy Asthma Proc. 2006;27(3):248–53.

    Article  CAS  PubMed  Google Scholar 

  51. Scadding GK. Optimal management of allergic rhinitis. Arch Dis Child. 2015;100(6):576–82.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Nasser SM, Ewan PW. Lesson of the week: depot corticosteroid treatment for hay fever causing avascular necrosis of both hips. BMJ (Clinical Res Ed). 2001;322(7302):1589–91.

    Article  CAS  Google Scholar 

  53. Meltzer EO, Malmstrom K, Lu S, Prenner BM, Wei LX, Weinstein SF, et al. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol. 2000;105(5):917–22.

    Article  CAS  PubMed  Google Scholar 

  54. Chen ST, Lu KH, Sun HL, Chang WT, Lue KH, Chou MC. Randomized placebo-controlled trial comparing montelukast and cetirizine for treating perennial allergic rhinitis in children aged 2-6 yr. Pediatr Allergy Immunol. 2006;17(1):49–54.

    Article  PubMed  Google Scholar 

  55. Knorr B, Matz J, Bernstein JA, Nguyen H, Seidenberg BC, Reiss TF, et al. Montelukast for chronic asthma in 6- to 14-year-old children: a randomized, double-blind trial. Pediatric montelukast study group. JAMA. 1998;279(15):1181–6.

    Article  CAS  PubMed  Google Scholar 

  56. Calapai G, Casciaro M, Miroddi M, Calapai F, Navarra M, Gangemi S. Montelukast-induced adverse drug reactions: a review of case reports in the literature. Pharmacology. 2014;94(1–2):60–70.

    Article  CAS  PubMed  Google Scholar 

  57. Gentile DPN, Bartholow A, Skoner D. Allergic Rhinitis. Pediatric Allergy: Principles and Practice. Third ed: Elsevier; 2015. p. 210–8.

  58. Ratner PH, Ehrlich PM, Fineman SM, Meltzer EO, Skoner DP. Use of intranasal cromolyn sodium for allergic rhinitis. Mayo Clin Proc. 2002;77(4):350–4.

    Article  CAS  PubMed  Google Scholar 

  59. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011;127(1 Suppl):S1–55.

    Article  PubMed  Google Scholar 

  60. Maloney J, Bernstein DI, Nelson H, Creticos P, Hebert J, Noonan M, et al. Efficacy and safety of grass sublingual immunotherapy tablet, MK-7243: a large randomized controlled trial. Ann Allergy Asthma Immunol. 2014;112(2):146–53 e2. Published data which showed some of the safety of grass SLIT and study efficacy data.

    Article  CAS  PubMed  Google Scholar 

  61. Halken S, Agertoft L, Seidenberg J, Bauer CP, Payot F, Martin-Munoz MF, et al. Five-grass pollen 300IR SLIT tablets: efficacy and safety in children and adolescents. Pediatr Allergy Immunol. 2010;21(6):970–6.

    Article  PubMed  Google Scholar 

  62. Maloney J, Prenner BM, Bernstein DI, Lu S, Gawchik S, Berman G, et al. Safety of house dust mite sublingual immunotherapy standardized quality tablet in children allergic to house dust mites. Ann Allergy Asthma Immunol. 2016;116(1):59–65. Use of dust mite SLIT in children, safety and efficacy data, just released.

    Article  PubMed  Google Scholar 

  63. Jacobsen L, Niggemann B, Dreborg S, Ferdous HA, Halken S, Host A, Kiovikko A, Norberg LA, Valovirta E, Wahn U, Moller C. Specific immunotherapy has long-term preventative effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy. 2007;62:943–38.

    Article  CAS  PubMed  Google Scholar 

  64. Moller C, Dreborg S, Ferdousi HA, Halken S, Host A, Jacobsen L, et al. Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study). J Allergy Clin Immunol. 2002;109(2):251–6.

    Article  PubMed  Google Scholar 

  65. Purello-D’Ambrosio F, Gangemi S, Merendino RA, Isola S, Puccinelli P, Parmiani S, et al. Prevention of new sensitizations in monosensitized subjects submitted to specific immunotherapy or not. A retrospective study. Clin Exp Allergy. 2001;31(8):1295–302.

    Article  PubMed  Google Scholar 

  66. Lourenço EA. Subcutaneous immunotherapy improves the symptomatology of allergic rhinitis. Eur Arch Otorhinolaryngol. 2016;20(1):6–12.

    Google Scholar 

  67. Poddighe D, Licari A, Caimmi S, Marseglia GL. Sublingual immunotherapy for pediatric allergic rhinitis: the clinical evidence. World J Clin Pediatr. 2016;5(1):47–56.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Calderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S. Allergen injection immunotherapy for seasonal allergic rhinitis. The Cochrane database of systematic reviews. 2007(1):CD001936.

