PITTSBURGH, PA – Pediatric allergic rhinitis – runny noses, sneezing and itching triggered by allergens such as pollen, mold and pets – is increasingly prevalent and leads to numerous health complications. New techniques and therapies on the horizon are expected to improve the treatment of pediatric allergic rhinitis, according to research published today in the Journal of Allergy and Clinical Immunology by Deborah Gentile, MD, and David Skoner, MD, of the Department of Allergy, Asthma and Immunology at Allegheny General Hospital.
“About 40 percent of children and 10 to 30 percent of adults suffer from allergic rhinitis, and its incidence is increasing,” Dr. Gentile said. “Unfortunately, the sniffles and sneezes are just the beginning of the problems, as they can lead to poor sleep quality, emotional well-being, productivity and cognitive functioning.”
“The emergence of new therapies, such as sublingual (under-the-tongue) immunotherapy to replace allergy shots and combination therapies, the increasing availability of over-the-counter treatments, and the possibility of more exact diagnostic techniques will all make it imperative for pediatric allergists, parents and children to work together for the best possible outcomes,” Dr. Skoner said.
The cost of treating allergic rhinitis is estimated at $11.2 billion annually, double the estimated cost in 2000. About a third of children diagnosed with allergic rhinitis also go on to develop asthma, and these children are also at higher risk for ear infections, sinusitis, impaired sleep and subsequent impact on school performance, behavior and mood. Genetic predisposition, combined with early-life environmental exposure to agents such as air pollution, smoke or respiratory viruses are believed to lead to the development of allergies.
Standard treatments include avoiding the allergen, taking medication such as antihistamines, and immunotherapy, administering increasing doses of the allergen, usually via injection in order to build immunity.
Future direction for allergic rhinitis treatment and diagnosis includes:
· Sublingual immunotherapy, which is widely used in Europe and nearing consideration for approval by the U.S. Food and Drug Administration. It is more convenient than allergy shots and appears to be safer than conventional immunotherapy, but may not be safe for patients with a history of anaphylaxis or persistent asthma. Drs. Skoner and Gentile said there is “cautious optimism” that sublingual immunotherapy will be effective for allergic rhinitis and possibly prevent the development of asthma.
· Newer diagnostic tests such as the ImmunoCAP are highly sensitive and accurate but not always adequately interpreted by general practitioners and pediatricians. The likely future availability of microarrayed recombinant allergens is likely to change the diagnostic landscape for allergic rhinitis tremendously, Drs. Gentile and Skoner said. It can potentially identify thousands of allergens with just a small amount of blood and allow more specific treatment tailored to the patient’s antibodies.
· Two new “dry” nasal spray options have received FDA approval, beclomethasone and ciclesonide. Younger patients may prefer the feeling of the dry spray, or their noses may be so blocked that the water-based spray is ineffective.
· Recent trials suggest that combining antihistamines with intranasal corticosteroids (nasal sprays) may be more effective than either therapy alone for patients with moderate to severe allergic rhinitis.
· Antihistamines are widely available over-the-counter for treatment of allergic rhinitis symptoms. An effort to make intranasal corticosteroids available over-the-counter, unsuccessful in years past, has been reinitiated. Safety concerns are a major deterrent, Drs. Skoner and Gentile said, and children treated for asthma with inhaled corticosteroids are slightly shorter as adults than other children.
Along with Drs. Skoner and Gentile, the paper was authored by Erkka Valovirta, MD, PhD, of Turku Allergy Center, Turku, Finland, and Glenis Scadding, MD, of The Royal National Throat, Nose and Ear Hospital, London, UK.
Allegheny General Hospital