Problemi correnti
La rinite allergica in età pediatrica
Allergic rhinitis in paediatrics: from scientific literature to clinical practice
Elisa Benelli1,2, Alessandro Ventura1,2, Giorgio Longo2
1IRCCS Materno-Infantile “Burlo Garofolo”, 2Università di Trieste
Aprile 2014 - pagg. 240 -248
Abstract
Allergic rhinitis (AR) is a common disease, especially among adolescents. Dust mite rhinitis
usually develops at the end of preschool age and it is characterized by obstructive symptoms.
AR due to pollens becomes more evident close to 10 years of age and it is mainly
characterized by irritative symptoms (sneezing, rhinorrhea and pharyngeal and oral pruritus)
and associated with allergic conjunctivitis. Pollen rhinitis can be associated also
with the pollen food syndrome that is characterized by oral pruritus and swelling after the
ingestion of raw fruits or vegetables, and is due to cross-reactivity between aeroallergens
and fruits/vegetables. Allergic asthma is also more frequent among patients with AR: in children
with dust mite allergy asthma usually develops before rhinitis, instead in patient with
pollen allergy it usually follows rhinitis. Among dust allergic patients, asthma is usually more
severe and persistent. The diagnosis is usually based on clinical history and positivity of
prick tests; other tests (such as RAST and nasal eosinophilia) should be limited to uncertain
cases. Therapy consists of intranasal corticosteroids and second generation oral antihistamines;
the latter are less effective on obstructive symptoms. In dust mite allergic patients,
allergy avoidance is essential and is based on mattress covers and pillow covers. Specific
immunotherapy should be limited to the rare cases in which standard therapy has not
been enough efficient.
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Suggerite dall'AI
Classificazione MeSH
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Bibliografia
1. Bjorkste’n B, Clayton T, Ellwood P, Stewart
A, Strachan D; ISAAC Phase III Study Group.
Worldwide time trends for symptoms of rhinitis
and conjunctivitis: Phase III of the International
Study of Asthma and Allergies in Childhood.
Pediatr Allergy Immunol 2008;19:110-24.
2. At-Khaled N, Pearce N, Anderson HR, et al.
Global map of the prevalence of symptoms of
rhinoconjunctivitis in children: The International
Study of Asthma and Allergies in Childhood
(ISAAC) Phase Three. Allergy 2009;64:
123-48.
3. Galassi C, De Sario M, Biggeri A, et al.
Changes in prevalence of asthma and allergies
among children and adolescent in Italy: 1994-
2002. Pediatrics 2006;117(1):34-42.
4. Peroni DG, Piacentini GL, Alfonsi L, et al.
Rhinitis in pre-school children: prevalence, association
with allergic diseases and risk factors.
Clin Exp Allergy 2003;33:1349-54.
5. Aberg N, Engström I. Natural history of allergic
diseases in children. Acta Paediatr
Scand 1990;79:206-11.
6. Wright AL, Holberg CJ, Martinez FD. Epidemiology
of physician-diagnosed allergic
rhinitis in childhood. Pediatrics 1994;94:895-
901.
7. Nwaru BI, Takkinen HM, Niemelä O, et al.
Introduction of complementary foods in infancy
and atopic sensitization at the age of 5
years: timing and food diversity in a Finnish
birth cohort. Allergy 2013;68(4):507-16.
8. Lodge CJ, Lowe AJ, Gurrin LC, et al. Pets at
birth do not increase allergic disease in at-risk
children. Clin Exp Allergy 2012;42(9):1377-85.
9. Bousquet J, Van Cauwenberge P, Khaltaev
N; Aria Workshop Group; World Health Orga-
nization. Allergic rhinitis and its impact on
asthma. J Allergy Clin Immunol 2001;108(5
Suppl):S147-334.
10. Montgomery S. Epidemiology and natural
history of asthma, allergic rhinitis and atopic
dermatitis (eczema). In: Middleton E Jr, et al
(Eds). Allergy Principle and Practice. Volume
II. The CV. Mosby Company, 1988.
11. Hagy GW, Settipane GA. Prognosis of positive
allergy skin tests in an asymptomatic population.
A three year follow-up of college students.
J Allergy Clin Immunol 1971;48:200-11.
12. Burr ML, Merrett TG, Dunstan FD,
Maguire MJ. The development of allergy in
high-risk children. Clin Exp Allergy 1997;27
(11):1247-53.
13. Wisniewski JA, Agrawal R, Minnicozzi S, et
al. Sensitization to food and inhalant allergens
in relation to age and wheeze among children
with atopic dermatitis. Clin Exp Allergy 2013;
43(10):1160-70.
14. Skoner DP. Allergic rhinitis: definitions,
epidemiology, pathophysiology, detection and
diagnosis. J Allergy Clin Immunol 2013;108
(1):S2-S8.
15. Reinberg A, Gervais P, Levi F, Smolensky
M, Del Cerro L, Ugolini C. Circadian and circannual
rhythms of allergic rhinitis: an epidemiologic
study involving chronobiologic
methods. J Allergy Clin Immunol 1988;81
(1):51-62.
