An Expert Opinion on the Management of Pediatric Allergic Rhinitis

Abstract This expert opinion sheds light on the Indian scenario of pediatric allergic rhinitis (AR) and its management. A virtual expert meeting with allergists, immunologists, and pulmonologists from across India was conducted. Discussion from this meeting was analyzed to formulate this expert opinion document. The experts highlighted the rising trend of allergies in rural India linked to pollen sensitivity, rapid urbanization, westernization, and construction, with a notable family history influence and higher prevalence in humid cities. Asthma and allergic conjunctivitis are the most common conditions associated with AR. The experts added that common triggers include house dust mites, aeroallergens, indoor molds in the bathrooms, pigeon feathers and droppings, and insects such as cockroaches. The diagnostic algorithm for AR in children primarily relies on patient history and typical symptoms. Treatment for AR focuses on allergen avoidance and education about minimizing exposure. Pharmacotherapy includes second-generation antihistamines like bilastine and fexofenadine, and intranasal corticosteroids such as mometasone furoate and fluticasone furoate. Leukotriene receptor antagonists and H1 antihistamines together may also improve outcomes, particularly for those with asthma or severe perennial AR. Emerging therapies, including biologics and immunotherapy, offer significant benefits in severe cases. This consensus report provides a comprehensive overview of expert recommendations for the management of pediatric AR in Indian patients.