With the changes in living environment, allergic rhinitis (also known as allergic rhinitis) has become a common and frequently-occurring disease in children.
I. Simple identification of allergic rhinitis and common cold
1. The cause is different: the common cold is an infectious disease caused by a virus (in which rhinovirus accounts for about 30% to 50%); and allergic rhinitis is a non-infectious inflammatory disease mediated by IgE after exposure to an allergen. .
2. The symptoms are different: the common cold often accompanied by sore throat, fever and general malaise, lasted about 7 to 10 days; allergic rhinitis usually without fever and general malaise, may be associated with itchy eyes, conjunctival congestion and other eye symptoms, continued Time > 2 weeks.
II. Does allergic need to be monitored for allergens?
Common allergens of seasonal allergic rhinitis are seasonal inhalations such as pollen and fungi; common allergens of perennial allergic rhinitis are dust mites, mites, animal dander and the like.
Most patients do not need to check for allergens, and symptomatic treatment can be alleviated.
For patients with oral antihistamines and moderate doses of nasal hormones that do not control symptoms, allergen testing can be performed so that immunotherapy can be given.
III. Commonly used drugs for children with allergic rhinitis
1. Nasal glucocorticoids
Glucocorticoids for nasal use are currently the most effective treatment for allergic rhinitis; usually within 36 hours of the first dose; continuous treatment is superior to intermittent therapy.
Nasal glucocorticoids are the first choice for moderate-to-severe allergic rhinitis (heavier symptoms, which have a significant impact on quality of life).
Clinical studies have shown that mometasone furoate, fluticasone propionate and budesonide have no significant effect on children’s growth and development.
Special reminder: If children use nasal glucocorticoids for a long time, the minimum effective amount should be used, and the growth and development should be monitored regularly.
2. The second generation of antihistamines
A single oral second-generation antihistamine can effectively control mild, and most moderate-to-severe allergic rhinitis; once daily, for ≥ 2 weeks.
Nasal antihistamines are superior to oral antihistamines and have a faster onset and can be administered on demand.
The main side effect of nasal antihistamines is bitterness, rare nasal burning, nosebleeds and headaches.
Special reminder: The first generation of antihistamines (chlorpheniramine, ketotifen, etc.) have central inhibition and anticholinergic effects and are not recommended for use in children.
3. Leukotriene receptor antagonist
Oral leukotriene receptor antagonists are better than second-generation oral antihistamines in improving the nasal congestion, and can be used as first-line treatment for patients with bronchial asthma.
Oral leukotriene receptor antagonists may be used if the patient cannot tolerate intranasal treatment and if oral antihistamines can cause drowsiness.
Special reminder: oral montelukast is associated with adverse events such as “excitement, sleep disorders, depression”, and rare cases include suicidal ideation and behavior. The doctor or pharmacist should respond to the guardian.
IV. Combination therapy
1. When single drug therapy is ineffective, a combination drug can be used.
2. Nasal hormone + oral antihistamine: no additional clinical benefit has been demonstrated.
3. Nasal hormone + nasal antihistamine: the improvement of nasal symptoms in patients with moderate to severe seasonal allergic rhinitis is better than single drug therapy.
4. Nasal hormone + oral leukotriene antagonist: nasal congestion and other symptoms are not well controlled, may consider oral leukotriene antagonists.
5. Oral antihistamine + oral leukotriene antagonist: better than oral antihistamine alone or oral leukotriene receptor antagonist alone.