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. The use of evidence-based guidelines for AR therapy results in improved disease control.Management is largely based on avoidance of the triggering allergen(s), the use of modern non-sedative antihistamines for mild disease, and of non-systemically bio-available nasal steroids for moderate/severe disease. 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.