Current and emerging pharmacotherapy for pediatric allergic rhinitis

ABSTRACT

Introduction

Allergic rhinitis (AR) is a global health problem in adults as well as the younger population, continuously increasing and posing a significant problem for patients, health care systems and economies. For the younger population, some aspects differ from treatment of adults, namely, prevention, compliance and adherence.

Areas covered

This narrative review summarizes all the pharmacotherapeutic options with special focus on the pediatric population. Moreover, it elucidates prevention strategies as well as future developments of AR treatment. Currently, symptomatic therapy in the form of steroids and antihistamines is applied topically and systemically where steroids need to be administered with caution and for a very short term. The only disease-modifying and causal treatment is allergen immunotherapy administered sublingually and subcutaneously. Future and current novel therapeutic options are human monoclonal antibodies.

Expert opinion

The greatest potential for future developments currently lie in allergen immunotherapy and here in different routes of administration and modification of (recombinant) allergens as well as immune‐modulating adjuvants and nanoparticles. Secondly, monoclonal antibodies are promising molecules blocking and/or interfering with up- and downstream immune mechanisms. Another important aspect lies in prevention of allergic sensitization and disease progression through both AIT and biologics which is particularly true for the pediatric population.

KEYWORDS:

• Allergen immunotherapy
• antihistamines
• biologics
• monoclonal antibodies
• pediatric allergic rhinitis
• pharmacotherapy
• prevention
• steroids

Article highlights

• Specific IgE sensitization and production in childhood is a major risk of developing multimorbidities and allergic rhinitis and asthma in late childhood and adolescence

• Nasal corticosteroids are well tolerated, act fast especially relieving nasal congestion and work best when combined with topical antihistamines

• SLIT and SCIT work well in children with applications routes impacting compliance

• Biologics provide symptom relief, are very well tolerated with little side effects and seem to have a synergistic effect with immunotherapy

• Omalizumab and Dupilumab are promising Biologics in treatment of pediatric allergic rhinitis and have multiple ways of acting anti-inflammatory

This box summarizes key points contained in the article.

Acknowledgments

The authors thank Laurie Murray for her effort in editing our manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.