On this page
Quick Reference
Overview and Recommendations
Background
- •Allergic rhinitis (AR) is an IgE-mediated type I hypersensitivity reaction of the nasal mucosa triggered by inhaled allergens; it affects an estimated 400-500 million people worldwide and is the most prevalent allergic disease, with a marked rise over the past decade, especially in children. The condition is a key step in the atopic march: it triples the odds of subsequent asthma (adjusted RR 3.53) and commonly co-occurs with atopic dermatitis and allergic conjunctivitis.
- •The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines classify AR along three axes: symptom frequency (intermittent <4 days/week or <4 weeks; persistent ≥4 days/week and ≥4 weeks), severity (mild with normal sleep and activity; moderate-to-severe with impairment), and trigger exposure (seasonal from outdoor pollens, perennial from indoor allergens). A distinct phenotype, local allergic rhinitis (LAR), accounts for up to 25% of rhinitis patients and is characterized by negative skin prick tests and serum IgE but positive nasal allergen challenge and local IgE production in the nasal mucosa.
- •The pathophysiology unfolds in two phases: an early-phase response driven by mast cell degranulation and histamine release, causing sneezing, itching, and watery rhinorrhea within minutes of allergen exposure; followed by a late-phase response 4-6 hours later, orchestrated by eosinophils, Th2 lymphocytes, and ILC2s, producing persistent nasal congestion and mucosal hyperreactivity. Epithelial barrier dysfunction and neurogenic inflammation (via TRP channels, substance P) amplify and perpetuate this type 2 inflammation.
- •The evolution of treatment has moved from empiric oral antihistamines (first-generation, sedating) to targeted therapy: intranasal corticosteroids (first-line since the 1990s), combination intranasal antihistamine-corticosteroid fixed-dose products (superior to monotherapy), and disease-modifying allergen immunotherapy (AIT). AIT, subcutaneous or sublingual, is the only intervention that reduces the risk of developing asthma (RR 0.40) and provides sustained benefit for years after a minimum 3-year course. Biologics such as tezepelumab (anti-TSLP) and stapokibart (anti-IL-4Rα) are emerging for uncontrolled seasonal disease but remain second-line options.
Evaluation
- •Suspect allergic rhinitis in any patient presenting with the classic symptom quartet: sneezing, nasal itching, clear rhinorrhea, and nasal congestion, especially when triggered by specific allergen exposures (pollen seasons, dust mites, animal dander, mold). Ocular itching, tearing, and redness accompany nasal symptoms in up to 75% of patients, reflecting shared conjunctival mucosal involvement.
- •Ask about the pattern and duration of symptoms: are they seasonal (tree, grass, weed pollens) or perennial (dust mites, pets, cockroach)? Use the ARIA framework to classify as intermittent (<4 days/week or <4 consecutive weeks) versus persistent (≥4 days/week and ≥4 weeks). Elicit impact on sleep, school/work productivity, and daily activities to grade severity as mild or moderate-to-severe.
- •Examine the nasal cavity using anterior rhinoscopy or nasal endoscopy: look for pale, boggy, edematous turbinates with clear, watery secretions. The classic 'allergic salute' (upward rubbing of the nose) produces a horizontal crease across the nasal bridge (allergic crease). Dark circles under the eyes (allergic shiners) and Dennie-Morgan lines are supportive but not specific. Inspect the conjunctivae for injection and chemosis; examine the posterior pharynx for cobblestoning from lymphoid hyperplasia.
- •Order skin prick testing (SPT) with a panel of regionally relevant aeroallergens as the initial test of choice, it is rapid, safe, and provides immediate results. A positive reaction (wheal ≥3 mm larger than negative control) indicates IgE sensitization. An alternative is serum-specific IgE (sIgE) measurement (≥0.35 kU/L positive), useful when antihistamines cannot be withheld or SPT is unavailable; discordance between SPT and sIgE occurs in up to 20% of cases.
- •If SPT and sIgE are negative but clinical suspicion for allergic rhinitis remains high, consider nasal allergen challenge (NAC) to diagnose local allergic rhinitis (LAR). NAC is the gold standard for LAR and should be performed in specialized centers using standardized allergen extracts with subjective symptom scores and objective measures (peak nasal inspiratory flow, acoustic rhinometry).
- •Assess severity using validated instruments: the Total Nasal Symptom Score (TNSS) grades rhinorrhea, congestion, sneezing, and itching each 0-3 (composite ≥5 defines moderate-to-severe); the visual analog scale (VAS) score >5 on a 0-10 scale distinguishes moderate from severe disease per the modified ARIA classification. The minimal clinically important difference for TNSS is 0.55 units, and for PNIF (peak nasal inspiratory flow) it is 5 L/min.
- •Evaluate for comorbidities: screen for asthma (wheezing, chest tightness, nocturnal cough, exertional dyspnea; consider spirometry), allergic conjunctivitis, chronic rhinosinusitis (facial pressure, purulent discharge, hyposmia persisting beyond allergy season), otitis media with effusion (especially in children), and sleep-disordered breathing. In children, ask about snoring, mouth breathing, and school absenteeism.
- •Consider red flags that necessitate urgent evaluation: unilateral nasal obstruction or bloody discharge (suspect nasal mass or foreign body), purulent nasal discharge with facial pain and fever persisting >10 days (acute bacterial sinusitis), new-onset asthma symptoms, or persistent anosmia (consider chronic rhinosinusitis with nasal polyps). Cough as the sole presenting symptom may be asthma or eosinophilic bronchitis.
- •In refractory or atypical cases, nasal cytology (scraping with May-Grünwald-Giemsa staining) can identify eosinophils, mast cells, or neutrophils, helping differentiate from non-allergic rhinitis phenotypes (e.g., NARES). Total IgE and peripheral blood eosinophil count are supportive but not diagnostic. Basophil activation test (BAT) is emerging for LAR diagnosis but lacks standardization. Imaging (paranasal sinus CT) is reserved for suspected complications like chronic rhinosinusitis or nasal polyps.
Management
- •Initiate first-line pharmacotherapy with an intranasal corticosteroid (INCS) for moderate-to-severe or persistent allergic rhinitis: fluticasone propionate 2 sprays (50 µg/spray) each nostril once daily, or mometasone furoate 2 sprays each nostril once daily. For mild intermittent symptoms, a second-generation oral antihistamine (e.g., cetirizine 10 mg daily, loratadine 10 mg daily, fexofenadine 180 mg daily) or INCS monotherapy alone may suffice.
- •If symptoms are not adequately controlled after 2-4 weeks of INCS monotherapy, add an intranasal antihistamine: olopatadine 0.6% 2 sprays each nostril twice daily, or use the fixed-dose combination spray (olopatadine HCl plus mometasone furoate) 1 spray each nostril twice daily, this combination is superior to either constituent alone, with onset of action as early as 15 minutes.
- •For patients with moderate-to-severe persistent symptoms despite combination INCS + intranasal antihistamine, consider a short course (5-7 days) of an oral decongestant (pseudoephedrine 60 mg twice daily) for severe congestion, but avoid prolonged use (>7 days) due to risk of rhinitis medicamentosa. Oral leukotriene receptor antagonists (montelukast 10 mg daily) are second-line options, reserved for patients with comorbid asthma or those intolerant to other agents; monitor for neuropsychiatric events.
- •Refer to an allergist for consideration of allergen immunotherapy (AIT) when pharmacotherapy is inadequate, the patient desires disease modification, or there is a goal to prevent asthma. AIT is the only treatment that alters the natural history of allergic rhinitis; both subcutaneous (SCIT) and sublingual (SLIT) routes are effective. SCIT requires in-clinic injections (weekly build-up then monthly maintenance); SLIT tablets (grass, ragweed, house dust mite, birch) are self-administered daily at home.
- •Recommend a minimum 3-year course of AIT to achieve long-term tolerance and sustained clinical benefit. For children with moderate-to-severe grass or birch pollen AR, AIT reduces the short-term risk of developing asthma by 40% (RR 0.40). Advise patients that adherence is critical, only about one-third complete the recommended 3-year course in real-world settings; shared decision-making improves compliance.
- •For SCIT, administer epinephrine auto-injectors and observe patients for at least 30 minutes after each injection due to risk of systemic anaphylaxis (0.1-0.2% of injections). Contraindications to AIT include uncontrolled asthma, severe immunodeficiency, active malignancy, and use of beta-blockers (relative). SLIT has a better safety profile with mostly local oral itching/swelling; systemic reactions are very rare.
- •Consider biologic therapy in selected patients with uncontrolled seasonal allergic rhinitis despite optimized pharmacotherapy and AIT: tezepelumab (anti-TSLP) 210 mg subcutaneously every 4 weeks, or dupilumab (anti-IL-4Rα) at standard asthma dosing (300 mg every 2 weeks). Biologics are not yet approved for AR as a standalone indication in most countries; use in specialist centers with shared decision-making.
- •Avoid first-generation oral antihistamines (diphenhydramine, chlorpheniramine) due to sedation, psychomotor impairment, and anticholinergic effects, they are no longer recommended for any form of allergic rhinitis. Avoid long-term use of oral decongestants (pseudoephedrine, phenylephrine) beyond 7 days. Avoid systemic corticosteroids for chronic disease due to unacceptable adverse effects.
- •Monitor treatment response using validated symptom scores (TNSS, RQLQ) at each follow-up visit. Assess adherence and address barriers. Evaluate for adverse effects: INCS may cause mild epistaxis (5-10%) or nasal irritation; educate on correct spray technique (aim lateral wall, not septum). For AIT, monitor for local and systemic reactions at each dose.
- •Discharge criteria for acute care: patients presenting with anaphylaxis from AIT or natural exposure should be observed for at least 4-6 hours after epinephrine administration for biphasic reactions. Prescribe epinephrine auto-injector, pause AIT, and reassess risk-benefit before resuming. Refer patients with severe reactions to an allergist for dose adjustment or switch to SLIT.
Board Review — High Yield
- •Allergic salute and allergic crease, The classic horizontal nasal crease from upward rubbing of the nose is a pathognomonic sign of long-standing allergic rhinitis in children.
- •ARIA classification, Classify symptoms as intermittent (<4 days/week or <4 weeks) vs. persistent (≥4 days/week and ≥4 weeks); and mild (normal sleep/activity) vs. moderate-to-severe (impaired sleep/activity). This guides step-up therapy.
- •Local allergic rhinitis (LAR), Up to 25% of rhinitis patients have negative skin prick tests and serum IgE but positive nasal allergen challenge; this phenotype responds to standard pharmacotherapy and AIT.
- •Intranasal corticosteroids are first-line, They suppress the late-phase inflammatory response (eosinophil infiltration) and are more effective than antihistamines for nasal congestion, the dominant symptom in persistent disease.
- •Combination intranasal corticosteroid + antihistamine, Fixed-dose olopatadine-mometasone is superior to either constituent alone, with onset of action as early as 15 minutes; recommended for moderate-severe disease not controlled by monotherapy.
- •Allergen immunotherapy (AIT) reduces asthma risk by 40%, A 3-year course of SCIT or SLIT is the only disease-modifying therapy; in children with grass/birch pollen AR, the RR for developing asthma is 0.40 (95% CI 0.30-0.54).
- •Epinephrine is first-line for anaphylaxis, In AIT-related or natural allergen-induced anaphylaxis, administer 0.3 mg IM (0.15 mg for children) into the anterolateral thigh; do not delay for antihistamines or corticosteroids.
- •Avoid first-generation antihistamines, They cause sedation and psychomotor impairment; second-generation agents (cetirizine, fexofenadine, loratadine) are equally effective and non-sedating.
- •Red flags: unilateral symptoms, purulent discharge, Unilateral nasal obstruction or bloody discharge suggests nasal mass/foreign body; purulent discharge with facial pain >10 days suggests bacterial sinusitis.
- •Atopic march, Allergic rhinitis triples the odds of asthma; screen children with atopic dermatitis or food allergy for AR from age 3 years onward.
Deep Dive — Evidence Details
Definition, Classification & Hypersensitivity Mechanism Type
- ▸AR should be distinguished from isolated aeroallergen sensitization; clinical disease requires a compatible rhinitis phenotype in the context of relevant sensitization [529][596].
- ▸Clinical classification should specify seasonal, perennial, or mixed exposure, duration, severity/impact, and whether symptoms were assessed retrospectively or prospectively [592][597].
- ▸Prospective electronic symptom diaries were evaluated in 815 patients with seasonal allergic rhinitis and may refine or reclassify disease compared with retrospective ARIA assessment [597].
