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Treatment of Allergic Rhinitis in Children

Comprehensive management of allergic rhinitis in children including allergen avoidance, pharmacotherapy and immunotherapy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Çocuk Sağlığı ve Hastalıkları department. Book Appointment →

What is Treatment of Allergic Rhinitis in Children?

Allergic rhinitis is the most common chronic allergic disease in children, affecting 10–30% of children with peak prevalence at age 5–14 years.

Pathophysiology: IgE-mediated type I hypersensitivity to inhaled allergens, with mast cell degranulation, histamine release and Th2-mediated inflammation in the nasal mucosa.

Subtypes: seasonal allergic rhinitis (pollen, mold spores), perennial allergic rhinitis (house dust mite, animal dander, cockroach), or mixed; atopic march association with atopic dermatitis and asthma.

Clinical impact: significant on quality of life, school performance, sleep, and psychosocial functioning; up to 40% of children with allergic rhinitis develop asthma.

Symptoms

Sneezing (paroxysmal, multiple in succession)
Watery rhinorrhea (anterior or posterior)
Nasal pruritus, ocular pruritus, conjunctival redness, lacrimation
Nasal congestion (often the dominant symptom in children)
Allergic shiners (dark periorbital circles), Dennie-Morgan lines
Allergic salute (transverse nasal crease from chronic upward rubbing)
Mouth breathing, snoring, sleep disturbance
Allergic gape (open-mouth posture)
Eustachian tube dysfunction: ear fullness, hearing impairment, otitis media
Cough (postnasal drip), throat clearing, hoarseness
Fatigue, poor school performance, sleep disturbance
Symptoms of associated asthma (wheezing, shortness of breath, exercise-induced cough)

Risk Factors

Atopic family history (1.5–2× increased risk)
Personal history of atopic dermatitis or asthma
Early-life respiratory viral infection
Indoor allergen exposure (house dust mite, cockroach, animal dander)
Outdoor allergen exposure: pollen (tree, grass, weed), mold
Tobacco smoke exposure (passive smoking)
Air pollution
Cesarean delivery and limited microbial diversity
Antibiotic exposure in early life
Hygiene hypothesis: limited early microbial exposure

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent rhinorrhea, congestion, sneezing >2 weeks
  • Sleep disturbance, school problems due to symptoms
  • Symptoms of asthma alongside allergic rhinitis
  • Recurrent ear infections, sinusitis
  • Symptoms not responding to over-the-counter therapy
  • Speech/language development concerns due to chronic congestion
  • Behavioral or learning difficulties
  • Need for allergen identification and immunotherapy planning

Treatment Methods

01
Diagnostic evaluation: detailed allergy history, family history, environmental assessment, physical examination (nose, ears, throat, skin)
02
Allergy testing: skin prick testing (gold standard, ages >6 months for selected allergens), specific IgE serum testing (alternative if skin testing not feasible)
03
Differential diagnosis: viral upper respiratory infection, non-allergic rhinitis, structural abnormalities (deviated septum, adenoid hypertrophy), sinusitis, choanal atresia
04
Environmental control: house dust mite reduction (mite-proof bedding, washing bedding at 60 °C, removing carpets, dehumidification), pet dander removal, cockroach control, mold elimination
05
Pollen avoidance: keeping windows closed during pollen season, air conditioning, after-outdoor showering, monitoring pollen counts, limiting outdoor activities during peak pollen times
06
Saline nasal irrigation: neti pot or sterile saline spray 1–2 times daily; effective for symptom relief and preventive use
07
Intranasal corticosteroids (most effective treatment): mometasone furoate 50 μg/spray (50–200 μg/day, ages ≥2), fluticasone furoate (50 μg/day, ages ≥2), budesonide (32–256 μg/day, ages ≥6); peak effect 2–4 weeks
08
Second-generation oral antihistamines: cetirizine (5–10 mg/day, ages ≥6 months), loratadine (5–10 mg/day, ages ≥2), fexofenadine (30 mg twice daily, ages ≥2); minimal sedation
09
Intranasal antihistamines: azelastine spray (1–2 sprays per nostril twice daily, ages ≥6 months), olopatadine (ages ≥6); rapid-onset alternative
10
Combination spray: azelastine-fluticasone (Dymista, ages ≥6); combined effect of both classes
11
Leukotriene receptor antagonists: montelukast (4 mg granules ages ≥6 months, 5 mg chewable ages ≥2, 10 mg ages ≥15); useful in concomitant asthma; black box warning for psychiatric effects
12
Decongestants (limited use): oral pseudoephedrine, intranasal oxymetazoline (only short-term <3 days, rebound rhinitis risk)
13
Cromolyn sodium nasal spray: prophylactic in mild seasonal disease; less effective than corticosteroids
14
Allergen-specific immunotherapy (AIT): subcutaneous immunotherapy (SCIT) ages ≥5, sublingual immunotherapy (SLIT) tablets and drops ages ≥4–5; 3–5 year duration; modifies underlying allergic response
15
SLIT preparations approved: timothy grass (Grastek, ages ≥5), 5-grass mix (Oralair, ages ≥10), short ragweed (Ragwitek, ages ≥5), house dust mite (Odactra, ages ≥18)
16
Asthma comorbidity management: integrated treatment with pediatric pulmonology for asthma; ICS, LABA, montelukast for combined effect
17
Eye symptoms: ocular antihistamines (olopatadine, ketotifen drops), artificial tears, cool compresses
18
Patient and family education: trigger identification, symptom diary, treatment compliance, when to seek care, immunotherapy benefit and risks
19
Long-term outcomes: 30–40% remission with childhood treatment; immunotherapy reduces asthma development risk by 30–50%
20
School and lifestyle adjustment: school health management, sport activity safety, travel planning
21
Multidisciplinary follow-up: pediatric allergy and immunology, otolaryngology, pulmonology, ophthalmology (for severe ocular symptoms)

Which Department to Visit?

You can visit our Çocuk Sağlığı ve Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.