Allergic rhinoconjunctivitis in children

doi:10.1136/bmj.39365.617905.BE

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Hans de Groot, allergologist1,
Paul L P Brand, paediatrician2,
Wytske F Fokkens, ENT specialist3,
Marjolein Y Berger, general practitioner4

¹Section of Allergology, Department of Internal Medicine, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, Netherlands
²Princess Amalia Children's Clinic, Isala Klinieken, PO Box 10400, 8000 GK, Zwolle, Netherlands
³Department of Otorhinolaryngology, Academic Medical Centre, PO Box 22700, 1100 DE, Amsterdam, Netherlands
⁴Department of General Practice, Erasmus MC

Correspondence to: H de Groot h.degroot{at}erasmusmc.nl

Allergic rhinoconjunctivitis is a common chronic disorder in children, especially in developed countries. It does not cause nasal symptoms only (such as congestion and sneezing) but may also cause general complaints such as fatigue and cough (box 1). It can also cause learning problems1 and has a great impact on quality of life. Uncontrolled allergic rhinoconjunctivtis may aggravate the symptoms of asthma.2 Although classic “hay fever” is easily recognised in children who have a runny nose, sneezing, and itchy eyes during the pollen season, the diagnosis of allergic rhinoconjunctivitis is often missed in children with perennial nasal congestion.

Box 1: Key symptoms of allergic rhinoconjunctivitis in children

Nasal

Blockage or congestion
Watery discharge
Sneezing
Itching

General

Cough
Fatigue, malaise, not feeling or looking well
Sore throat, repeated throat clearing
Halitosis, snoring, open mouth breathing

The term allergic rhinoconjunctivitis is preferable to allergic rhinitis because most patients also have ocular symptoms. In this review, we discuss the prevalence of allergic rhinoconjunctivitis in children, its causes, how it is diagnosed, and how it can be treated.

Sources and selection criteria

We used the Cochrane library to identify relevant systematic reviews on drugs for allergic rhinoconjunctivitis in children. Medline was searched for systematic reviews on diagnosis and treatment of allergic rhinoconjunctivitis in children using the keywords “rhinoconjunctivitis”, “systematic review”, “meta-analysis”, “diagnosis”, and “treatment”. We limited our searches to “all child”. We took additional references from our personal files.

SUMMARY POINTS

Most evidence on diagnosis and treatment allergic rhinitis and guidelines for the disease are based on adult studies
The disease has a high prevalence, a strong impact on quality of life and school performance, and may exacerbate allergic asthma
Initial treatment in primary care should be an individualised combination of allergen avoidance and pharmacotherapy
Nasal corticosteroids are the first line drugs for maintenance of persistent or severe intermittent disease
Sublingual immunotherapy should not be used in children until …