- ▸Component-resolved classification distinguishes CC-SCIT, MCD-SCIT, and MCD-SLIT for house-dust-mite immunotherapy preparations [592].
- ▸The hypersensitivity mechanism is best designated type I and IgE-associated, with downstream eosinophilic, cytokine, chemokine, and vascular inflammatory activity [529][536][596].
- ▸AR may coexist with asthma, adenoid hypertrophy, and middle-ear or eustachian-tube dysfunction; these should be documented as comorbid phenotypes rather than conflated with the core definition [523][527][528][599].
Definition
Allergic rhinitis (AR) is best characterized in the available evidence as a clinically expressed allergic airway phenotype associated with sensitization to one or more aeroallergens and rhinitis symptoms. The supplied studies operationalized AR using established ARIA-based clinical classifications, physician diagnosis, allergen-specific testing, or combinations of these approaches [527][530]. Molecular confirmation may include skin-prick testing and multiplex component-resolved diagnostics, as used in children with rhinitis and/or asthma [596]. In population research, it is useful to distinguish sensitization—for example, detectable Artemisia-specific IgE—from clinically expressed allergic rhinitis, because exposure intensity and host susceptibility contribute independently to disease expression [529].
AR commonly occurs within an allergic-airway spectrum that includes asthma and multimorbidity. Pediatric studies examined AR alone, asthma alone, and combined allergic rhinitis with asthma as clinically separable phenotypes [527][599]. AR also frequently coexists with adenoid hypertrophy, and transcriptomic data suggest that the combined phenotype has molecular features that are not identical to adenoid hypertrophy without AR [528]C. Middle-ear and eustachian-tube outcomes are additional comorbid manifestations reported in patients with AR, although pooled estimates vary according to the operational definition and study size [523].
Clinical classification
The conventional clinical framework classifies AR according to pattern of exposure, duration, and severity or impact. Seasonal allergic rhinitis (SAR) is linked to time-limited exposure, typically to pollens, whereas perennial disease is assessed in relation to more persistent allergens such as house-dust mite. The supplied evidence directly evaluates seasonal disease through prospective symptom recording and perennial or dust-mite disease through allergen immunotherapy studies [592][597].
The established ARIA approach uses retrospective assessment of symptom frequency and severity or impact. However, prospective daily electronic diaries may provide a different and potentially more granular classification. In the @IT.2020 project, 815 children and adults with SAR recorded daily organ-specific and general symptoms; the study specifically tested agreement between prospective symptom data and retrospective ARIA classification and developed a symptom-diary-based SAR classification [597]. Thus, classifications should state whether they are based on retrospective clinical recall or prospective patient-recorded symptoms [597].
For pediatric research, age and phenotype should be reported explicitly. Treatment evidence has separately evaluated children younger than 12 years with seasonal or perennial AR [518], children and adolescents aged ≤18 years receiving nasal saline irrigation [519], and children aged 3–17 years receiving individualized sublingual immunotherapy in routine care [525]. These age boundaries describe study populations rather than universal diagnostic thresholds [518][519][525].
Component-resolved classification adds an allergen-composition dimension. In house-dust-mite immunotherapy research, preparations were classified as comprehensive-component subcutaneous immunotherapy (CC-SCIT), major-component-dominant subcutaneous immunotherapy (MCD-SCIT), or major-component-dominant sublingual immunotherapy (MCD-SLIT) [592]. This classification is relevant to treatment characterization and should not be confused with the clinical seasonal/perennial classification of AR [592][597]. Molecular sensitization patterns may also vary by geography and exposome; a multicentre Spanish study used component-resolved diagnostics to identify pediatric molecular signatures across contrasting regional environments [596].
Hypersensitivity mechanism type
AR is classified mechanistically as a type I, immediate, IgE-associated hypersensitivity phenotype when clinical symptoms correspond to sensitization to an inhaled allergen. The supplied evidence supports this mechanism through allergen-specific IgE measurement in population studies and through skin-prick and component-resolved testing in pediatric rhinitis cohorts [529][596]. Sensitization alone does not establish symptomatic AR: the population study explicitly separated healthy individuals, sensitized participants, patients with AR, and patients with acute asthma exacerbation, while modeling environmental pollen exposure and host susceptibility [529].
The inflammatory phenotype is not limited to IgE detection. In a randomized study of 300 dust-mite-sensitized patients, six months of conventional therapy plus sublingual dust-mite drops was associated with greater reductions in IL-4, IL-17, eosinophil cationic protein, thymus and activation-regulated chemokine, and vascular cell-adhesion molecule-1 than conventional therapy alone [536]. These findings are compatible with modulation of type 2, eosinophilic, T-cell, chemokine, and vascular inflammatory pathways, but they do not redefine AR as a separate hypersensitivity type [536].
Transcriptomic studies further indicate biological heterogeneity rather than a single molecular subtype. Olive-pollen stimulation produced differential leukocyte gene-expression responses in sensitized patients [598], while nasopharyngeal transcriptomics identified divergent signatures in adenoid hypertrophy with versus without AR [528]C. A circulating odd-chain-fatty-acid signature was investigated to distinguish pediatric AR with asthma from related airway phenotypes, reinforcing the clinical distinction between AR and combined allergic airway disease [599].
Practical classification statement
A complete case definition should therefore record: (1) clinical rhinitis symptoms and objective or clinician-confirmed diagnosis; (2) relevant allergen sensitization, preferably with component-resolved testing when available; (3) seasonal, perennial, or mixed exposure pattern; (4) duration and severity/impact using ARIA or prospective symptom measures; (5) age group; and (6) coexisting asthma, adenoid hypertrophy, or middle-ear disease [523][527][528]C[529][596][597]. Evidence from oral medicines, saline irrigation, immunotherapy, and histaglobulin concerns management efficacy and should not be used to alter the underlying definition or hypersensitivity-mechanism classification of AR [518][519][525][592][593].
| Axis | Categories or operational approach | Evidence |
|---|---|---|
| Exposure pattern | Seasonal, perennial, or mixed; dust-mite disease is a major perennial model | [592][597] |
| Symptom assessment | Retrospective ARIA classification or prospective electronic symptom diaries | [597] |
| Sensitization | Allergen-specific IgE, skin-prick testing, and component-resolved diagnostics | [529][596] |
| Immunotherapy composition | CC-SCIT, MCD-SCIT, or MCD-SLIT | [592] |
| Associated phenotype | AR alone, AR with asthma, adenoid hypertrophy with AR, or middle-ear/eustachian-tube involvement | [523][527][528]C[599] |
| Mechanism | Type I, IgE-associated hypersensitivity with inflammatory amplification | [529][536][596] |
Pathophysiology & Immune Mechanism
- ▸AR involves coordinated epithelial, IgE-mediated, eosinophilic, Th2, and potentially Th17-associated inflammation rather than a single immune pathway. [536][608][609][611]
- ▸HDM group 1, 2, and 23 allergens are prominent IgE-binding components and may promote inflammation through epithelial-barrier disruption, receptor activation, and dendritic-cell maturation. [611]
- ▸Six months of sublingual dust-mite immunotherapy reduced IL-4, IL-17, ECP, TARC, and VCAM-1 in a randomized trial. [536]
- ▸CPA3 and ELAVL1 represent a proposed post-transcriptional pathway linked to Th2 differentiation in pediatric AR. [609]
- ▸Nasal Corynebacterium depletion was associated with polysensitization, defined as sensitization to ≥4 inhalant allergens, but causality was not established. [539]
- ▸Environmental exposure, regional climate, host susceptibility, molecular allergen components, and microbiome composition may contribute to heterogeneous AR phenotypes. [529][539][596][598][604][610]
Overview
Allergic rhinitis (AR) is a chronic inflammatory disease of the nasal mucosa driven by interactions among host susceptibility, environmental exposure, epithelial and innate immune responses, allergen-specific IgE, and type 2 inflammation. Recent evidence also implicates Th17-associated inflammation, eosinophil activation, endothelial adhesion pathways, epithelial-barrier disruption, and the nasal microbiome. [536][539][598][609][611]D
Sensitization and environmental determinants
Sensitization begins when aeroallergens are encountered by the nasal epithelium and antigen-presenting cells. House-dust-mite (HDM) allergens are particularly important indoor aeroallergens; more than 30 HDM allergenic components have been identified, including proteases, lipid-binding proteins, structural proteins, and proteins of incompletely characterized function. Group 1, group 2, and group 23 allergens show strong IgE-binding activity and are implicated in sensitization and downstream inflammation. [611]D
HDM allergens can disrupt epithelial-barrier integrity, activate epithelial or immune-cell surface receptors, and promote dendritic-cell maturation through Toll-like-receptor-associated mechanisms, thereby facilitating allergen presentation and type 2 immune activation. [611]D The clinical relevance of allergen exposure depends on both exposure intensity and host susceptibility. In a population study of Artemisia exposure, participants were classified as healthy, sensitized, having AR, or having acute asthma exacerbation; the study specifically evaluated the relative contributions of regional pollen exposure and host susceptibility in a high-exposure setting. [529] Olive-pollen stimulation likewise produced allergen-responsive transcriptomic changes in peripheral blood leukocytes from sensitized individuals, supporting molecular heterogeneity in pollen sensitization. [598]
Childhood rhinitis and asthma appear to reflect dynamic interactions between genetic predisposition and the exposome. In a multicentre Spanish pediatric cohort, component-resolved molecular diagnostics were used to characterize sensitization signatures across eight cities with contrasting climatic contexts, indicating that regional environmental heterogeneity may shape IgE profiles during early life. [596]
IgE, mast cells, eosinophils, and mediator release
Allergen-specific IgE binds FcεRI on mast cells and basophils, and subsequent allergen-mediated cross-linking triggers rapid mediator release that produces nasal itching, sneezing, rhinorrhea, and congestion. Evidence from an eosinophil activation study supports a parallel cellular signature: patients with AR had higher baseline eosinophil counts and CD63 expression than patients with non-allergic rhinitis or healthy controls; allergen stimulation was assessed using dust-mite extract, and CD63/FcεRI responses were evaluated in relation to serum-specific IgE. [608]
Eosinophil cationic protein (ECP) is a marker of eosinophil-associated tissue inflammation. In a randomized trial of 300 dust-mite-sensitized patients, 6 months of sublingual dust-mite immunotherapy added to conventional treatment reduced ECP, thymus and activation-regulated chemokine (TARC), vascular cell adhesion molecule-1 (VCAM-1), IL-4, and IL-17 more than conventional treatment alone, while also improving symptoms and pulmonary-function measures. [536] TARC reflects type 2 chemotactic activity, whereas VCAM-1 may facilitate recruitment and retention of eosinophils and other inflammatory leukocytes in vascular and mucosal tissues. [536]
T-cell polarization and molecular regulation
The adaptive response in AR is characterized predominantly by Th2 polarization and production of type 2 cytokines, particularly IL-4, which supports IgE-associated sensitization. [536][609] Recent mechanistic work identified increased CPA3 expression in nasal mucosa from children with AR and examined the RNA-binding protein ELAVL1 as a regulator of CPA3 messenger-RNA stability. The study investigated whether this pathway promotes CD4+ T-cell differentiation toward a Th2 phenotype, linking post-transcriptional regulation with allergic inflammation. [609]
IL-17 may also contribute to AR-associated inflammation. In the randomized immunotherapy study, IL-17 concentrations decreased after sublingual dust-mite treatment, indicating that treatment-responsive disease may include both type 2 and Th17-associated inflammatory components. [536] These findings should not be interpreted as evidence that IL-17 replaces Th2 immunity; rather, they support a broader inflammatory network in which multiple T-cell pathways may influence disease expression. [536][609]
Polysensitization, microbiome, and disease heterogeneity
Polysensitization is associated with greater clinical complexity. A Ningxia study compared mono-sensitized and multi-sensitized AR patients using serum-specific IgE testing, while a U.S. NHANES analysis identified multidimensional sensitization patterns and examined their cross-sectional associations with allergic diseases. [604][610] A Spanish pediatric study similarly used component-resolved diagnostics to identify molecular sensitization signatures, emphasizing that positive extract-based testing may conceal clinically relevant differences in component-level sensitization. [596]
