What is the treatment plan for allergic rhinitis in children?

From the Guidelines

The treatment plan for allergic rhinitis in children should begin with allergen avoidance measures and first-line pharmacotherapy with intranasal corticosteroids, such as fluticasone or mometasone, which have been shown to be effective in reducing inflammation and improving symptoms 1.

Allergen Avoidance Measures

• Keeping windows closed during high pollen seasons
• Using air purifiers
• Removing carpets if dust mites are triggers
• Washing bedding regularly in hot water

Pharmacotherapy

• Intranasal corticosteroids: fluticasone (32-64 mcg/day for children 4-11 years) or mometasone (50 mcg/day for children 2-11 years) 1
• Second-generation oral antihistamines: cetirizine (5-10 mg daily for children 6-11 years, 2.5-5 mg for 2-5 years) or loratadine (10 mg daily for children >6 years, 5 mg for 2-5 years) for breakthrough symptoms 1
• Combination of intranasal corticosteroids and antihistamines for moderate to severe symptoms 1

Additional Therapies

• Nasal saline irrigation to clear allergens and mucus
• Referral to an allergist for consideration of immunotherapy for persistent symptoms despite optimal medical therapy 1

Treatment Duration

• Treatment should be continued throughout the allergy season for seasonal allergies or year-round for perennial allergies, with periodic attempts to use the lowest effective medication dose 1

From the FDA Drug Label

Children age 4 to 11 should use a lower dose of Fluticasone Propionate Nasal Spray, USP for a shorter period of time Ages | Children 4 to 11 years of age | Users 12 years of age and older Dosage | 1 spray in each nostril once daily | Up to 2 sprays in each nostril once daily Duration before checking with a doctor | Up to 2 months of use a year | Up to 6 months of daily use When used long-term, intranasal glucocorticoids like Fluticasone Propionate Nasal Spray, USP may cause the growth rate of some children to be slower. CHILDREN 4 TO 11 YEARS OF AGE the growth rate of some children may be slower while using this product. Children should use for the shortest amount of time necessary to achieve symptom relief.

The treatment plan for allergic rhinitis in children involves using Fluticasone Propionate Nasal Spray, USP at a lower dose and for a shorter period.

• Dosage: 1 spray in each nostril once daily for children aged 4-11.
• Duration: Up to 2 months of use per year before checking with a doctor.
• Key consideration: The potential for slower growth rate in children using intranasal glucocorticoids long-term, emphasizing the need for the shortest treatment duration necessary to achieve symptom relief 2, 2.

From the Research

Treatment Plan for Allergic Rhinitis in Children

The treatment plan for allergic rhinitis in children involves a combination of pharmacotherapy and avoidance of triggering allergens 3, 4, 5. The choice of treatment depends on the severity and duration of symptoms.

Pharmacotherapy

• For mild, intermittent symptoms, oral second-generation antihistamines such as cetirizine, loratadine, fexofenadine, and azelastine nasal spray are recommended 3, 4.
• For more persistent and severe symptoms, intranasal corticosteroids such as fluticasone propionate and mometasone furoate are indicated 3, 6.
• Other agents that may be used include pseudoephedrine, an oral vasoconstrictor, for nasal congestion, and the anticholinergic nasal spray ipratropium bromide for rhinorrhoea 3.
• Leukotriene receptor antagonists such as montelukast may also be used to treat allergic rhinitis in children 4, 6.

Specific Treatment Options

• Cetirizine has been shown to be effective in treating seasonal allergic rhinitis in children aged 6 to 11 years 7.
• Fluticasone propionate has been compared to second-generation oral antihistamines such as cetirizine, loratadine, and montelukast, and has been found to have equal or greater efficacy in reducing nasal symptom scores 6.
• Combination therapy of fluticasone propionate and an oral antihistamine such as loratadine has been found to have efficacy comparable to that of intranasal corticosteroid alone 6.

Considerations

• The choice of treatment should be based on the severity and duration of symptoms, as well as the patient's age, comorbidities, and prior treatment 3, 4, 6.
• The safety and efficacy of treatment options should be considered, as well as the cost and availability of medications 3, 4, 6.
• Allergen-specific immunotherapy may be considered for patients who do not respond to pharmacotherapy or who require continuous medication 3, 5.