title: A control model to evaluate pharmacotherapy for allergic rhinitis in children.
abstract: OBJECTIVE
  Although the question of whether early diagnosis and treatment of pediatric allergic rhinitis (AR) improve disease control is important, a more crucial question is whether we can evaluate the effect of treatment on disease control using an impairment-risk model.
  
  
  OBJECTIVE
  To conduct a systematic review evaluating application of a control model based on domains of impairment and risk (similar to that used for asthma) in pharmacotherapy for children with AR.
  
  
  METHODS
  We searched the MEDLINE and EMBASE databases (January 1, 1996, through May 31, 2012) for controlled studies lasting 2 weeks or longer in children with confirmed diagnoses of AR, including measures assessing impairment and/or risk of comorbid conditions.
  
  
  RESULTS
  Sixteen controlled clinical trials, including more than 3000 children (aged 2-18 years) with AR (seasonal, n = 2290; perennial, n = 800), met the study criteria. All medication classes improved impairment related to AR, but between-treatment comparisons were limited because of different assessments. Intranasal steroids improved risk outcomes associated with asthma and obstructive sleep apnea. Small single studies suggested possible effects of oral antihistamines on asthma and sleep-disordered breathing. No risk data were available for nasal antihistamines or montelukast sodium.
  
  
  CONCLUSIONS
  Treatment of AR, particularly with intranasal steroids, improves disease control in children by reducing disease-associated impairment and risk. All AR medications with proved efficacy probably improve impairment, paralleling symptom reduction. Intranasal steroids may reduce the likelihood of comorbidities that increase health care use. These observations, although limited by different protocols and outcomes measures among studies, support current practice recommendations. Studies that use standardized measures of impairment to permit better comparison and appropriate protocols for risk evaluation are needed.
authors: Executive Care Center for Asthma, Allergy, and Respiratory Diseases, Geffen School of Medicine at the University of California, Los Angeles, 1131 Wilshire Blvd, Ste 202, Santa Monica, CA 90401, USA.
authors: Gary
authors: G
authors: Rachelefsky
authors: Judith Rosen
authors: JR
authors: Farrar
mesh_terms: D019819:Budesonide / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D042241:Early Diagnosis; D005938:Glucocorticoids / Q000627:therapeutic use; D006305:Health Status Indicators; D006801:Humans; D011788:Quality of Life; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D005938:Glucocorticoids; D019819:Budesonide