The nasal microbiome may modify sensitization burden. In adults, depletion of nasal Corynebacterium was investigated in relation to sensitization categories ranging from no sensitization to polysensitization; polysensitization was defined as sensitization to ≥4 inhalant allergens. [539] This association is observational and does not establish whether microbial depletion causes broader sensitization or results from allergic disease. [539]
Immune modulation by immunotherapy and biologic therapy
Allergen immunotherapy modifies disease-associated immune signals rather than merely suppressing symptoms. In the randomized dust-mite trial, sublingual therapy reduced IL-4, IL-17, ECP, TARC, and VCAM-1 over 6 months, supporting attenuation of both cellular and cytokine components of inflammation. [536] Subcutaneous histaglobulin—an immunoglobulin/histamine complex—has been used as a non-allergen-specific immunotherapy for allergic diseases, including AR, chronic urticaria, and atopic dermatitis. A 2026 systematic review and meta-analysis was designed to synthesize its efficacy and safety across these conditions; the available abstract does not provide the pooled effect estimates, so its mechanistic or clinical benefit in AR should not be overstated. [593]
IgE-directed biologic therapy provides an additional mechanistic example. Omalizumab targets free IgE, although a case report described bullous erythema multiforme after its first injection in a patient with asthma, AR, allergic conjunctivitis, and chronic spontaneous urticaria. This rare adverse event does not define AR pathophysiology but underscores that immune-targeted treatment can produce clinically important immune-mediated reactions. [546]C
Integrated clinical implications
The current model of AR is therefore a heterogeneous mucosal disorder involving allergen penetration, dendritic-cell activation, IgE-dependent effector-cell degranulation, eosinophilic inflammation, Th2 and potentially Th17 signaling, vascular adhesion, and environmental or microbial modifiers. [536][539][596][608][609][611]D Airborne sensitization may also contribute to persistent upper-airway dysfunction: in children with residual mouth breathing after adenotonsillectomy, airborne-allergen sensitization was investigated as an overlooked determinant of incomplete postoperative resolution. [602] AR is additionally linked to lower-airway disease and exercise-related respiratory abnormalities; studies have examined FeNO and eosinophil counts in children with coexisting asthma and AR, and exercise-induced bronchoconstriction in children with moderate-to-severe persistent AR undergoing early subcutaneous immunotherapy. [527][540]
| Mechanism | Evidence or implication |
|---|---|
| Epithelial activation | HDM allergens can impair epithelial-barrier integrity and activate receptors that promote dendritic-cell maturation. [611]D |
| IgE-dependent effector response | Allergen-specific IgE and FcεRI-associated activation are reflected by eosinophil CD63/FcεRI studies in AR. [608] |
| Type 2 inflammation | IL-4 reduction after dust-mite immunotherapy and the ELAVL1–CPA3 investigation support Th2 involvement. [536][609] |
| Th17-associated inflammation | IL-17 decreased with sublingual dust-mite immunotherapy, suggesting a treatment-responsive Th17 component. [536] |
| Eosinophilic inflammation | ECP and eosinophil activation markers are associated with inflammatory activity in AR. [536][608] |
| Environmental and microbial modifiers | Pollen exposure, host susceptibility, regional exposome, and nasal Corynebacterium depletion may shape sensitization and disease expression. [529][539][596][598] |
Epidemiology, Etiology & Risk Factors
- ▸AR is a common chronic inflammatory nasal disease with reported rising global prevalence, but the supplied references do not provide one definitive worldwide prevalence estimate. [601]
- ▸Atopy, aeroallergen sensitization, genetic susceptibility, and exposome-related environmental heterogeneity are the principal risk frameworks supported by the cited evidence. [596][614]
- ▸The nasal microbiome, including Corynebacterium depletion and Haemophilus abundance, is associated with sensitization or treatment response in observational studies, but causality is unproven. [521][539]
- ▸AR commonly clusters with asthma and atopic dermatitis and is associated with upper-airway, middle-ear, and selected lower-airway manifestations. [614][523][524][540]
- ▸Selected surgical or specialty cohorts should not be used as estimates of population prevalence. [547]
Epidemiology
Allergic rhinitis (AR) is a common chronic inflammatory disease of the nasal mucosa, and its global prevalence is described as increasing; however, the supplied references do not provide a single contemporary worldwide prevalence estimate. [601] AR affects children and adults and commonly occurs within a broader atopic phenotype that may include asthma and atopic dermatitis. [614][596] In a multicentre Spanish study, 354 children aged 0–15 years with AR and/or asthma were recruited from eight cities with contrasting climatic environments; all participants were sensitized to at least one aeroallergen by skin-prick testing. [596] A selected prospective cohort of 212 adults undergoing septorhinoplasty reported coexisting AR in 57%, chronic sinusitis in 22%, and obstructive sleep apnea in 22%; these figures describe a surgical population and should not be interpreted as community prevalence. [547]
In a prospective diagnostic study of 1,150 patients with clinically suspected AR in Wuhan, China, symptom-based assessment of itching, congestion, sneezing, rhinorrhea, ocular symptoms, and overall discomfort was compared with confirmation by skin-prick testing and/or serum IgE-based evaluation. [538] This study reflects the substantial clinical overlap between AR and non-allergic rhinitis (NAR), rather than establishing population prevalence. [538] Pediatric allergic disease may also vary during periods of rapid urbanization: a multicentre Chinese study enrolled 10,754 infants, including 327 diagnosed with cow’s milk protein allergy, and followed them longitudinally to ages 3 and 5 years, providing context for early-life allergic trajectories rather than direct evidence of AR incidence. [594]
Etiology and pathobiology
AR is characterized in the supplied literature as an inflammatory nasal disorder associated with allergic sensitization, particularly to inhalant or airborne allergens. [538][596] Its occurrence appears to reflect interactions between genetic predisposition and the exposome, including regional environmental and climatic heterogeneity. [596] Molecular sensitization patterns differed across Spanish regions in children with AR and/or asthma, supporting geographic variation in allergen exposure and immune response; the available abstract does not establish that any individual exposure causes AR. [596]
The nasal microbiome is a potential modifier of allergic sensitization and disease expression. In adults, polysensitization to inhalant allergens—defined in the cited study as sensitization to ≥4 allergens—was examined in relation to nasal microbial composition, with particular attention to Corynebacterium depletion. [539] In children with AR, Haemophilus abundance was investigated as a correlate of response to 1 year of house-dust-mite sublingual immunotherapy, using a >20% reduction in Total Nasal Symptom Score to define response. [521]C These observational microbiome findings identify possible biomarkers or mechanisms but do not prove that bacterial abundance causes AR or determines treatment response. [521]C[539]
Risk factors and associated conditions
The strongest recurring risk framework in these references is atopy and aeroallergen sensitization. [596][614] In the All of Us Research Program, a cumulative atopic burden score from 0 to 3 was constructed from asthma, atopic dermatitis, and AR in a large adult cohort, and was evaluated against keratoconus risk after adjustment for demographic, socioeconomic, and healthcare-utilization variables. [614] This supports clustering of AR with other atopic diseases but does not establish that asthma or atopic dermatitis causes AR. [614] A separate pediatric study examined airborne-allergen sensitization as a potential explanation for residual mouth breathing after adenotonsillectomy, suggesting that persistent nasal allergic inflammation may contribute to postoperative upper-airway symptoms in susceptible children. [602]
Environmental context may modify sensitization profiles, but the available studies cannot separate effects of climate, urbanization, pollution, lifestyle, or healthcare access. [594][596] Early-life conditions may also influence allergic outcomes: the CORAL cohort studied children born during the 2020 COVID-19 lockdown and reassessed atopic dermatitis, food allergy, and aeroallergen sensitization at 5 years; the cited evidence concerns broader atopic outcomes and does not demonstrate a specific lockdown-related increase or decrease in AR. [595]
AR is associated with upper-airway and lower-airway comorbidity. [547][540] Among 62 children aged 6–18 years with moderate-to-severe persistent AR but without asthma or asthma symptoms, exercise-induced bronchoconstriction was assessed during the early phase of subcutaneous allergen immunotherapy; the study defined a positive response as a ≥10% fall in FEV1 after exercise. [540] This evaluates an airway phenotype associated with AR rather than a proven cause of AR. [540] Middle-ear disease and Eustachian-tube dysfunction are also clinically relevant associated outcomes: systematic reviews evaluated objective dysfunction, abnormal tympanometry, otitis-media-with-effusion-compatible findings, and pediatric OME in relation to AR or allergic sensitization, but emphasized heterogeneity in definitions and study populations. [523][524]
Clinical and epidemiologic interpretation
The supplied evidence supports AR as a common, heterogeneous, sensitization-related disease shaped by atopic predisposition and environmental context, with frequent respiratory and otologic comorbidity. [601][596][523][524] It does not establish a single causal exposure, nor does it provide sufficient evidence to treat microbiome composition, urbanization, parental factors, or coexisting atopic disease as independent confirmed causes. [521]C[539][594][615] Parental health literacy was studied in relation to adherence and outcomes in 132 adolescents with AR compared with 120 healthy controls, indicating that family-level factors may influence management and symptom outcomes, but not necessarily disease onset. [615] Finally, a systematic review and meta-analysis specifically examined rhinitis or sinusitis as exposures in relation to dementia risk in adults using cohort, case-control, and Mendelian-randomization evidence; this concerns a possible long-term consequence or association of rhinitis and should not be interpreted as an etiologic risk factor for developing AR. [612]
| Domain | Evidence from supplied references | Interpretation |
|---|---|---|
| Population and age | Pediatric cohorts included children aged 0–15 years and adolescents; adult studies included surgical and population-based cohorts. [596][615][547] | AR occurs across the life course. |
| Atopic multimorbidity | Asthma, atopic dermatitis, and AR were combined into a 0–3 cumulative atopic burden score. [614] | Supports clustering, not a proven causal pathway. |
| Aeroallergen sensitization | Spanish children were positive to at least one aeroallergen; polysensitization was defined as ≥4 inhalant allergens in an adult microbiome study. [596][539] | Sensitization is a central disease-associated feature. |
| Environmental context | Regional climate and exposome differences were examined across eight Spanish cities; urbanization was considered in a Chinese infant allergy cohort. [596][594] | Environmental contribution is plausible but not individually quantified. |
| Microbiome | Corynebacterium depletion correlated with polysensitization; Haemophilus abundance was studied as a predictor of SLIT response. [539][521]C | Potential modifiers or biomarkers; causality remains uncertain. |
| Airway and ear outcomes | Exercise-induced bronchoconstriction used a ≥10% FEV1 decrease threshold; systematic reviews assessed ETD, OME, and abnormal tympanometry. [540][523][524] | Important comorbid or associated outcomes rather than established causes. |
Clinical Presentation
- ▸The cardinal symptoms are nasal obstruction, rhinorrhea, sneezing, and nasal itching; ocular symptoms may coexist. [555,518]
- ▸Presentation varies by rhinitis subtype, exposure pattern, age, and molecular sensitization profile. [555,596,72]
- ▸Pediatric assessment spans children under 12 years in oral-treatment evidence and patients up to 18 years in saline-irrigation evidence. [518,519]
- ▸Document asthma and lower-airway symptoms, because pediatric AR cohorts commonly include or evaluate coexisting asthma. [72,525]
- ▸In children, assess possible otitis media with effusion or Eustachian-tube dysfunction when ear symptoms or hearing concerns are present. [524]
- ▸TNSS, TOSS, visual analogue scales, and quality-of-life tools can quantify baseline severity and treatment-related change. [518,521,555]
Core nasal and ocular manifestations
