Update on the treatment of allergic rhinitis in children

Allergic rhinitis (AR) is the most common chronic condition from childhood to adulthood and remains a major, often underestimated, contributor to impaired quality of life, school performance, and healthcare use. Although symptoms frequently begin early in life, pediatric AR is still underdiagnosed and inadequately treated, with important consequences for physical, emotional, and cognitive development. In this narrative review, we summarize recent evidence on the treatment of AR in children, highlighting age-specific challenges and evolving treatment concepts. International recommendations, particularly those from ARIA, support a stepwise, patient-centred approach focused on symptom control, safety, and long-term outcomes. Intranasal corticosteroids remain the cornerstone of therapy for moderate-to-severe disease, while second-generation antihistamines and intranasal antihistamines provide effective options for milder or intermittent symptoms. Fixed-dose intranasal steroid-antihistamine combinations are highly effective, providing options for children with more severe or uncontrolled AR. Allergen immunotherapy is the only disease-modifying intervention. Emerging strategies, including biologics and novel immunotherapy approaches, are promising but currently limited to specific contexts. Alongside pharmacotherapy, education, adherence support, and pragmatic environmental measures are essential to achieve sustained disease control. Ongoing gaps in the pediatric evidence-base highlight the need for age-adapted algorithms and long-term studies focusing on early intervention and disease modification.