Pediatric Allergic Rhinitis Follow-up

  • Author: Jack M Becker, MD; Chief Editor: Harumi Jyonouchi, MD   more...
 
Updated: Mar 28, 2012
 

Further Outpatient Care

  • Patients with allergic rhinitis (AR) need continuous follow-up care because allergic rhinitis is a chronic disease that waxes and wanes with seasons and age. The fluctuation of symptoms requires adjustment of medications.
  • Patients rarely outgrow allergic rhinitis in childhood.
  • Refer patients in whom allergic rhinitis becomes hard to manage or diagnose to an allergist for complete evaluation and advanced treatment, including institution of allergen-specific immunotherapy.
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Deterrence/Prevention

  • The best deterrent is to avoid allergens that trigger symptoms. This means diligent environmental controls and patient compliance with medication use.
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Complications

  • Primary complications of allergic rhinitis are associated diseases.
  • Sinusitis is a common complication occurring secondary to the inflamed nasal turbinates that block the ostiomeatal complex of the sinuses and other sinus passages.
  • Recurrent or chronic otitis media can also be a secondary complication. It is thought to occur as a result of an inflamed nasal passages that adversely affect the drainage of the auditory tube.
  • Allergic rhinitis can lead to rhinitis medicamentosa when topical nasal decongestants are used in excess.
  • Allergic rhinitis can cause other conditions, such as insomnia, irritability, headache, chronic fatigue, and pharyngitis. These occur secondary to chronic nasal congestion and discharge, mouth breathing, and sleep disturbance.
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Prognosis

  • Most patients are able to live normal lives with the symptoms.
  • Only patients who receive allergen-specific immunotherapy are cured of the disease; however, many patients do very well with intermittent symptomatic care. Allergic rhinitis symptoms may recur 2-3 years after discontinuation of allergen immunotherapy.
  • A small percentage of patients improve during the teenage years, but in most, symptoms recur in the early twenties or later. Symptoms begin to wane when patients reach the fifth decade of life.
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Patient Education

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Contributor Information and Disclosures
Author

Jack M Becker, MD  Clinical Associate Professor of Pediatrics, Drexel University School of Medicine

Jack M Becker, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, and American College of Allergy, Asthma and Immunology

Disclosure: gsk Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Ivax Honoraria Speaking and teaching

Specialty Editor Board

C Lucy Park  MD, Head, Division of Allergy, Immunology, and Pulmonology, Associate Professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine

C Lucy Park is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Medical Association, Chicago Medical Society, Clinical Immunology Society, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John Wilson Georgitis, MD  Consulting Staff, Lafayette Allergy Services

John Wilson Georgitis, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association for the Advancement of Science, American College of Chest Physicians, American Lung Association, American Medical Writers Association, and American Thoracic Society

Disclosure: Nothing to disclose.

David Pallares, MD  Clinical Assistant Professor, Department of Pediatrics, Division of Allergy and Immunology, University of Louisville School of Medicine

David Pallares, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD  Associate Professor, Division of Pulmonary, Allergy/Immunology, and Infectious Diseases, Department of Pediatrics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Mucosal Immunology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. Meltzer EO. Productivity costs of antihistamines in the workplace. Occup Health Saf. Aug 1996;65(8):46-50. [Medline].

  2. [Guideline] World Health Organization (WHO). Allergic rhinitis and its impact on asthma. 2008;[Full Text].

  3. Crystal-Peters J, Neslusan C, Crown WH, Torres A. Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits. J Allergy Clin Immunol. Jan 2002;109(1):57-62. [Medline].

  4. Gendo K, Larson EB. Evidence-based diagnostic strategies for evaluating suspected allergic rhinitis. Ann Intern Med. Feb 17 2004;140(4):278-89. [Medline].

  5. Malone DC, Lawson KA, Smith DH, Arrighi HM, Battista C. A cost of illness study of allergic rhinitis in the United States. J Allergy Clin Immunol. Jan 1997;99(1 Pt 1):22-7. [Medline].

  6. Herr M, Clarisse B, Nikasinovic L, et al. Does allergic rhinitis exist in infancy? Findings from the PARIS birth cohort. Allergy. Feb 2011;66(2):214-21. [Medline].

  7. Söderström L, Lilja G, Borres MP, Nilsson C. An explorative study of low levels of allergen-specific IgE and clinical allergy symptoms during early childhood. Allergy. Aug 2011;66(8):1058-64. [Medline].

