45. More options for treatment of paediatric allergy:

Multiple options for treatment of a chronic condition usually means that no one intervention is reliably effective in gaining control. In this series of abstracts, note has already been taken of the primary role of steroids in managing paediatric allergy, but reference has also been made to a role for anti-leukotrienes and sub-lingual immunotherapy. Recent articles have also commented on a possible place for hypertonic saline nasal irrigations in sinonasal disease . While a fair amount of work has previously been done in adult subjects, there has not been much in the way of paediatric research. Adults used a Water Pik device adapted for intranasal delivery and treated themselves twice daily for 3 to 6 weeks. Users showed statistically significant improvement in 23 of 30 nasal symptoms queried as well as on health status and quality of life questions. A smaller study in children with seasonal allergic rhinitis not only showed lower rhinitis scores (blocking, running, itching, sneezing) but was also associated with lower rates of anti-histamine use. Subjects irrigated 3 times per day for the six weeks of the pollen season. The authors conclude that the treatment is inexpensive, effective and tolerable, although the latter aspect must surely be age-dependent i.e. in the very young child in whom oral agents are the preferred route because of difficulties in administering medications via alternative methods such as inhalation, it cannot be easy to irrigate the nose three times per day for 6 weeks.

Read more:
Laryngoscope 2000; 110:1189-93
Pediatr Allergy Immunol 2003;14:140-3
Pediatr Allergy Immunol 2004;15:190