16. Zicari AM, Anastasio E, Brunetti L, et al.
Rinocongiuntivite allergica. Rivista di Immunologia
e Allergologia Pediatrica 2012;Supplemento
5:1-26.
17. Murray AB, Milner RA. Allergic rhinitis
and recurrent epistaxis in children. Ann Allergy
Asthma Immunol. 1995;74(1):30-3.
18. Roberts G, Xatzipsalti M, Borrego LM, et
al. Paediatric rhinitis: position paper of the European
Academy of Allergy and Clinic Immunology.
Allergy 2013; 68:1102-16.
19. Anuntaseree W, Rookkapan K, Kuasirikul
S, Thongsuksai P. Snoring and obstructive
sleep apnea in Thai school-age children:
prevalence and predisposing factors. Pediatr
Pulmonol 2001;32(3):222-7.
20. Alkhalil M, Lockey R. Pediatric obstructive
sleep apnea syndrome (OSAS) for the allergist:
update on the assessment and management.
Ann Allergy Asthma Immunol 2011;
107(2):104-9.
21. Sauer C, Schlüter B, Hinz R, Gesch D.
Childhood obstructive sleep apnea syndrome:
an interdisciplinary approach: a prospective
epidemiological study of 4,318 five-and-a-halfyear-
old children. J Orofac Orthop 2012;73(5):
342-58.
22. Zicari AM, Indinnimeo L, De Castro G, et
al. A survey on features of allergic rhinitis in
children. M Curr Med Res Opin 2013;29(5):
415-20.
23. Dondi A, Tripodi S, Panetta V, et al. Polleninduced
allergic rhinitis in 1360 Italian children:
Comorbidities and determinants of
severity. Pediatr Allergy Immunol 2013:24:
742-51.
24. Eriksson NE, Formgren H, Svenonius E.
Food hypersensitivity in patients with pollen
allergy. Allergy 1982;37(6):437-43.
25. Cingi C, Catli T. Phenotyping of allergic
rhinitis. Curr Allergy Asthma Rep 2012;12:
115-9.
26. Leynaert B, Neukirch C, Kony S, et al. Association
between asthma and rhinitis according
to atopic sensitization in a populationbased
study. J Allergy Clin Immunol 2004;11
(3):86-93.
27. Illi S, von Mutius E, Lau S, Niggemann B,
Grüber C, Wahn U; Multicentre Allergy Study
(MAS) group. Perennial allergen sensitisation
early in life and chronic asthma in children: a
birth cohort study. Lancet 2006;26:368(9537):
763-70.
28. Lack G. Pediatric allergic rhinitis and comorbid
disorders. J Allergy Clin Immunol
2001;108:S9-15.
29. Krouse JH. Allergy and Chronic Rhinosinusitis.
Otolaryngol Clin N Am 2005;38:1257-66.
30. Rachelefsky GS, Goldberg M, Katz RM, et
al. Sinus disease in children with respiratory
allergy. J Allergy Clin Immunol 1978;61:310-4.
31. Shapiro GG. Role of allergy in sinusitis. Pediatr
Infect Dis J 1985;4:S55-9.
32. Sedaghat AR, Phipatanakul W, Cunningham
MJ. Atopy and the Development of
Chronic Rhinosinusitis in Children with Allergic
Rhinitis. J Allergy Clin Immunol Pract
2013;6(1):689-91.
33. Leo G, Piacentini E, Incorvaia C, Consonni
D, Frati F. Chronic rhinosinusitis and allergy.
Pediatr Allergy Immunol 2007;Suppl. 18:19-21.
34. Fireman P. Otitis media and eustachian
tube dysfunction: Connection to allergic rhinitis.
J Allergy Clin Immunol 1997;99:S787-97.
35. Bruno I, Longo G. Prick e RAST: troppo o
troppo poco. Medico e Bambino 2004;23:641-
8.
36. Wallace DV, Dykewicz MS, Bernstein DI,
et al. The diagnosis and management of rhinitis:
an updated practice parameter. J Allergy
Clin Immunol 2008;122(2 Suppl):S1-84.
37. Crobach MJ, Hermans J, Kaptein A, Ridderikhoff
J, Mulder J.D. Nasal smear
eosinophilia for the diagnosis of allergic rhinitis
and eosinophilic non-allergic rhinitis.
Scand J Prim Health Care 1996;14:116-21.
38. Longo G, Panontin E, Ventura G. Nonatopic
persistent asthma in children. Thorax
2009;64(5):459.
39. Nurmatov U, Van Schayck CP, Hurwitz B,
Sheikh A. House dust mite avoidance measures
for perennial allergic rhinitis: an updated
Cochrane Systematic Review. Allergy
2012;67:158-65.
40. Pingitore G, Pinter E. Environmental interventions
for mite-induced asthma: a journey
between systematic reviews, contrasting
evidence and clinical practice. Eur Ann Allergy
Clin Immunol 2013;45(3):74-7.