  8. [Best Evidence] Compalati E, Penagos M, Tarantini F, Passalacqua G, Canonica GW. Specific immunotherapy for respiratory allergy: state of the art according to current meta-analyses. Ann Allergy Asthma Immunol. Jan 2009;102(1):22-8. [Medline].

  9. Cox LS, Larenas Linnemann D, Nolte H, Weldon D, Finegold I, Nelson HS. Sublingual immunotherapy: a comprehensive review. J Allergy Clin Immunol. May 2006;117(5):1021-35. [Medline].

  10. Aaronson DW. Side effects of rhinitis medications. J Allergy Clin Immunol. Feb 1998;101(2 Pt 2):S379-82. [Medline].

  11. Allergies in America. Allergies in America Executive Summary. myallergiesinamerica. Available at http://www.myallergiesinamerica.com/pdfs/myaia.pdf. Accessed June 2007.

  12. Busse W. Allergic rhinitis: charting a course for the 21st century. J Respir Dis. 1998;19:S1-64.

  13. Day J. Pros and cons of the use of antihistamines in managing allergic rhinitis. J Allergy Clin Immunol. Mar 1999;103(3 Pt 2):S395-9. [Medline].

  14. Day JH, Briscoe M, Widlitz MD. Cetirizine, loratadine, or placebo in subjects with seasonal allergic rhinitis: effects after controlled ragweed pollen challenge in an environmental exposure unit. J Allergy Clin Immunol. May 1998;101(5):638-45. [Medline].

  15. Delafuente JC, Davis TA, Davis JA. Pharmacotherapy of allergic rhinitis. Clin Pharm. Jul 1989;8(7):474-85. [Medline].

  16. Hemp P. Presenteeism: at work--but out of it. Harv Bus Rev. Oct 2004;82(10):49-58, 155. [Medline].

  17. Hussain I, Kline JN. DNA, the immune system, and atopic disease. J Investig Dermatol Symp Proc. Jan 2004;9(1):23-8. [Medline].

  18. LaForce C. Use of nasal steroids in managing allergic rhinitis. J Allergy Clin Immunol. Mar 1999;103(3 Pt 2):S388-94. [Medline].

  19. [Best Evidence] Lange B, Lukat KF, Rettig K, Holtappels G, Bachert C. Efficacy, cost-effectiveness, and tolerability of mometasone furoate, levocabastine, and disodium cromoglycate nasal sprays in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol. Sep 2005;95(3):272-82. [Medline].

  20. Ledford DK, Lockey RF. Allergic rhinitis: understanding the process. J Respir Dis. 1998;19(7):576-84.

  21. Middleton E, Reed C, Ellis E. Allergic and non-allergic rhinitis. In: Allergy: Principles and Practice. Vol 2. 5th ed. Mosby-Year Book; 1998:Chapter 70.

  22. Naclerio R, Solomon W. Rhinitis and inhalant allergens. JAMA. Dec 10 1997;278(22):1842-8. [Medline].

  23. Plevkova J, Brozmanova M, Pecova R, Tatar M. Effects of intranasal histamine on the cough reflex in subjects with allergic rhinitis. J Physiol Pharmacol. Sep 2005;56 Suppl 4:185-95. [Medline].

  24. Settipane RJ, Hagy GW, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc. Jan-Feb 1994;15(1):21-5. [Medline].

  25. Spector S. Pathophysiology and pharmacotherapy of allergic rhinitis. Foreword. J Allergy Clin Immunol. Mar 1999;103(3 Pt 2):S377. [Medline].

  26. Sublett JL. The environment and risk factors for atopy. Curr Allergy Asthma Rep. Nov 2005;5(6):445-50. [Medline].

  27. [Best Evidence] Wahn U, Tabar A, Kuna P, et al. Efficacy and safety of 5-grass-pollen sublingual immunotherapy tablets in pediatric allergic rhinoconjunctivitis. J Allergy Clin Immunol. Jan 2009;123(1):160-166.e3. [Medline].

  28. Wheeler PW, Wheeler SF. Vasomotor rhinitis. Am Fam Physician. Sep 15 2005;72(6):1057-62. [Medline].

 
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Photo demonstrates the allergic salute, which is the action performed when a patient rubs the nose using a motion across the nose.
Photo demonstrates allergic shiners. Note the periorbital edema and bluish discoloration seen in allergic rhinitis and sinusitis.
Impact of nasal allergies.
How patient feel when they have allergy symptoms.
Nasal symptoms and affect on work performance.
 
 
 
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