Allergic rhinitis (AR) is characterized clinically by a variable combination of nasal obstruction, rhinorrhea, sneezing, and nasal itching; these are the principal symptoms used in symptom scores such as the Total Nasal Symptom Score (TNSS). [555]C Symptom intensity and the relative prominence of individual symptoms vary among patients and across rhinitis subtypes, so presentation should be documented symptom-by-symptom rather than reduced to a single severity label. [555]C Ocular symptoms may accompany nasal disease and are commonly evaluated separately with a Total Ocular Symptom Score (TOSS), particularly in studies of children with seasonal or perennial AR. [518]
Age and pediatric presentation
In children, AR is evaluated across both seasonal and perennial exposure patterns. Evidence syntheses of oral treatment trials included children aged under 12 years, whereas pediatric saline-irrigation evidence included patients aged 18 years or younger, indicating that AR presentation and assessment span early childhood through adolescence. [518][519] Pediatric studies generally require physician-confirmed AR or clinically established disease, rather than relying solely on self-reported nasal symptoms. [519]
Children with moderate-to-severe AR may be identified using symptom burden, including a greater than 20% reduction in TNSS as a response threshold in a prospective pediatric sublingual-immunotherapy cohort; this threshold illustrates how clinically meaningful change is operationalized but is not itself a diagnostic criterion. [521]C In another pediatric cohort, moderate-to-severe AR was distinguished from mild AR before house-dust-mite sublingual immunotherapy, supporting the use of symptom severity categories in clinical characterization. [521]C
Allergen sensitization and phenotypic heterogeneity
The clinical phenotype is heterogeneous because sensitization profiles differ by patient, age, geography, and exposure context. In a multicentre Spanish study of 354 children aged 0–15 years with AR and/or asthma, all participants were sensitized to at least one aeroallergen and underwent molecular component-resolved testing; regional climatic differences were examined in relation to molecular sensitization signatures. [596] In a propensity-score-matched pediatric study, the matched cohort included 1,206 children with AR or asthma, and house-dust-mite mixture sensitization was reported in 41%; allergen co-sensitization patterns were evaluated in relation to upper- and lower-airway phenotypes. [72]C4
Clinical assessment should therefore record the suspected trigger pattern—such as house dust mite, pollens, animal allergens, or other aeroallergens—alongside timing, persistence, and exposure relationship. Component-resolved studies and house-dust-mite immunotherapy trials distinguish preparations by allergen composition, underscoring that “house-dust-mite allergy” may represent sensitization to different molecular components rather than a uniform biological phenotype. [592]
Lower-airway and related comorbidity
AR may occur with asthma or other manifestations of allergic multimorbidity. The pediatric sensitization study specifically compared children with AR and asthma and investigated factors associated with lower-airway involvement, while a real-world pediatric sublingual-immunotherapy cohort included 954 patients with AR among a broader group with allergic multimorbidity. [72]C4[525] When AR coexists with asthma, the history should document wheeze, cough, exercise limitation, nocturnal symptoms, and exacerbations; however, these lower-airway symptoms should not be attributed to AR without appropriate respiratory assessment. [72]C4
Middle-ear symptoms may also be clinically relevant in children. A systematic review evaluated AR, allergic sensitization, and allergy-related symptoms in relation to otitis media with effusion, Eustachian-tube dysfunction, abnormal tympanometry, and middle-ear dysfunction, reflecting the potential clinical overlap between nasal inflammation and pediatric ear disease. [524] Hearing difficulty, aural fullness, recurrent effusion, or school-performance concerns should therefore prompt assessment for coexisting middle-ear disease rather than being classified as nasal symptoms alone. [524]
Inflammatory and microbiome-associated features
Studies of dust-mite AR have investigated systemic and airway inflammatory correlates, including eosinophil cationic protein, thymus and activation-regulated chemokine, vascular cell adhesion molecule-1, interleukin-4, and interleukin-17; these are research or adjunctive biomarkers and are not required for routine clinical diagnosis. [536] In children with moderate-to-severe AR, nasal microbiome composition—particularly the abundance of Haemophilus—has been studied as a possible marker associated with response to sublingual immunotherapy, but microbiome testing is not established as a standard component of clinical presentation assessment. [521]C
Practical severity documentation
A complete presentation record should describe nasal obstruction, rhinorrhea, sneezing, itching, ocular symptoms, duration and seasonality, suspected aeroallergen exposure, functional effects, sleep disturbance, medication use, asthma symptoms, and relevant ear complaints. [518][524][555]C Severity should be expressed using validated symptom or quality-of-life instruments when possible; treatment studies commonly use TNSS, TOSS, visual analogue scales, and rhinoconjunctivitis quality-of-life measures to quantify the patient’s baseline burden. [518][555]C
| Domain | Features to record | Evidence |
|---|---|---|
| Nasal | Obstruction, rhinorrhea, sneezing, itching; severity and pattern | [555]C |
| Ocular | Ocular symptom burden, when present | [518] |
| Exposure and sensitization | Seasonal/perennial pattern; suspected aeroallergen; molecular sensitization where indicated | [518][596][592] |
| Lower airway | Asthma, wheeze, cough, and other respiratory symptoms | [72]C4[525] |
| Ear and functional effects | Effusion, Eustachian-tube dysfunction, hearing concerns, quality-of-life impact | [524][518] |
| Objective symptom measurement | TNSS, TOSS, visual analogue scales, and quality-of-life instruments | [518][521]C[555]C |
Diagnosis & Immunodiagnostics
- ▸SPT (≥3mm) or sIgE (≥0.35 kU/L) confirms sensitization.
- ▸Nasal allergen challenge is gold standard for LAR when systemic tests negative.
Diagnosis combines clinical history with positive skin prick test (wheal ≥3mm) or serum specific IgE (≥0.35 kU/L) [1]A1c[13]A1c. Nasal allergen challenge (NAC) is gold standard for local allergic rhinitis (LAR) when systemic tests are negative [201]D5. Supportive labs: total IgE, nasal cytology (eosinophils), basophil activation test (BAT), molecular diagnostics for component‑resolved testing [27]D5[92]D5. Imaging not routine; CT reserved for complications.
Diagnostic algorithm:
- History/physical suggestive of AR.
- SPT or sIgE → if positive, diagnose AR, classify severity.
- If SPT/sIgE negative but high suspicion, perform NAC → if positive, diagnose LAR.
- Negative NAC effectively rules out IgE‑mediated rhinitis.
- Consider molecular diagnostics in polysensitized patients.
- Refractory cases: nasal cytology, BAT, immunodeficiency workup.
Pearl: In any patient with persistent rhinitis symptoms and negative skin prick test/serum IgE, consider nasal allergen challenge to identify local allergic rhinitis, a treatable phenotype that responds to standard AR pharmacotherapy and allergen immunotherapy [104]D5[123]D5.
Severity, Grading & Risk Stratification
- ▸Use symptom frequency, intensity, functional impact, and longitudinal control together; the supplied evidence does not establish a new universal numerical severity threshold. [555][597]
- ▸Prospective electronic symptom diaries may improve classification when retrospective ARIA-based grading does not reflect day-to-day SAR burden. [597]
- ▸Assess nasal, ocular, sleep, smell, mouth-breathing, quality-of-life, rescue-medication, and corticosteroid requirements as complementary severity domains. [518][560][621][602]
- ▸Record asthma and atopic comorbidity explicitly because several treatment analyses excluded asthma, whereas HDM immunotherapy evidence included patients with controlled asthma. [560][619]
- ▸Component-resolved sensitization profiles may refine phenotype and treatment selection but are not validated substitutes for clinical severity grading. [592][596]
Scope and principles
Allergic rhinitis (AR) severity should be assessed multidimensionally rather than inferred from sensitization alone. The evidence supplied here supports documenting symptom intensity, frequency, organ involvement, functional impact, comorbidity, treatment requirements, and longitudinal control, while recognizing that no included study establishes a new universal numerical severity threshold. [555]C[597] The conventional ARIA approach classifies seasonal allergic rhinitis (SAR) retrospectively according to symptom frequency and severity, whereas prospective electronic symptom diaries may provide a more granular alternative. [597]
Symptom burden and prospective grading
Core nasal symptoms include obstruction, rhinorrhea, sneezing, and itching; ocular and general symptoms may add materially to overall burden. [555]C[538] A systematic review and meta-analysis was designed to characterize baseline symptom presentation across rhinitis subtypes using the Total Nasal Symptom Score (TNSS) and equivalent visual analogue scale (VAS) measures, but the supplied evidence does not provide pooled severity cut-offs or establish that any single symptom defines severe disease. [555]C A prospective study evaluated a symptom-based model using VAS ratings for nasal itching, congestion, sneezing, rhinorrhea, ocular symptoms, and overall discomfort to distinguish AR from non-allergic rhinitis, with AR diagnosis confirmed by clinical testing; this supports symptom-based risk assessment but does not replace objective confirmation. [538]
The @IT.2020 multicentre observational project enrolled 815 children and adults with SAR and prospectively collected daily rhinoconjunctivitis and general symptoms through electronic diaries. [597] Its stated purpose was to test agreement between prospectively recorded symptoms and retrospective ARIA classification and to generate a prospective SAR classification. [597] Accordingly, clinicians should record symptom trajectories during relevant exposure periods rather than relying solely on recall, particularly when symptoms fluctuate or retrospective grading appears inconsistent with day-to-day impairment. [597]
Functional impact and high-burden features
Severity assessment should include ocular symptoms, sleep, smell, mouth breathing, quality of life, and rescue-medication requirements, because nasal symptom scores alone may underrepresent disease burden. [518][560][621][615] In children, oral antihistamine and leukotriene-receptor-antagonist trials evaluated TNSS, total ocular symptom score, and the Rhinoconjunctivitis Quality-of-Life Questionnaire, indicating that nasal, ocular, and quality-of-life outcomes are complementary severity domains. [518] In adolescents with AR, a controlled longitudinal study measured symptoms over baseline, 4-week, and 8-week assessments and examined treatment adherence and clinical outcomes in relation to parental health literacy; the supplied abstract does not establish a validated severity threshold. [615]
Objective or clinically consequential features may identify higher-risk phenotypes. Adults with perennial AR and objectively confirmed hyposmia were studied using psychophysical smell testing and the Nasal Obstruction Symptom Evaluation scale, while comparative intranasal antihistamine and corticosteroid regimens assessed changes after one month. [621] A separate systematic review evaluated glucocorticoids for non-traumatic olfactory disorders, including etiology-specific effects, but its population was broader than AR and therefore cannot define AR severity grades. [563] In children undergoing adenotonsillectomy, airborne-allergen sensitization was investigated as a potential factor associated with residual mouth breathing; this supports considering persistent mouth breathing and sleep-related symptoms during risk assessment, but does not prove that sensitization alone predicts severe AR. [602]
Comorbidity and risk stratification
Asthma status should be explicitly recorded. Several treatment syntheses excluded patients with asthma or analyzed AR without comorbid asthma, limiting direct extrapolation to multimorbid patients. [619] Conversely, the HDM sublingual-immunotherapy trial included patients with moderate-to-severe HDM-associated AR with or without controlled asthma, and assessed symptom and rescue-medication reduction over approximately 12 months. [560] The steroid-sparing analysis specifically evaluated antihistamine, intranasal corticosteroid, and oral corticosteroid use, making corticosteroid requirements a potentially useful marker of treatment burden rather than a standalone severity definition. [560]
Allergen profile and molecular sensitization may refine risk characterization but should not be equated with clinical severity. A multicentre Spanish study of 354 children with AR and/or asthma used multiplex component-resolved diagnostics to identify molecular IgE-sensitization signatures across regions and exposomes. [596] A 2026 network meta-analysis classified HDM immunotherapy by allergen compositional breadth—comprehensive-component subcutaneous immunotherapy, major-component-dominant subcutaneous immunotherapy, and major-component-dominant sublingual immunotherapy—to compare efficacy in trials lasting at least 12 months. [592] These data concern treatment response and phenotype characterization, not validated severity grades.
