Allergic rhinitis-an overview of a common disease

Allergic rhinitis (AR) is the most common chronic disease in childhood and yet is often ignored and/or misdiagnosed. It can present as part of the atopic spectrum of disorders and can affect not only the nose but also its connections, manifesting often with a multiplicity of symptoms, sometimes atypical. If uncontrolled or inappropriately treated, AR can severely impair quality of life for children and their families. Growing evidence of its association with bronchial asthma is emerging: both as a risk factor for asthma development and a major factor in exacerbations. This article aims to give advice about diagnosis and management of this important, common condition to generalists who will encounter it frequently in their clinical practice.The use of evidence-based guidelines for AR therapy results in improved disease control. Current management is based on avoidance of triggering allergen(s), non-sedative anti-histamines for mild disease, and use of non-systemically bioavailable nasal steroids for moderate/severe disease. The use of an intranasal combined preparation of fluticasone propionate and azelastine for those unresponsive to these measures is under investigation. Allergen-specific immunotherapy, currently recommended for severe cases, is the only treatment modality potentially able to alter long term not only disease severity, but also progression. Immunotherapy is often unavailable to deserving patients and concern regarding risk/benefit and acceptability can hamper its use in children. Evidence on efficacy and safety of the more child-friendly sublingual route of administration is emerging, however further well-designed paediatric studies are needed. Education of patients, carers and of practitioners in the nature of AR, the possible need for long term concordance with therapy and the optimal use of this is a vital part of disease management.