PE28.1 | Allergic Rhinitis — Summary & Reflection

KEY TAKEAWAYS

Allergic rhinitis is the most common chronic atopic disease in children, caused by IgE-mediated Th2 inflammation of the nasal mucosa. Diagnosis is clinical — the quartet of rhinorrhoea, nasal itch, paroxysmal sneezing, and congestion with pale swollen turbinates, allergic salute, and allergic shiners. The ARIA 2008 classification grid (intermittent vs persistent × mild vs moderate-severe) drives treatment intensity. Diagnostic workup: skin prick test (≥3 mm wheal = positive) or serum specific IgE (ImmunoCAP); nasal cytology (eosinophilia); spirometry for comorbid asthma screening. Management: allergen avoidance + saline irrigation as the foundation; INCS (mometasone/budesonide/fluticasone) as the most effective pharmacotherapy and first-line for persistent moderate-severe disease; second-generation antihistamines (cetirizine 0.25 mg/kg, loratadine 0.2 mg/kg) for itch/sneeze/rhinorrhoea; montelukast (LTRA) when asthma coexists. Avoid sedating first-generation antihistamines and topical decongestants beyond 3–5 days. Allergen immunotherapy is disease-modifying for selected moderate-severe patients ≥5 years. The allergic march (AR → asthma) is partly preventable with early correct management.

REFLECT

Think about a child you have seen (or imagine Priya from the opening scenario) whose chronic nasal symptoms were being managed only with chlorpheniramine prescribed by a local pharmacist — and who had also been given a salbutamol inhaler for a cough that was labelled 'recurrent viral bronchitis'. How would the 'one airway, one disease' framework and the ARIA-guided management plan you have now learned change the approach to that child's care? What would you tell the parents about why treating the nose can help the lungs — and about what to realistically expect from INCS therapy in terms of onset and duration of effect? Reflect on how chronic under-recognised allergic rhinitis could be contributing to poor school performance in your future practice population.