Evidence boundaries and treatment-related interpretation
The available intervention studies mainly enroll or target moderate-to-severe disease but do not establish universally transferable grading thresholds. [560][620] A phase 2 trial of pumecitinib nasal spray specifically enrolled adults with moderate-to-severe SAR and assessed efficacy, safety, and pharmacokinetics during 14 pollen-season days; its eligibility category should not be used as a diagnostic definition of severity. [620] Network meta-analyses of symptomatic treatments compared dose-specific interventions in AR without comorbid asthma, while pediatric analyses compared oral antihistamines and leukotriene-receptor antagonists in children younger than 12 years; differences in populations and endpoints limit direct cross-study ranking of severity. [619][518]
Histaglobulin, probiotics, press-needle therapy, and homeopathic treatment have been examined in systematic reviews or trials, but these studies address therapeutic efficacy or safety rather than validated AR grading. [593][618][535][561] Likewise, studies of dupilumab in pediatric atopic dermatitis, cumulative atopic burden and keratoconus, and septorhinoplasty outcomes are not AR severity-classification studies, although they emphasize that atopic comorbidity, ocular disease risk, and structural nasal obstruction may complicate clinical assessment. [613][614][547]
Practical classification
A defensible clinical record should therefore state: (1) intermittent or persistent pattern and exposure relationship; (2) nasal, ocular, general, sleep, smell, and mouth-breathing symptoms; (3) patient-reported VAS, TNSS, ocular score, and quality-of-life impact; (4) objective confirmation of relevant sensitization; (5) asthma and other atopic comorbidity; and (6) treatment intensity, rescue-medication use, adherence, and control over time. [538][555]C[597][596][560][615] Patients with persistent functional impairment, substantial ocular or sleep burden, hyposmia, ongoing need for corticosteroids, difficult-to-control symptoms, or coexisting asthma warrant higher clinical priority even when a single symptom score is not extreme. [518][560][621][602][619]
| Domain | Practical assessment | Evidence boundary |
|---|---|---|
| Symptoms | TNSS, VAS, rhinoconjunctivitis symptoms, symptom frequency and trajectory | No universal cut-offs were established in the supplied evidence. [555]C[538][597] |
| Functional burden | Quality of life, sleep, smell, mouth breathing, daily activities | These domains may identify clinically important burden beyond nasal scores. [518][602][621][615] |
| Comorbidity | Asthma, atopic disease, ocular and structural nasal conditions | Comorbidity influences applicability and interpretation of treatment evidence. [560][613][614][547][619] |
| Treatment burden | Rescue medication, intranasal or oral corticosteroid use, adherence, and control | Steroid-sparing and adherence outcomes are severity-related management markers, not standalone grades. [560][615] |
| Sensitization | Skin testing, serum IgE, and component-resolved diagnostics | Molecular profiles support phenotyping but do not independently define clinical severity. [538][596][592] |
Acute Management & Anaphylaxis Pathway
- ▸The supplied references do not contain a validated anaphylaxis algorithm, adrenaline/epinephrine dosing schedule, or emergency observation protocol.[518][536][572]
- ▸Intranasal corticosteroid tolerability, technique, and adherence are key modifiable determinants of allergic-rhinitis treatment use.[290][520][570]
- ▸Oral antihistamines and leukotriene receptor antagonists have pediatric comparative evidence for allergic-rhinitis outcomes, but not for treatment of anaphylaxis.[518]
- ▸Allergen immunotherapy is a long-term intervention and must not be used as rescue treatment for an acute systemic reaction.[536][592]
- ▸Response to sublingual immunotherapy is heterogeneous, with prediction and biomarker studies requiring further validation.[521][554]
Scope and evidence boundary
The supplied 2026 evidence supports acute allergic-rhinitis symptom management, treatment adherence, and allergen-specific immunotherapy, but it does not provide a validated emergency algorithm for anaphylaxis, dosing instructions for adrenaline/epinephrine, or comparative evidence for emergency-department interventions. The pathway below therefore separates evidence-supported allergic-rhinitis actions from anaphylaxis procedures that require confirmation against local resuscitation guidance. The absence of an anaphylaxis protocol in the supplied references is important because allergic-rhinitis treatment studies generally evaluate symptoms, quality of life, inflammatory markers, adherence, or immunotherapy outcomes rather than emergency outcomes.[518][520][536][570]
Immediate triage: allergic rhinitis versus systemic emergency
Assess whether symptoms remain confined to the nose and eyes or are accompanied by rapidly evolving respiratory, cardiovascular, gastrointestinal, or multisystem features. The supplied studies do not define diagnostic thresholds for anaphylaxis, so suspected anaphylaxis should be managed according to the institution’s current emergency protocol rather than extrapolated from allergic-rhinitis trials.[518][536][572]C Do not treat a potentially systemic reaction as uncomplicated allergic rhinitis solely because nasal symptoms are prominent; none of the provided allergic-rhinitis studies establishes that intranasal corticosteroids, oral antihistamines, leukotriene receptor antagonists, or immunotherapy can substitute for emergency treatment.[518][520]
Acute allergic-rhinitis treatment when no systemic emergency is present
Intranasal corticosteroids remain the directly relevant local anti-inflammatory treatment represented in the supplied evidence. A crossover trial evaluated standard fluticasone spray against a fluticasone metered-dose inhaler used with a nasal adaptor over 3 weeks, specifically addressing post-nasal drip and nasal irritation that may impair tolerability.[520] The device study was small, with 16 participants per group, so it informs administration acceptability rather than comparative emergency efficacy.[520]
Administration technique and patient education are clinically material because a survey of 262 adults found substantial gaps in intranasal corticosteroid knowledge, including correct head positioning identified by fewer than 40% of participants, while 49.24% had misconceptions about systemic adverse effects from long-term use.[570] A systematic review and meta-analysis of 12 studies involving 191,103 patients estimated pooled adherence to intranasal corticosteroids and oral antihistamines at 43%, with self-reported adherence higher than pharmacy-refill estimates.[290]B2a Acute review should therefore confirm the product, dose, technique, duration, and actual use before labeling treatment failure.[290]B2a[570]
Oral antihistamines and leukotriene receptor antagonists are supported by a pediatric network meta-analysis covering children younger than 12 years with seasonal or perennial allergic rhinitis; evaluated outcomes included nasal symptoms, ocular symptoms, quality of life, and adverse or serious adverse events.[518] Because the supplied abstract does not provide the comparative rankings or effect estimates, it should not be used to declare a specific oral agent superior or to infer an anaphylaxis role.[518]
Immunotherapy and acute safety considerations
Allergen immunotherapy is a disease-modifying strategy, not rescue therapy for an acute reaction. The HDM network meta-analysis included double-blind, placebo-controlled trials lasting at least 12 months and classified preparations by allergen compositional breadth as comprehensive-component subcutaneous immunotherapy, major-component-dominant subcutaneous immunotherapy, or major-component-dominant sublingual immunotherapy.[592] A randomized trial of 300 dust-mite-sensitized patients compared conventional treatment with conventional treatment plus sublingual dust-mite drops for 6 months; the combination group had greater reductions in reported inflammatory markers and improved pulmonary-function measures, but these findings do not establish treatment for acute systemic reactions.[536]
Evidence concerning response prediction and longer-term benefit remains heterogeneous. A prediction-model study included 346 patients receiving sublingual immunotherapy and noted that approximately 30%–40% may show poor response.[554] A pediatric prospective cohort classified responders using a greater than 20% reduction in total nasal symptom score after 1 year of dust-mite sublingual immunotherapy; the cohort included 63 children with allergic rhinitis and 40 healthy controls.[521]C A real-world pediatric cohort followed 1,208 patients aged 3–17 years across 6–36 months, while a retrospective study assessed 86 patients after 3 years of dust-mite sublingual immunotherapy.[525][566] These studies support longitudinal assessment, not emergency escalation.
Evidence limitations and safety warnings
Studies of sensitization profiling, inflammatory biomarkers, nasal microbiota, radiofrequency treatment, and biologic therapy may inform phenotype or longer-term disease management but do not provide an anaphylaxis pathway.[60]D5[521]C[603][622] The remaining supplied reports address unrelated comorbidity, pregnancy, osteoporosis, eosinophilic esophagitis, atopic dermatitis, or mental-health outcomes and should not be used to guide acute allergic-rhinitis or anaphylaxis treatment.[178]B2b[526][551][569][623]C[624] An ultra-short recombinant Art v 1 subcutaneous immunotherapy study was a 30-participant phase I trial; its early-phase design does not establish emergency safety management.[572]C
For suspected anaphylaxis, activate the local emergency response immediately and follow the current institutional anaphylaxis protocol; do not delay emergency care while attempting intranasal or oral allergic-rhinitis treatment. The supplied references cannot specify the required first-line drug, dose, route, repeat interval, observation duration, or discharge plan, so those details must be sourced from an approved resuscitation guideline rather than inferred here.[518][536][572]C
| Clinical situation | Evidence-supported action | Evidence limit |
|---|---|---|
| Uncomplicated allergic rhinitis | Review intranasal corticosteroid product, technique, tolerability, and adherence.[290]B2a[520][570] | The adaptor trial was small and lasted 3 weeks.[520] |
| Pediatric allergic rhinitis | Consider oral antihistamine or leukotriene-receptor-antagonist evidence when selecting therapy.[518] | Comparative rankings and emergency outcomes are not reported in the supplied abstract.[518] |
| Dust-mite allergic rhinitis | Discuss sublingual or subcutaneous immunotherapy as a long-term option in appropriately selected patients.[536][592] | Immunotherapy is not acute rescue treatment.[536][592] |
| Suspected anaphylaxis | Activate emergency response and follow the current local anaphylaxis protocol.[518][536][572]C | Drug, dose, route, repeat interval, and observation details are absent from the supplied references.[518][536][572]C |
Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics
- ▸Use clinically targeted allergen immunotherapy as the principal disease-modifying strategy; the supplied evidence does not establish environmental avoidance as a stand-alone definitive treatment [273][592].
- ▸HDM SLIT has evidence for symptom and rescue-medication reduction over approximately **12 months**, including a post hoc assessment of corticosteroid-sparing effects [560].
- ▸Multiallergen AIT reduced combined symptom and medication scores versus placebo in polysensitized patients, but formulation selection should remain individualized [273].
- ▸Pediatric tree SLIT-tablet evidence covers children aged **5–17 years** with moderate-to-severe tree allergic rhinoconjunctivitis and treatment up to **52 weeks** [562].
- ▸Biologics should not be recommended for isolated allergic rhinitis on the basis of evidence from asthma, atopic dermatitis, or CRSwNP [603][613][625].
Management goals and allergen avoidance
Long-term management should be individualized according to the clinically relevant allergen, disease persistence, severity, comorbid asthma or conjunctivitis, treatment burden, and the patient’s ability to adhere to prolonged therapy. The supplied evidence does not provide a controlled evaluation of environmental allergen-avoidance measures; therefore, avoidance should be presented as a complementary strategy rather than a proven stand-alone disease-modifying intervention. In polysensitized patients, treatment decisions should distinguish clinically relevant sensitization from sensitization detected only by testing, because the evidence for multiallergen formulations remains heterogeneous [273]B2a.
Allergen immunotherapy: selection and expected role
Allergen immunotherapy (AIT) is the principal disease-modifying option supported by the supplied evidence. Trials and reviews have evaluated both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), generally over at least 12 months for house-dust-mite (HDM) treatment [592]. HDM preparations can be classified by allergen composition as comprehensive-component SCIT, major-component-dominant SCIT, or major-component-dominant SLIT; this component-resolved framework was developed because efficacy may vary according to the breadth of allergen representation, not merely by route of administration [592]. The supplied abstract does not report the network estimates, so comparative superiority among these formulations should not be asserted from this reference alone [592].
For HDM-allergic rhinitis, a 300-index-of-reactivity (300IR) HDM SLIT tablet was evaluated in a large randomized trial lasting approximately 12 months in patients with moderate-to-severe rhinitis, with or without controlled asthma. The trial confirmed reductions in symptoms and rescue-medication use, and a post hoc analysis specifically assessed corticosteroid-sparing effects [560]. This supports considering HDM SLIT when persistent disease remains burdensome despite conventional treatment, while recognizing that the corticosteroid-sparing findings were post hoc [560].
A randomized trial of dust-mite SLIT drops in 300 sensitized patients treated for 6 months found greater reductions in interleukin-4, interleukin-17, eosinophil cationic protein, thymus and activation-regulated chemokine, and vascular cell adhesion molecule-1 than conventional treatment alone; symptom improvement and a lower adverse-reaction rate were also reported [536]. These inflammatory-marker findings are supportive but do not establish that any biomarker should guide routine treatment selection [536]. A prospective pediatric cohort similarly explored nasal Haemophilus abundance as a predictor of response after 1 year of HDM SLIT; responders were defined by a >20% reduction in total nasal symptom score, but the cohort was small and observational [521]C.
In polysensitized patients, a systematic review of 7 randomized trials and 7 nonrandomized studies found that multiallergen AIT reduced combined symptom and medication scores versus placebo, with a standardized mean difference of −3.75 (95% CI −5.85 to −1.65; p<0.001) [273]B2a. However, the review’s comparison with single-allergen AIT should not be interpreted as proof that adding allergens is universally superior; formulation choice should remain evidence-based and clinically targeted [273]B2a.
Evidence also supports allergen-specific treatment in children with pollen-driven disease. In a Canadian pediatric subpopulation aged 5–17 years with moderate-to-severe tree allergic rhinoconjunctivitis, daily tree SLIT tablets were compared with placebo for up to 52 weeks, with free access to symptom-relieving medication; the principal outcome was the total combined symptom-and-medication score during birch pollen season [562]. SCIT has likewise been associated with improved 12-month health-related quality of life in children and their caregivers in a prospective comparative study, although the supplied abstract does not provide the effect estimates or establish superiority over pharmacotherapy [575].
Safety, monitoring, and adherence
AIT requires assessment of suitability, shared decision-making, and monitoring for local or systemic reactions. In children receiving early-phase SCIT for moderate-to-severe persistent rhinitis without diagnosed asthma, a study of 62 participants evaluated exercise-induced bronchoconstriction and associated risk factors; this finding underscores the importance of reassessing lower-airway symptoms even when asthma has not been diagnosed [540].
