Intended for healthcare professionals

Clinical Review

Allergic rhinoconjunctivitis in children

BMJ 2007; 335 doi: (Published 08 November 2007) Cite this as: BMJ 2007;335:985
  1. Hans de Groot, allergologist1,
  2. Paul L P Brand, paediatrician2,
  3. Wytske F Fokkens, ENT specialist3,
  4. Marjolein Y Berger, general practitioner4
  1. 1Section of Allergology, Department of Internal Medicine, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, Netherlands
  2. 2Princess Amalia Children's Clinic, Isala Klinieken, PO Box 10400, 8000 GK, Zwolle, Netherlands
  3. 3Department of Otorhinolaryngology, Academic Medical Centre, PO Box 22700, 1100 DE, Amsterdam, Netherlands
  4. 4Department of General Practice, Erasmus MC
  1. Correspondence to: H de Groot h.degroot{at}

    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

    • Blockage or congestion

    • Watery discharge

    • Sneezing

    • Itching

    • 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.


    • 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 …

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