Proactive pediatric legislation has boosted research and development of allergy drugs for children, leading to new pediatric labeling and novel pharmacotherapy. This has been a boon to allergen immunotherapy, resulting in more child-friendly options, such as the recently FDA-approved Grastek
(Timothy grass pollen allergen extract), Oralair (allergen pollen extract of 5 grasses), and Qnasl
(beclomethasone dipropionate). With approximately 40% of children reported to suffer from allergic rhinitis, the widened range of treatment choices is beneficial for prescribing suitable medications to those with the chronic condition.
Prevention is helpful while treating children with allergic rhinitis, and patients and caregivers should be educated on the potential triggers. Encourage awareness of pollen counts, and recommend keeping indoors when there are high levels reported. Advise about the relationship to time of day, such as for the grass pollen season of spring and summer, which typically has the highest levels in the evening. When ragweed pollen season arrives in late summer and early fall, morning is the worst time. Mold allergies can also have seasonal connections, such as the higher prevalence of leaf mold in the fall. Patients should be made aware that sunny, windy days have the potential to increase allergy symptoms. When pollen counts are high, advise to keep windows closed and to rely on an air conditioner, in order to reduce the exposure to the triggers.
Since it is practically impossible to avoid allergens altogether, medications to relieve symptoms offer management options. FDA-regulated products include nasal corticosteroids (including Qnasl, a once-daily, pressurized, HFA-propelled nonaqueous aerosol), oral and topical antihistamines (such as Clarinex
), decongestants (such as Allegra-D
), non-steroidal nasal sprays (such as Atrovent Nasal Spray
), and leukotriene receptor antagonists (such as Singulair
). A more recently added class is the allergen extracts (such as the sublingually administered Grastek, Oralair, and Ragwitek
[short ragweed pollen allergen extract], the last of which is a new addition to this class and is indicated for patients 18–65 years of age). Grastek is indicated for treatment of grass pollen-induced allergic rhinitis with or without conjunctivitis confirmed by positive skin test or in vitro testing for pollen-specific IgE antibodies for Timothy grass or cross-reactive grass pollens in patients 5–65 years of age. Similarly, Oralair received FDA approval for treatment of allergic rhinitis with or without conjunctivitis that is induced by certain grass pollens in individuals 10–65 years of age.
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and by keeping your contact information up to date with us
. If you use an electronic health record (EHR), please ask for it to include the PDR drug data feeds, including PDR BRIEF
. Updated drug information, full labeling, and safety warnings will be integrated into your electronic prescribing system automatically, and at no cost to you.
Salvatore Volpe, MD, FAAP, FACP, CHCQM
Chief Medical Officer