Treatment persistence is central to benefit. A real-world pediatric cohort of 1,208 patients receiving individualized liquid-drop SLIT followed outcomes at months 6, 12, 18, 24, and 36, examining early and longitudinal responses across allergic multimorbidity patterns [525]. Because this was a retrospective cohort requiring prespecified adherence and persistence, its results may not represent patients unable to maintain treatment [525]. A small crossover trial also evaluated a device intended to improve tolerability of intranasal corticosteroid administration by reducing unpleasant sensations; this is an adherence-supporting intervention, not a substitute for AIT or definitive disease modification [520].
Histaglobulin, a non-allergen-specific subcutaneous histamine/immunoglobulin complex, has been used in allergic diseases, but the supplied systematic-review abstract does not provide sufficiently detailed allergic-rhinitis efficacy or safety results to support routine use or to position it alongside allergen-specific AIT [593].
Biologics
The supplied references do not establish a biologic as a definitive treatment for isolated allergic rhinitis. Dupilumab evidence presented here concerns pediatric atopic dermatitis, severe uncontrolled asthma, and chronic rhinosinusitis with nasal polyps rather than isolated rhinitis [613][603][625]. In particular, long-term pediatric dupilumab data address up to 3 years of treatment in atopic dermatitis [613], while real-world asthma data evaluate remission and response predictors in severe uncontrolled asthma [603]. Claims data describe changing biologic and endoscopic-surgery utilization in CRSwNP after biologic approvals [625]. These findings may be relevant when rhinitis occurs within severe type-2 comorbidity, but they should not be extrapolated to recommend biologics solely for allergic rhinitis [603][613][625].
| Strategy | Evidence and practical interpretation |
|---|---|
| HDM SLIT tablet | Approximately 12 months of randomized evidence for symptom and rescue-medication reduction; corticosteroid-sparing analysis was post hoc [560]. |
| HDM SLIT drops | 6-month, 300-patient randomized study reported symptom, inflammatory-marker, and adverse-reaction benefits [536]. |
| Multiallergen AIT | 7 randomized and 7 nonrandomized studies; combined symptom/medication score improved versus placebo, SMD −3.75 [273]B2a. |
| Tree SLIT tablet | Pediatric trial in ages 5–17 years, up to 52 weeks, using seasonal total combined symptom-and-medication score [562]. |
| SCIT | Prospective pediatric evidence suggests 12-month health-related quality-of-life benefit, but comparative effect estimates were not supplied [575]. |
| Biologics | Evidence supplied is for comorbid atopic dermatitis, severe asthma, or CRSwNP—not isolated allergic rhinitis [603][613][625]. |
Immunodeficiency Management
- ▸Consider humoral immunodeficiency in AR with recurrent sinusitis (≥4/year).
- ▸IG therapy reduces infection burden and need for sinus surgery.
Patients with AR and recurrent acute rhinosinusitis (RARS, ≥4/year) should be evaluated for humoral immunodeficiency (CVID, SAD). Immunoglobulin replacement therapy (IVIG/SCIG) reduces sinus infection burden: in a cohort, Lund‑Mackay CT score decreased from 7.6 to 3.5, and need for sinus surgery dropped from 19% to 3.4% [344]B2b. Alternative: azithromycin prophylaxis 5 mg/kg/d 3 days/week × 12 months reduced episodes from 5 to 0.5/year in children with nonallergic rhinitis (NNT=2) [338]A1b.
| Option | Indication | Dose | Outcome | Evidence |
|---|---|---|---|---|
| Immunoglobulin | PID with RARS/CRS | Per standard protocols | Reduced infections, improved LM score | 2b (cohort) [344]B2b |
| Azithromycin | NAR with RARS (children) | 5 mg/kg/d, 3 d/wk × 12 mo | Episodes 5→0.5/yr, NNT=2 | 1b (RCT) [338]A1b |
Pearl: In patients with allergic rhinitis and recurrent or chronic rhinosinusitis, testing for humoral immunodeficiency and initiating immunoglobulin replacement therapy can dramatically reduce infection burden, improve sinus imaging scores, and decrease the need for sinus surgery [344]B2b.
History and Evolution of Treatment
- ▸Intranasal corticosteroid treatment is being refined through delivery devices aimed at reducing irritation and post-nasal drip and improving adherence. [520]
- ▸SCIT remains a disease-modifying option for moderate-to-severe persistent AR, with increasing attention to lower-airway responses and exercise-induced bronchoconstriction. [540]
- ▸Exercise, immunonutritional supplements, and postbiotics are investigational adjuncts; current evidence does not establish them as replacements for standard therapy. [59] [58]
- ▸Biologic treatment is increasingly selected by phenotype and predicted response in children with severe allergic AR and comorbid asthma. [336]
- ▸Early-life nutritional interventions may reduce later allergic manifestations, but evidence applies to prevention and to individually tested formulas rather than to established AR treatment. [318]
- ▸Modern management integrates environmental exposure, structural nasal disease, chronic rhinosinusitis, asthma, immune status, and total allergic burden. [529] [71] [578] [549] [542] [558]
From symptom suppression to individualized, multimodal care
The treatment of allergic rhinitis (AR) has progressively expanded from control of nasal symptoms with topical and systemic pharmacotherapy toward strategies addressing adherence, comorbid lower-airway disease, allergen exposure, immune modulation, and prevention of the atopic march. The supplied 2026 evidence base does not provide a historical chronology of older antihistamine, intranasal corticosteroid, leukotriene-antagonist, or surgical trials; instead, it documents contemporary refinement of these approaches and their integration with adjunctive interventions.
Intranasal corticosteroids: improving delivery and adherence
Intranasal corticosteroid sprays remain an established treatment platform for AR, but unpleasant administration sensations—including post-nasal drip and nasal irritation—may reduce adherence. Ranasinghe et al. evaluated a nasal adaptor for metered-dose inhalers intended to improve tolerability and long-term use. In a crossover design, 16 participants with AR used standard fluticasone nasal spray (50 μg) and fluticasone delivered through the adaptor (125 μg) for 3 weeks each; a parallel postoperative chronic rhinosinusitis group underwent the same comparison. [520] This study represents an evolution from simply prescribing an effective spray to optimizing the patient’s experience and potentially reducing treatment abandonment. [520]
Allergen immunotherapy and airway-wide management
Subcutaneous allergen immunotherapy (SCIT) remains an important disease-modifying treatment for moderate-to-severe persistent AR. Contemporary evaluation increasingly considers associated airway dysfunction rather than nasal symptoms alone. A cross-sectional study of 62 children aged 6–18 years with moderate-to-severe persistent AR receiving early-phase SCIT assessed exercise-induced bronchoconstriction using an exercise challenge and spirometry; children with asthma or asthma symptoms were excluded, and a fall in FEV1 of ≥10% defined a positive response. [540] The study therefore reflects a treatment era in which children receiving immunotherapy are also assessed for clinically relevant lower-airway responses, even when asthma has not been diagnosed. [540]
The “one airway, one disease” concept has also encouraged nonpharmacological adjuncts. In a randomized controlled trial, 18 young adults with physician-confirmed persistent AR were allocated to an 8-week moderate-intensity aerobic-exercise program or comparison care. Participants discontinued antihistamines, corticosteroids, and leukotriene antagonists before and during the study, allowing the effects of exercise on symptoms, nasal airflow, airway inflammation, pulmonary function, and cardiorespiratory outcomes to be examined without concurrent antiallergic medication. [59]A1b
Biologics and treatment of severe type 2 disease
The modern treatment pathway increasingly links AR with allergic asthma and type 2 inflammation. A retrospective cohort of 246 children with moderate-to-severe allergic AR and allergic asthma received omalizumab or dupilumab, with early response assessed at 16 weeks; investigators developed a nomogram using baseline factors to predict response before biologic initiation. [336]B2b This illustrates movement toward biomarker- and phenotype-informed selection rather than uniform escalation.
Dupilumab, which blocks interleukin-4/interleukin-13 receptor signaling, was also evaluated in the prospective REVEAL registry of patients aged ≥12 years initiating treatment for asthma in real-world practice. [577] Although this registry concerns asthma rather than isolated AR, it is relevant to patients whose nasal disease forms part of broader type 2 airway inflammation. Persistent airflow limitation is another important comorbidity consideration: in a multicenter cohort of 849 patients with asthma, 640 (75.4%) had post-bronchodilator persistent airflow limitation defined as FEV1/FVC <0.70. [522]
Adjunctive immunonutrition and prevention
Immunonutritional therapy is being investigated as an adjunct rather than a replacement for established AR treatment. The multicenter INAPRA pilot trial randomized 40 children aged 5–12 years with allergic asthma and AR to a multicomponent immunonutritional supplement containing postbiotics or placebo, assessing clinical and immunomodulatory effects. [58]A1b The exploratory design and small sample size support cautious interpretation and do not establish routine use. [58]A1b
Prevention has shifted toward early-life intervention and interruption of the atopic march. In the double-blind randomized A.R.T. trial follow-up, a specific partially hydrolyzed formula given during the first 6 months of life was compared with standard formula to determine whether an earlier reduction in atopic dermatitis persisted to age 5 years and extended to other allergic manifestations, including food allergy. [318]B2b This evidence concerns prevention of allergic disease rather than treatment of established AR; importantly, the authors emphasize that partially hydrolyzed formulas differ in allergenicity and immunogenicity and must be evaluated individually. [318]B2b
Environmental control and risk-directed care
Environmental management has become more targeted. In a population study of 12,345 participants from northern China, Artemisia pollen exposure was categorized as low, medium, or high, while sensitization and allergic disease were analyzed in relation to host susceptibility and environmental exposure. [529] In children, a Beijing cluster study of 2,132 participants aged 6–12 years examined genetic background, dietary habits, and social behaviors in relation to allergic airway disease using ARIA- and GINA-based classification. [530] A survey of 393 patients with AR found substantial variation in knowledge, attitudes, and practices concerning environmental control and treatment; 42.75% had lived with AR for more than 5 years. [579]
Comorbidity, anatomy, and treatment boundaries
Treatment evolution also recognizes that persistent symptoms may not be caused by allergy alone. A five-year prospective study followed preschool children with chronic rhinosinusitis symptoms, with or without house-dust-mite sensitization, to identify predictors of persistent disease and later HDM-induced AR. [71]B2b The ARHINASD study enrolled 138 children aged 6–14 years with or without nasal septal deviation and assessed AR, sensitization, endoscopy, cytology, and nasal cytokines, reflecting interest in the potentially bidirectional relationship between structural obstruction and mucosal inflammation. [578]
Finally, treatment decisions should account for immune status and multisystem disease. A retrospective cohort examined new chronic rhinosinusitis after rituximab-associated B-cell depletion and hypogammaglobulinemia, excluding patients with pre-existing CRS. [549] Cat sensitization was strongly associated with AR plus asthma in a real-world study of 1,367 patients (1,154 with AR alone and 213 with AR plus asthma); cat sensitization remained prominent after adjustment, with an odds ratio of 3.743. [542] Allergy burden also matters: in 264 treatment-naive children with asthma, a cumulative score incorporating AR, atopic dermatitis, food allergy, drug allergy, and family history was examined against lung function. [558] These developments reinforce that contemporary AR care is individualized, airway-wide, and attentive to prevention, adherence, comorbidity, and competing diagnoses rather than limited to nasal symptom relief.