  69. Radulovic S, Wilson D, Calderon M, Durham S. Systematic reviews of sublingual immunotherapy (SLIT). Allergy. 2011;66(6):740–52.

    Article  CAS  PubMed  Google Scholar 

  70. Chelladurai Y, Suarez-Cuervo C, Erekosima N, Kim JM, Ramanathan M, Segal JB, Lin SY. Effectiveness of subcutaneous versus sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review. J Allergy Clin Immunol Prac. 2013;1(4):361–9.

    Article  Google Scholar 

  71. Roberts G, Hurley C, Turcanu V, Lack G. Grass pollen immunotherapy as an effective therapy for childhood seasonal allergic asthma. J Allergy Clin Immunol. 2006;117(2):263–8.

    Article  PubMed  Google Scholar 

  72. Dahl R, Kapp A, Colombo G, de Monchy JG, Rak S, Emminger W, et al. Sublingual grass allergen tablet immunotherapy provides sustained clinical benefit with progressive immunologic changes over 2 years. J Allergy Clin Immunol. 2008;121(2):512–8 e2.

    Article  CAS  PubMed  Google Scholar 

  73. Kim JM, Lin S, Suarez-Cuervo C, Chelladurai Y, Ramanathan M, Segal JB, Erekosima N. Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review. Pediatrics. 2013;131:1155–67.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Rodriguez Perez N, Ambriz Moreno Mde J. Safety of immunotherapy and skin tests with allergens in children younger than five years. Rev Alergia Mexico (Tecamachalco, Puebla, Mexico : 1993). 2006;53(2):47–51.

    Google Scholar 

  75. Finegold I. Immunotherapy: when to initiate treatment in children. Allergy Asthma Proc. 2007;28(6):698–705.

    Article  PubMed  Google Scholar 

  76. Coop CA, Tankersley MS. Patient perceptions regarding local reactions from allergen immunotherapy injections. Ann Allergy Asthma Immunol. 2008;101(1):96–100.

    Article  PubMed  Google Scholar 

  77. Dahl R, Kapp A, Colombo G, de Monchy JG, Rak S, Emminger W, et al. Efficacy and safety of sublingual immunotherapy with grass allergen tablets for seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;118(2):434–40.

    Article  CAS  PubMed  Google Scholar 

  78. Cox L, Larenas-Linnemann D, Lockey RF, Passalacqua G. Speaking the same language: the world allergy organization subcutaneous immunotherapy systemic reaction grading system. J Allergy Clin Immunol. 2010;125(3):569–74. 74 e1–74 e7

    Article  PubMed  Google Scholar 

  79. Bousquet J, Hejjaoui A, Dhivert H, Clauzel AM, Michel FB. Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. Systemic reactions during the rush protocol in patients suffering from asthma. J Allergy Clin Immunol. 1989;83(4):797–802.

    Article  CAS  PubMed  Google Scholar 

  80. Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol. 1987;79(4):660–77.

    Article  CAS  PubMed  Google Scholar 

  81. Reid MJ, Lockey RF, Turkeltaub PC, Platts-Mills TA. Survey of fatalities from skin testing and immunotherapy 1985-1989. J Allergy Clin Immunol. 1993;92(1 Pt 1):6–15.

    Article  CAS  PubMed  Google Scholar 

  82. Bernstein DI, Wanner M, Borish L, Liss GM. Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001. J Allergy Clin Immunol. 2004;113(6):1129–36. Large survey results looking at the safety of SCIT in practice.

    Article  PubMed  Google Scholar 

  83. Epstein TG, Liss GM, Murphy-Berendts K, Bernstein DI. Risk factors for fatal and nonfatal reactions to subcutaneous immunotherapy: National surveillance study on allergen immunotherapy (2008–2013). Ann Allergy Asthma Immunol 2016.

  84. Kopp MV, Brauburger J, Riedinger F, Beischer D, Ihorst G, Kamin W, et al. The effect of anti-IgE treatment on in vitro leukotriene release in children with seasonal allergic rhinitis. J Allergy Clin Immunol. 2002;110(5):728–35.

    Article  CAS  PubMed  Google Scholar 

  85. Klunker S, Saggar LR, Seyfert-Margolis V, Asare AL, Casale TB, Durham SR, et al. Combination treatment with omalizumab and rush immunotherapy for ragweed-induced allergic rhinitis: inhibition of IgE-facilitated allergen binding. J Allergy Clin Immunol. 2007;120(3):688–95.

    Article  CAS  PubMed  Google Scholar 

  86. Hankin CS, Cox L, Bronstone A, Wang Z. Allergy immunotherapy: reduced health care costs in adults and children with allergic rhinitis. J Allergy Clin Immunol. 2013;131(4):1084–91. Study that examines healthcare costs in a large population on immunotherapy.

