The Primary Care Pediatrician and Allergic Rhinitis

Allergic rhinitis (AR) is an inflammation of the nasal mucosa after exposure to an allergen in previously sensitized people. Characteristic symptoms include nasal itching, rhinorrhea, sneezing and nasal congestion, which may be accompanied by otic, pharyngeal and ocular symptoms (allergic rhinoconjunctivitis). AR has a great impact on quality of life and is considered undertreated and underdiagnosed. Dust mites and grass pollens are the most important allergens. The diagnosis is made through a detailed medical history that includes exposure to environmental triggers and the child's environment at the family, school, leisure and pet levels. It is advisable to perform an allergy study to identify allergic triggers, especially in case of persistent rhinitis. Treatment is based on the identification and elimination of specific allergens, when possible, and the use of stepwise medications that reduce symptoms. Nasal corticosteroids (NC) are part of the first line of treatment, their use being unavoidable in moderate-severe AR. When there is no adequate response to the initial treatment, combining antihistamine (AH) is indicated. Intranasal AH are more effective in improving nasal congestion than oral AH and have a faster onset of action than oral AH and NC, and are part of the first line of treatment in seasonal AR and intermittent AR. Immunotherapy will be used in selected patients who do not respond to other treatments.