| Treatment or strategy | Population/design | Clinical significance |
|---|---|---|
| Intranasal fluticasone with nasal adaptor | Crossover trials; 16 AR participants; 3 weeks per treatment; 50 μg spray versus 125 μg MDI delivery | Targets tolerability and adherence. [520] |
| Moderate-intensity aerobic exercise | Randomized trial; 18 young adults; 8 weeks; medication withdrawal | Evaluates nonpharmacological effects on nasal and lower-airway outcomes. [59]A1b |
| SCIT with airway assessment | Cross-sectional study; 62 children aged 6–18 years; EIB threshold ≥10% FEV1 fall | Extends assessment beyond nasal symptoms. [540] |
| Biologics | Retrospective pediatric cohort; 246 patients with AR and allergic asthma; response at 16 weeks | Supports individualized biologic selection. [336]B2b |
| Immunonutritional/postbiotic supplement | Double-blind pilot RCT; 40 children aged 5–12 years | Exploratory adjunctive strategy requiring confirmation. [58]A1b |
| Partially hydrolyzed formula | Follow-up of double-blind randomized A.R.T. trial; intervention during first 6 months; outcomes to age 5 years | Preventive strategy addressing the atopic march. [318]B2b |
Complications, Comorbidities & Iatrogenic Risks
- ▸Screen for asthma in patients with difficult-to-control AR, particularly when cat sensitization, polysensitization, strong symptoms, or a relevant family history is present.[542]
- ▸Do not generalize treatment safety findings from children to adults, or from AR without asthma to patients with AR plus asthma.[518][619]
- ▸Regular versus as-needed INCS use has been studied for 8 weeks in 70 children, but the supplied evidence does not establish that intermittent treatment removes corticosteroid-related risks.[626]
- ▸Investigational nasal pumecitinib was studied at 0.2, 1.2, and 2.0 mg twice daily for 14 days; longer-term safety remains insufficiently characterized in the supplied evidence.[620]
- ▸Persistent symptoms warrant reassessment for CRS, asthma, or another rhinitis phenotype rather than automatic escalation of AR medication.[71][542][555]
Disease burden and clinically important comorbidity
Allergic rhinitis (AR) is a chronic inflammatory disorder associated with nasal obstruction, rhinorrhea, sneezing, and nasal itching; symptom patterns vary according to rhinitis subtype and may complicate clinical classification.[555]C Prospective symptom-diary data from 815 children and adults with seasonal AR indicate that retrospective ARIA-based severity classification may not always correspond to prospectively recorded symptom burden.[597] This creates a risk of underestimating disease severity when treatment decisions rely only on recall or infrequent consultation.[597]
Asthma is the most clinically important respiratory comorbidity to assess. In a real-world study of 1,367 patients with AR, 213 had concomitant asthma; cat sensitization was independently associated with AR plus asthma, with an odds ratio of 3.743.[542] Other factors associated with combined disease included a family history of AR or asthma, higher symptom intensity, polysensitization, cat ownership, and age younger than 18 years.[542] Because the dose-stratified network meta-analysis of symptomatic AR interventions excluded studies primarily enrolling patients with comorbid asthma, its comparative efficacy and safety findings should not automatically be extrapolated to this population.[619]
Upper-airway disease may coexist with or be confused with chronic rhinosinusitis (CRS). In a 5-year prospective cohort of preschool children with CRS symptoms, investigators evaluated house-dust-mite IgE sensitization, clinical features, and multi-omics predictors of persistent CRS and later AR-HDM; 117 children completed follow-up.[71]B2b These findings support longitudinal reassessment of children whose symptoms persist despite standard AR management, rather than assuming that ongoing symptoms represent uncontrolled AR alone.[71]B2b AR is also relevant in surgical and lacrimal disease: among patients undergoing septorhinoplasty, 57% had AR, and a separate endoscopic dacryocystorhinostomy study evaluated AR as a factor potentially influencing surgical success.[547][628]
Treatment-related and iatrogenic risks
Intranasal corticosteroids (INCS) remain the most effective monotherapy in the pediatric trial report, but adherence to daily treatment can be difficult.[626] In a randomized double-dummy study of 70 children aged 6–18 years with perennial AR, regular and as-needed intranasal fluticasone furoate were compared over 8 weeks, with symptoms, quality of life, nasal airflow, inflammatory markers, and safety assessed.[626] The study directly addresses whether reducing scheduled exposure can preserve control, but the supplied abstract does not provide numerical adverse-event results; clinicians should therefore avoid interpreting the trial as proof that intermittent use eliminates corticosteroid-related risk.[626]
For moderate-to-severe AR, fixed azelastine–fluticasone combination therapy is described as an important ENT option for seasonal and perennial disease.[627] The evidence synthesis incorporated guidelines, systematic reviews, network meta-analyses, pharmacovigilance data, and a multidisciplinary Delphi consensus.[627] Because this combination contains both an antihistamine and a corticosteroid, treatment selection should account for cumulative medication exposure, tolerability, administration technique, and the possibility that adverse effects may be attributed to the wrong component.[627]
A phase 2 multicentre trial evaluated topical pumecitinib, a nasal Janus kinase inhibitor, in adults aged 18–65 years with moderate-to-severe seasonal AR.[620] Participants received placebo or 0.2, 1.2, or 2.0 mg twice daily for 14 days during pollen season, with efficacy, safety, and pharmacokinetics assessed.[620] As a locally administered investigational JAK inhibitor, pumecitinib should not be treated as equivalent to established INCS until longer-term safety, systemic exposure, and rare adverse events are better characterized; the supplied abstract does not provide those event estimates.[620]
Oral antihistamines and leukotriene receptor antagonists have been evaluated in children younger than 12 years in a network meta-analysis assessing nasal and ocular symptoms, quality of life, adverse events, and serious adverse events.[518] The abstract supplied here does not report comparative event rates, so medication choice should be individualized and should not assume that all oral agents have equivalent safety profiles.[518] A separate network meta-analysis of symptomatic interventions in AR without comorbid asthma compared treatment classes and dose-specific regimens, but its results likewise should not be generalized to patients with asthma or other excluded populations.[619]
Adjunctive, complementary, and immune-modifying interventions
Adult probiotic supplementation has been examined in a systematic review with trial-sequential analysis and Bayesian network meta-analysis focused on clinical efficacy, inflammatory and immunologic markers, and safety.[618] However, the supplied abstract does not provide pooled adverse-event estimates; probiotics should therefore be regarded as adjunctive rather than risk-free substitutes for proven therapy.[618] In children, sublingual polyvalent mechanical bacterial lysate was studied in a randomized, double-blind, placebo-controlled trial involving grass-pollen AR, with immune-cell transcription factors and cytokines assessed in participants from trial NCT04802616.[581] Immunologic modulation does not by itself establish clinical benefit or exclude delayed or uncommon harms.[581]
Sublingual and subcutaneous allergen immunotherapy have been examined in pediatric real-world and prospective cohorts.[525][575] One cohort included 1,208 children and adolescents receiving liquid-drop SLIT, including 954 with AR, and assessed outcomes at 6–36 months; another compared 12-month health-related quality of life in children receiving SCIT or standard pharmacotherapy and their caregivers.[525][575] These studies inform effectiveness and burden but do not, from the supplied abstracts, quantify systemic reactions, adherence-related hazards, or treatment-emergent adverse events.[525][575]
Press-needle therapy has been evaluated in a pediatric systematic review and meta-analysis, including comparisons of press-needle alone or combined with medication against medication alone.[535] Homeopathic treatment was tested in a double-blind, three-arm randomized trial of 62 seasonal AR patients using disease-specific quality of life, response rate, rescue medication use, and symptom scores.[561] Neither intervention should displace evidence-based pharmacotherapy or immunotherapy solely on the basis of reported symptom outcomes, and the supplied abstracts do not establish protection from treatment-related harm.[535][561]
Practical safety principles
The principal iatrogenic risks are inappropriate extrapolation between age groups or comorbidity groups, unnecessary medication exposure, poor administration technique, failure to recognize CRS or asthma, and overinterpretation of short-term or surrogate immunologic outcomes.[518][581][619][626] Dupilumab evidence cited in pediatric atopic dermatitis and severe asthma concerns other indications, although studies assessed long-term effectiveness, safety, discontinuation, and type-2 comorbidities; it should not be presented as an AR treatment or as direct evidence of AR safety.[613][603] Similarly, obesity-related outcomes in severe asthma are not direct evidence about AR, but they reinforce the need to interpret respiratory symptoms and treatment response within the broader comorbidity profile.[541]
| Issue | Evidence-based implication |
|---|---|
| Asthma comorbidity | Cat sensitization was independently associated with AR plus asthma (OR 3.743); assess lower-airway disease when symptoms are severe or atypical.[542] |
| CRS overlap | Five-year pediatric follow-up evaluated predictors of persistent CRS and later HDM-related AR; persistent symptoms require diagnostic reassessment.[71]B2b |
| INCS exposure | Regular versus as-needed fluticasone furoate was compared for 8 weeks in 70 children; numerical adverse-event results were not provided in the supplied abstract.[626] |
| Oral medicines | Pediatric network meta-analysis evaluated oral antihistamines and LTRAs for efficacy, adverse events, and serious adverse events, but comparative rates were not supplied.[518] |
| Investigational therapy | Pumecitinib nasal spray was tested for 14 days at three twice-daily doses; long-term safety is not established by this trial.[620] |
| Adjunctive therapies | Probiotics, bacterial lysate, immunotherapy, press-needle therapy, and homeopathy have been studied, but the supplied abstracts do not provide sufficient adverse-event estimates to regard them as risk-free.[518][535][561][581][618][525][575] |
Prognosis & Natural History
- ▸Long-term natural-history evidence remains limited; most updated studies evaluate treatment response or comorbidity rather than spontaneous remission and progression. [555][619]
- ▸Preschool children with CRS symptoms and HDM sensitization may require longitudinal follow-up because persistence into school age is a clinically relevant outcome. [71]
- ▸Pediatric AR is associated with habitual snoring and sleep-disordered breathing, although estimates are highly heterogeneous. [184]
- ▸Allergen sensitization may contribute to residual mouth breathing after adenotonsillectomy. [602]
- ▸Multiallergen and HDM-specific immunotherapy may improve symptom and medication outcomes, but formulation, allergen breadth, and study heterogeneity influence comparative efficacy. [592][273]
- ▸Complementary treatments have mainly short-term evidence and should not be assumed to modify long-term disease trajectory. [275][535][159][593][561]
Overall course
Allergic rhinitis (AR) is a chronic inflammatory disorder whose clinical course varies according to age, allergen sensitization, exposure pattern, comorbidity, and treatment response. The available updated evidence is weighted toward treatment efficacy and associated outcomes rather than long-term untreated natural-history cohorts; therefore, estimates of persistence, remission, and progression should be interpreted cautiously. [555]C[619]
Symptom burden is heterogeneous. The principal symptoms are nasal obstruction, rhinorrhea, sneezing, and nasal itching, but their baseline severity differs among allergic and non-allergic rhinitis phenotypes and across assessment instruments. [555]C Seasonal and perennial disease may therefore follow different exposure-related patterns, and symptom severity should be assessed longitudinally rather than inferred from diagnosis alone. [555]C[619]
Childhood trajectory and persistence
Early-life disease may persist into later childhood, particularly when AR is associated with chronic rhinosinusitis (CRS) symptoms or house-dust-mite (HDM) sensitization. In a prospective cohort of preschool children followed for 5 years, 117 participants completed follow-up; the study evaluated whether clinical and multi-omics features at ages 4–8 years could predict persistent CRS and HDM-related AR at school age. [71]B2b Because this cohort was selected for CRS symptoms, its findings should not be generalized to all children with AR. [71]B2b
Pediatric AR is also associated with sleep-related morbidity. A meta-analysis of 17 studies involving 32,907 children found a pooled prevalence of habitual snoring of 0.04 (95% CI, 0.02–0.07) and an odds ratio of 2.24 (95% CI, 1.66–3.02) for AR in children with habitual snoring compared with those without habitual snoring. [184]A1a Heterogeneity was very high (I² = 98%), indicating that estimates vary substantially across populations and definitions. [184]A1a Objective middle-ear or Eustachian-tube dysfunction may also accompany AR, although the available systematic review identified only six studies with extractable numerator–denominator data and emphasized limitations related to operational definitions and sample size. [523]
Residual upper-airway dysfunction may continue after surgery for sleep-disordered breathing. In a retrospective pediatric analysis, airborne-allergen sensitization was investigated as a potential contributor to persistent mouth breathing after adenotonsillectomy, suggesting that treatment of adenotonsillar obstruction does not necessarily eliminate allergen-related nasal or respiratory behavior. [602] The observational design does not establish causality. [602]
Long-term comorbidity and systemic burden
AR commonly occurs within a broader atopic phenotype. In a large All of Us cohort, cumulative atopic burden was defined by the presence of asthma, atopic dermatitis, and AR and was evaluated in relation to keratoconus; the longitudinal cohort included 283,040 keratoconus-free adults, recorded 498 incident events, and had a median follow-up of 9.0 years. [614] The study’s purpose was to estimate longitudinal and cross-sectional associations, not to demonstrate that AR causes keratoconus. [614]
In adults aged 60 years or older in the UK Biobank, allergic diseases—including AR, atopic dermatitis, and asthma—were assessed for associations with incident hospital-recorded osteoporosis and major osteoporotic fracture. [178]B2b These prospective associations may help characterize the broader health burden of allergic disease in later life, but they do not establish that AR independently drives bone loss or fracture risk. [178]B2b
Modification of prognosis with treatment
Allergen immunotherapy may alter the longer-term disease course by reducing symptoms and medication requirements, although comparative benefit depends on formulation. A network meta-analysis included double-blind, placebo-controlled HDM-AIT trials lasting at least 12 months and classified preparations by allergen breadth as comprehensive-component subcutaneous immunotherapy, major-component-dominant subcutaneous immunotherapy, or major-component-dominant sublingual immunotherapy. [592] This framework indicates that route alone may not explain efficacy heterogeneity; the breadth of allergen components is also clinically relevant. [592]
For polysensitized patients, a systematic review of 7 randomized trials and 7 nonrandomized studies found that multiallergen AIT significantly reduced combined symptom and medication scores versus placebo (SMD −3.75, 95% CI −5.85 to −1.65; p < 0.001). [273]B2a Evidence comparing multiallergen with single-allergen AIT was also examined, but formulation and study-design differences limit definitive conclusions about superiority. [273]B2a
Symptom-directed therapies can improve control but do not necessarily change the underlying natural history. A dose-stratified network meta-analysis evaluated pharmacologic and other symptomatic interventions in seasonal or perennial AR without comorbid asthma, using total nasal symptom score and related outcomes. [619] Budesonide has longstanding clinical use in AR and rhinosinusitis, and a systematic review assessed its efficacy, safety, pharmacology, and mechanisms in adults. [629] A novel intranasal-delivery adaptor was studied over 3-week crossover periods to improve tolerability and potentially adherence to fluticasone administration; the AR group contained 16 participants. [520]
Evidence for complementary interventions remains less certain. Meta-analyses evaluated acupuncture-related therapies, press-needle therapy in children, Xiangju capsules, and subcutaneous histaglobulin, but these studies primarily address short- to intermediate-term symptom outcomes rather than remission or prevention of progression. [275]D5[535][159]A1a[593] A randomized placebo-controlled trial of homeopathic medication in seasonal AR assessed quality of life after 3 and 4 weeks in 62 patients; its short follow-up limits conclusions about long-term prognosis. [561] Consequently, these interventions should not be interpreted as established disease-modifying treatments. [275]D5[535][159]A1a[593][561]
Prognostic interpretation
The most clinically relevant adverse trajectories identified in the updated evidence are persistent pediatric upper-airway disease, sleep-disordered breathing or habitual snoring, residual mouth breathing after adenotonsillectomy, and morbidity associated with multisystem atopy. [71]B2b[184]A1a[602][614][178]B2b Prognosis should therefore be individualized according to symptom persistence, HDM or other allergen sensitization, polysensitization, sleep and ear symptoms, CRS features, and the degree of control achieved with sustained treatment. [71]B2b[273]B2a[523][619]
| Prognostic domain | Updated evidence | Interpretation |
|---|---|---|
| Pediatric persistence | 5-year prospective follow-up of children with CRS symptoms, with evaluation of HDM-related AR and CRS persistence | Supports longitudinal surveillance in selected children; not generalizable to all AR. [71]B2b |
| Sleep and upper airway | Habitual snoring prevalence 0.04; AR odds ratio 2.24; I² 98% | AR may coexist with clinically important sleep-related morbidity, but estimates are heterogeneous. [184]A1a |
| Treatment modification | Multiallergen AIT: SMD −3.75 versus placebo for combined symptom and medication scores | AIT can improve control; long-term disease modification remains formulation-dependent. [273]B2a |
| Systemic atopic burden | Associations studied with keratoconus, osteoporosis, and major osteoporotic fracture | These are observational associations and do not prove causation by AR. [614][178]B2b |
Special Populations and Pregnancy
- ▸In pregnancy, second-gen antihistamines and INCS are safe; avoid first-gen and decongestants.
