Paeds · allergy-and-immunology
Allergic rhinitis and rhinoconjunctivitis
Also known as hay fever · AR · SAR · PAR · seasonal allergic rhinitis · perennial allergic rhinitis · allergic rhinoconjunctivitis
An IgE-mediated inflammation of the nasal and ocular mucosa driven by aeroallergen exposure, presenting with sneezing, itch, rhinorrhoea and congestion in children; classified by the ARIA framework and managed with a stepwise allergen-avoidance and pharmacotherapy ladder culminating in disease-modifying immunotherapy.
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Target exams
Red flags
- unilateral nasal obstruction raising suspicion of foreign body or tumour
- purulent nasal discharge suggesting infection rather than allergy
- recurrent epistaxis or midfacial mass
- signs of systemic illness or immune deficiency
- severe eye pain or visual change suggesting complications
Life stages
Care settings
Clinical exam formats
Board mappings
- recognise and manage allergic rhinitis in children
- identify the link between allergic rhinitis and asthma
- apply the ARIA stepwise classification and escalate therapy including immunotherapy referral
- high-yield: ARIA classification, pharmacotherapy ladder, atopic march
- short-case assessment of a child with chronic nasal symptoms
- allergic rhinitis — diagnosis and stepwise management
- ARIA classification, intranasal corticosteroid efficacy, allergen immunotherapy indications
- assess and counsel a child with hay fever
- allergic rhinitis — diagnosis and management
- allergic rhinitis — milestone: distinguishes from infectious rhinitis, initiates stepwise therapy
- allergic rhinitis — recognise and manage
Overview & Definition
A school-aged child who rubs the tip of their nose upwards, sneezes in bursts each spring morning, and breathes through their mouth at night is the classic picture of allergic rhinitis. The problem is an immunoglobulin-E-mediated inflammation of the nasal mucosa triggered by inhaled aeroallergens, producing the quartet of sneezing, nasal itch, anterior rhinorrhoea and congestion. [3]
When the same allergic process inflames the conjunctiva, the term allergic rhinoconjunctivitis is used, reflecting how often the nose and eyes are affected together. The 2024–2025 ARIA-EAACI guideline reaffirms allergic rhinitis as the most common chronic allergic disease of childhood and a major driver of impaired school attendance, sleep disturbance and reduced quality of life. [1]
References14ShowHide
- [1]Sousa-Pinto B, Bousquet J, Vieira RJ Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part I-Guidelines. Allergy, 2026.PMID 41324154
- [2]Licari A, Magri P, De Silvestri A Epidemiology of Allergic Rhinitis in Children: A Systematic Review and Meta-Analysis. J Allergy Clin Immunol Pract, 2023.PMID 37236349
- [3]Skoner DP Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol, 2001.PMID 11449200
- [4]Gil-Mata S, Vieira RJ, Borowiack E Intranasal Treatments for Allergic Rhinitis in Preschool- and School-Age Children: Network Meta-Analysis. J Allergy Clin Immunol Pract, 2025.PMID 40675325
- [5]Li Y, Xiong J, Zhang Z Efficacy and safety of various corticosteroids in the treatment of children with allergic rhinitis. J Evid Based Med, 2024.PMID 39313999
- [6]Zhang M, Ni JZ, Cheng L Safety of intranasal corticosteroids for allergic rhinitis in children. Expert Opin Drug Saf, 2022.PMID 35199623
- [7]Linton S, Hossenbaccus L, Ellis AK Evidence-based use of antihistamines for treatment of allergic conditions. Ann Allergy Asthma Immunol, 2023.PMID 37517656
- [8]Roberts G, Pfaar O, Akdis CA EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis. Allergy, 2018.PMID 28940458
- [9]Yang J, Lei S Efficacy and safety of sublingual versus subcutaneous immunotherapy in children with allergic rhinitis. Front Immunol, 2023.PMID 38162647
- [10]Paller AS, Spergel JM, Mina-Osorio P, et al. The atopic march and atopic multimorbidity: Many trajectories, many pathways. J Allergy Clin Immunol, 2019.PMID 30458183
- [11]Norhafizah S, Salina H, Goh BS Prevalence of allergic rhinitis in children with otitis media with effusion. Eur Ann Allergy Clin Immunol, 2020.PMID 31668057
- [12]Seidman MD, Gurgel RK, Lin SY Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg, 2015.PMID 25644617
- [13]Yadegari B, Houshmand H, Ghaemi MR Effectiveness of the Nasal Irrigation in Treating Allergic Rhinitis in Children 6 to 12 Years. Iran J Allergy Asthma Immunol, 2025.PMID 40052885
- [14]Schuler CF, Montejo JM Allergic Rhinitis in Children and Adolescents. Immunol Allergy Clin North Am, 2021.PMID 34602232