41. Mahakittikun V, Boitano JJ, Tovey E, et al.
Mite penetration of different types of material
claimed as mite proof by the Siriraj chamber
method. J Allergy Clin Immunol 2006;118
(5):1164-8.
42. Brozek JL, Bousquet J, Baena-Cagnani CE,
et al. Allergic rhinitis and its impact on asthma
(ARIA) guidelines: 2010 revision. J Allergy
Clin Immunol 2010;126(3):466-76.
43. Simons FE. Prospective, long-term safety
evaluation of the H1-receptor antagonist cetirizine
in very young children with atopic dermatitis.
ETAC Study Group. Early Treatment
of the Atopic Child. J Allergy Clin Immunol
1999;104(2 Pt 1):433-40.
44. Phan H, Moeller ML, Nahata MC. Treatment
of allergic rhinitis in infants and children:
efficacy and safety of second-generation antihistamines
and the leukotriene receptor antagonist
montelukast. Drugs 2009;69(18): 2541-76.
45. Estelle F, Simons R. Advances in H1-antihistamines.
N Engl J Med 2004;351:2203-17.
46. Avunduk AM, Tekelioglu Y, Turk A, Akyol
N. Comparison of the effects of ketotifen fumarate
0.025% and olopatadine HCl 0.1% ophthalmic
solutions in seasonal allergic conjunctivities:
a 30-day, randomized, double-masked,
artificial tear substitute-controlled trial. Clin
Ther 2005;27(9):1392-402.
47. van Cauwenberge P, Bachert C, Passalacqua
G, et al. Consensus statement on the treatment
of allergic rhinitis. European Academy of
Allergology and Clinical Immunology. Allergy
2000;55(2):116-34.
48. Weiner JM, Abramson MJ, Puy RM. Intranasal
corticosteroids versus H1 oral receptor
antagonists in allergic rhinitis: systematic
review of randomized controlled trials. BMJ
1998;317(7173):1624-9.
49. Blaiss MS. Safety update regarding intranasal
corticosteroids for the treatment of
allergic rhinitis. Allergy Asthma Proc 2011;32:
413-8.
50. Allen DB. Systemic effects of intranasal
steroids: an endocrinologist’s perspective. J
Allergy Clin Immunol 2000;106:S179-90.
51. Hoover RM, Erramouspe J, Bell EA, Cleveland
KW. Effect of inhaled corticosteroids on
long-term growth in pediatric patients with
asthma and allergic rhinitis. Ann Pharmacother
2013;47(9):1175-81.
52. Petty DA, Blaiss MS. Intranasal corticosteroids
topical characteristics: side effects, formulation
and volume. Am J Rhinol Allergy
2013;27:510-3.
53. Scadding GK, Durham SR, Mirakian R, et
al. British Society for Allergy and Clinical Immunology.
BSACI guidelines for the management
of allergic and non-allergic rhinitis. Clin
Exp Allergy 2008;38:19-42.
54. Di Lorenzo G, Pacor ML, Pellitteri ME, et
al. Randomized placebo-controlled trial comparing
fluticasone aqueous nasal spray in mono-
therapy, fluticasone plus cetirizine, fluticasone
plus montelukast and cetirizine plus
montelukast for seasonal allergic rhinitis. Clin
Exp Allergy 2004;34(2):259-67.
55. Plaut M, Valentine M. Allergic Rhinitis. N
Engl J Med 2005;353:1934-44.
56. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic
Rhinitis and its Impact on Asthma
(ARIA) 2008 update. Allergy 2008;63 Suppl
86:8-160.
57. Bel EH. Clinical Practice. Mild asthma. N
Engl J Med 2013;369(6):549-57.
58. Kim JM, Lin SY, Suarez-Cuervo C, et al. Allergen-
specific immunotherapy for pediatric
asthma and rhinoconjunctivitis: a systematic
review. Pediatrics 2013;131(6):1155-67.
59. Marogna M, Spadolini I, Massolo A,
Canonica GW, Passalacqua G. Long-lasting effects
of sublingual immunotherapy according
to its duration: A 15-year prospective study. J
Allergy Clin Immunol 2010;126:969-75.
60. Eng PA, Borer-Reinhold M, Heijnen
IAFM, Gnehm HPE. Twelve-year follow-up after
discontinuation of preseasonal grass
pollen immunotherapy in childhood. Allergy
2006;61:198-20.
61. Calderon MA, Alves B, Jacobson M, Hurwitz
B, Sheikh A, Durham S. Allergen injection
immunotherapy for seasonal allergic
rhinitis. Cochrane Database Syst Rev 2007;
24(1):CD001936.
62. Radulovic S, Wilson D, Calderon M,
Durham S. Systematic reviews of sublingual
immunotherapy (SLIT). Allergy 2011;66(6):
740-52.
Corrispondenza: elisa.benelli@gmail.com