    Article  PubMed  Google Scholar 

  87. Hankin CS, Cox L, Lang D, Levin A, Gross G, Eavy G, Meltzer E, Burgoyne D, Bronstone A, Wang Z. Allergy immunotherapy amoung Medicaid-enrolled children with allergic rhinitis: patterns of care, resource use, and costs. J Allergy Clin Immunol. 2008;121(1):227–32.

    Article  PubMed  Google Scholar 

  88. Hankin CS, Cox L, Lang D, Bronstone A, Fass P, Leatherman B, Wang Z. Allergen immunotherapy and health care cost benefits for children with allergic rhinitis: a large-scale, retrospective, matched cohort study. Ann Allergy Asthma Immunol. 2010;104:79–85.

    Article  PubMed  Google Scholar 

  89. Li H, Sha Q, Zuo K, Jiang H, Cheng L, Shi J, et al. Nasal saline irrigation facilitates control of allergic rhinitis by topical steroid in children. ORL. 2009;71(1):50–5.

    Article  PubMed  Google Scholar 

  90. Garavello W, Romagnoli M, Sordo L, Gaini RM, Di Berardino C, Angrisano A. Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: a randomized study. Pediatr Allergy Immunol. 2003;14(2):140–3.

    Article  PubMed  Google Scholar 

  91. Shoseyov D, Bibi H, Shai P, Shoseyov N, Shazberg G, Hurvitz H. Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis. J Allergy Clin Immunol. 1998;101(5):602–5.

    Article  CAS  PubMed  Google Scholar 

  92. Slapak I, Skoupa J, Strnad P, Hornik P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol--Head Neck Surg. 2008;134(1):67–74.

    Article  PubMed  Google Scholar 

  93. Meltzer EO, Johnson S. Objective and subjective responses to a mechanical external nasal dilator in healthy children and children with nasal congestion. Allergy Asthma Proc. 2015;36(6):481–6.

    Article  PubMed  Google Scholar 

  94. Rajan TV, Tennen H, Lindquist RL, Cohen L, Clive J. Effect of ingestion of honey on symptoms of rhinoconjunctivitis. Ann Allergy Asthma Immunol. 2002;88(2):198–203.

    Article  CAS  PubMed  Google Scholar 

  95. Feng S, Han M, Fan Y, Yang G, Liao Z, Liao W, et al. Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2015;29(1):57–62.

    Article  PubMed  Google Scholar 

  96. Reinhold T, Roll S, Willich SN, Ortiz M, Witt CM, Brinkhaus B. Cost-effectiveness for acupuncture in seasonal allergic rhinitis: economic results of the ACUSAR trial. Ann Allergy Asthma Immunol. 2013;111(1):56–63.

    Article  PubMed  Google Scholar 

  97. Guo R, Pittler MH, Ernst E. Herbal medicines for the treatment of allergic rhinitis: a systematic review. Ann Allergy Asthma Immunol. 2007;99(6):483–95.

    Article  PubMed  Google Scholar 

  98. Butterbur. National Center for Complementary and Integrative Heath; 2012 [updated April 2012; cited 2016 April 8, 2016]; Available from: https://nccih.nih.gov/health/butterbur.

  99. Ueno-Iio T, Shibakura M, Yokota K, Aoe M, Hyoda T, Shinohata R, et al. Lavender essential oil inhalation suppresses allergic airway inflammation and mucous cell hyperplasia in a murine model of asthma. Life Sci. 2014;108(2):109–15.

    Article  CAS  PubMed  Google Scholar 

  100. Sabroe RA, Holden CR, Gawkrodger DJ. Contact allergy to essential oils cannot always be predicted from allergy to fragrance markers in the baseline series. Contact Dermatitis. 2016;74(4):236–41.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Dr. Elizabeth Erwin, Dr. Roger Friedman, and Dr. David Stukus for their thoughtful comments on this manuscript.

Author information

Authors and Affiliations

  1. Division of Infectious Disease and Immunology, Nationwide Children’s Hospital, Columbus, OH, USA

    Margaret T. Redmond MD & Kara J. Wada MD

  2. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The Ohio State University, Columbus, OH, USA

    Margaret T. Redmond MD & Kara J. Wada MD

  3. Section of Allergy, Nationwide Children’s Hospital, Columbus, OH, USA

    David W. Hauswirth MD

Authors
  1. Margaret T. Redmond MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kara J. Wada MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David W. Hauswirth MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David W. Hauswirth MD.

Ethics declarations

Conflict of Interest

Dr. Margaret T. Redmond, Dr. Kara J. Wada, and Dr. David W. Hauswirth declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pediatric Allergy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Redmond, M.T., Wada, K.J. & Hauswirth, D.W. Pediatric Allergic Rhinitis: the Stepwise Treatment Approach. Curr Treat Options Allergy 3, 253–267 (2016). https://doi.org/10.1007/s40521-016-0092-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40521-016-0092-2

Keywords

Search

Navigation