Allergic Rhinitis in Children and Adolescents Aged 5–17 Years: Key Links in the Atopic March, Clinical and Diagnostic Features, and Management Strategies

The aim of the study – a comprehensive study of allergic rhinitis as one of the key stages of the atopic march in children and adolescents aged 5 to 17 years based on the analysis of clinical data of patients included in our own research. Materials and Methods. This study was conducted from January to April 2025 in a pediatric outpatient setting involved 198 children, of whom 42 aged 5–17 years had allergic rhinitis (AR) symptoms. Participants were categorized by age, gender, social-territorial factors, and clinical features for comprehensive analysis. The middle age group (10–13 years) accounted for the highest prevalence (40.5 %), indicating age-related susceptibility. Boys slightly predominated (55 %), consistent with global trends in early allergic disease development. Seasonal analysis revealed 60 % of cases during winter, likely due to viral infections exacerbating AR, and 40 % in spring, correlating with pollen exposure. Urban residence predominated (75 %), reflecting environmental risk factors like pollution. Genetic predisposition was significant, with 65 % having a family history of allergic diseases, associated with more severe and prolonged symptoms. Comorbidities were frequent: bronchial asthma (28 %), allergic conjunctivitis (32 %), atopic dermatitis (4.7 %), otitis media (18 %), sinusitis (12 %), and adenoiditis (10 %), highlighting the allergic multimorbidity concept. Clinical symptoms included serous rhinorrhea (90 %), sneezing (81.6 %), nasal itching (75 %), obstruction (70 %), and ophthalmic symptoms (58.3 %), reflecting the classical AR presentation. The ARIA (AR and its Impact on Asthma) protocol enabled effective diagnosis and stratification: 65 % had persistent rhinitis, 35 % intermittent. Results and Discussion. Treatment response to intranasal corticosteroids and antihistamines was positive in 85 % within 5–7 days, supporting trial therapy’s diagnostic role. Combined therapy (antihistamines plus corticosteroids) showed superior efficacy, improving quality of life by 85 % versus 65 % and 48 % in monotherapy groups. Psycho-emotional impact was significant, with sleep disturbances, attention deficits, anxiety, and depressive symptoms noted, adversely affecting academic and social functioning. Oxygen saturation monitoring revealed mild nocturnal hypoxia in 22 %, linking nasal obstruction to impaired ventilation. Conclusions. The study underscores the need for early diagnosis, personalized management, and comprehensive care addressing comorbidities and psychosocial effects in pediatric AR, especially in urban environments with genetic and environmental risk factors.