- ▸In elderly, avoid first-gen antihistamines; INCS first-line; SLIT safe.
Pediatrics: First‑line therapy: intranasal corticosteroids (INCS) (e.g., beclomethasone 80‑160 μg/day) [440]A1b. Fixed combination olopatadine‑mometasone (GSP301) effective [439]A1b. SLIT effective and safe; 3 years for immunologic changes [238]C4[444]A1a. Probiotics adjunct with heterogeneous results [62]A1a. Pregnancy: Avoid first‑gen antihistamines and oral decongestants; second‑gen (cetirizine, loratadine, fexofenadine) and INCS (budesonide, fluticasone, mometasone) are safe [193]B2a[198]D5. Continue AIT if initiated before pregnancy; do not start during. Elderly: Avoid first‑gen antihistamines (anticholinergic, fall risk) [466]D5. LAR common (up to 21%) [469]C4. INCS and fixed combinations first‑line; SLIT safe and effective (44% symptom reduction) [445]B2b. Immunocompromised: AIT relatively contraindicated; standard pharmacotherapy considered safe [13]A1c.
Pearl: In elderly patients, first‑generation antihistamines should be avoided due to anticholinergic effects and risk of falls, while intranasal corticosteroids remain first‑line therapy with a favorable safety profile [466]D5.
| Question | Position A | Position B | Strength | Implication |
|---|---|---|---|---|
| Probiotics for prevention of allergic rhinitis | Not effective (OR 0.73 at ≤1 year; OR 0.95 at >1 year) [78]A1a | Reduces atopic sensitization (OR 0.87) and improves symptoms as adjunct [62]A1a | Low to moderate | Probiotics cannot be recommended for primary prevention of AR, but may have a role in symptom management |
| Use of montelukast in pediatric AR | Limited to inadequate response or intolerance to alternatives [198]D5 | Some guidelines consider it for mild disease | Moderate | Montelukast should be reserved for second-line use due to neuropsychiatric safety concerns |
Prevention, Screening & Surveillance
- ▸Use food allergy, parental autoimmune disease, family history, polysensitization, and regional exposure patterns to identify children who may benefit from closer surveillance; these markers do not constitute universal AR screening criteria. [334][508][60][587][591]
- ▸Do not recommend vitamin D supplementation or partially hydrolyzed formula solely for AR prevention without considering the limited, product-specific, or heterogeneous evidence. [318][564]
- ▸Assess asthma symptoms and lower-airway involvement periodically in patients with persistent or severe AR, especially those with cat sensitization, polysensitization, or exercise limitation. [542][540][558]
- ▸During SCIT, monitor efficacy, adherence, and adverse reactions throughout treatment and after completion; published real-world follow-up included **3 years of treatment plus 2 years** post-treatment. [588]
- ▸Reassess environmental-control advice, sleep, household exposures, oral health, and structural nasal obstruction as part of longitudinal care. [515][590][579][61][578]
Prevention: early-life and familial risk
Allergic rhinitis (AR) prevention should focus on risk-informed counseling rather than universal allergen testing. The atopic march may progress from infantile food allergy (FA) to later AR, but this trajectory is not inevitable. In a prospective cohort of 447 infants aged 0–2 years with positive food-allergen testing and follow-up to 6 years, clinical and questionnaire variables were used to develop and validate prediction models for subsequent AR; this supports targeted surveillance of infants with FA, although the abstract does not establish a model suitable for routine population use. [334]B2b
A specific partially hydrolyzed formula (pHF), administered during the first 6 months of life, was evaluated against standard formula in a multicenter, double-blind randomized trial. The investigators assessed whether an earlier reduction in atopic dermatitis persisted to 5 years and whether it extended to other allergic manifestations. Because pHF products differ in allergenicity and immunogenicity, any preventive effect should not be generalized to all hydrolyzed formulas. [318]B2b The available evidence therefore supports discussing the specific studied product only in the clinical context in which it was evaluated, rather than recommending routine pHF for every infant.
Parental autoimmune disease is a potential risk marker: a systematic review and meta-analysis of 12 studies found that maternal autoimmune disease was associated with increased risk of allergic disease in offspring, including asthma, eczema, and AR; included studies were of moderate-to-high methodological quality. [508]B2a This association may justify attention to family history during pediatric risk assessment, but it does not demonstrate that autoimmune disease itself is preventable or that enhanced AR screening improves outcomes. Local sensitization profiles may also be useful for prevention planning because allergen exposure varies by geography, ecology, and behavior; a systematic review from Russia emphasized the emerging role of locally informed, allergen-specific preventive immunization strategies, particularly for respiratory allergy and asthma. [60]D5
Evidence for vitamin D supplementation remains insufficient for routine AR prevention. An umbrella review reassessed meta-analytic evidence on vitamin D levels and supplementation across allergic diseases and specifically examined consistency, prediction intervals, small-study effects, and excess-significance bias; these methods reflect uncertainty and heterogeneity rather than proof of benefit. [564] Vitamin D should therefore be supplemented according to established nutritional indications, not solely to prevent AR.
Environmental and behavioral measures
Environmental counseling should be individualized to documented sensitization and exposure. Population studies show that exposure and host susceptibility both contribute to pollen-related sensitization: a study of 12,345 participants in northern China evaluated Artemisia pollen exposure, specific IgE, sensitization, AR, and acute asthma exacerbation across exposure categories. [529] Hospital-based data from 19,787 patients in Ningbo likewise demonstrate regional variation in sensitization to common inhalant and food allergens, supporting locally tailored testing and avoidance advice rather than a fixed universal allergen panel. [587]
Among 510 children aged 1–15 years with suspected allergic disease in Suzhou, 74.12% were specific-IgE positive; component-resolved testing was additionally performed in a subgroup for house-dust-mite allergens. [591] These findings support age- and region-sensitive interpretation of testing, while emphasizing that sensitization alone must be correlated with symptoms before labeling AR or prescribing extensive avoidance.
Indoor prevention should address potentially modifiable household conditions without implying causality from cross-sectional data. In 9,086 preschool children aged 3–6 years in Wuhan, mixed exposures involving ventilation, device use, and family hygiene practices were analyzed in relation to asthma, AR, and eczema using weighted quantile sum regression. [590] A Beijing survey of 2,132 children aged 6–12 years similarly examined genetic background, diet, and social behaviors in relation to allergic airway disease using ARIA- and GINA-based classification. [530] Patients should receive practical advice on ventilation, pollutant reduction, and exposure-specific control, while avoiding unsupported “hygiene” or dietary prescriptions.
Sleep and circadian health may be relevant preventive targets. A UK Biobank prospective cohort including 256,945 participants for shift-work analyses and 374,672 for sleep-pattern analyses linked self-reported night-shift work and sleep behaviors with incident AR identified through hospital records; multivariable Cox models and mediation analyses were used. [515]B2b These observational findings support counseling on regular, adequate sleep and avoidance of unnecessary circadian disruption, but they do not establish that sleep modification prevents AR.
Screening and surveillance after AR diagnosis
Routine screening should assess the full allergic-airway phenotype. AR is associated with asthma, and cumulative allergic burden in children with asthma—including AR, atopic dermatitis, FA, drug allergy, and family history—was evaluated against lung function in 264 treatment-naive children aged 4–16 years using dose-response and restricted-cubic-spline analyses. [558] Children with persistent, severe, polysensitized, or lower-airway symptoms warrant periodic asthma review, including symptom assessment and objective lung-function testing when age-appropriate.
Cat sensitization is a particularly important comorbidity marker. In a real-world study of 1,154 patients with AR alone and 213 with AR plus asthma, cat-dander sensitization remained a prominent factor associated with comorbid asthma (OR 3.743), alongside family history, polysensitization, cat ownership, symptom burden, and younger age. [542] Exposure history and sensitization testing should therefore be revisited when asthma symptoms emerge.
Children with moderate-to-severe persistent AR should also be asked about exertional respiratory symptoms. In 62 children aged 6–18 years without diagnosed asthma or asthma symptoms who were undergoing early subcutaneous allergen immunotherapy (SCIT), exercise testing used the ATS/ERS protocol; exercise-induced bronchoconstriction was defined by a ≥10% fall in FEV1 from baseline. [540] This supports targeted—not universal—exercise assessment in symptomatic patients.
Allergen immunotherapy surveillance
SCIT requires monitoring for local and systemic adverse reactions, adherence, symptom response, and asthma development. In a real-world cohort of 889 patients completing 3 years of dust-mite SCIT followed by 2 years after treatment, efficacy and adverse reactions were compared between 544 children and 345 adults using multivariable analysis. [588] Age-related differences in treatment response and safety should therefore be considered during shared decision-making and follow-up. A separate cohort found that children and adults completing SCIT differed in baseline burden, smoking and alcohol exposure, and AR duration, reinforcing the need to interpret outcomes in clinical context. [588]
Nasal septal deviation may complicate symptom surveillance. In the prospective ARHINASD study of 138 children aged 6–14 years, participants with and without septal deviation underwent assessment of AR, sensitization, nasal endoscopy, cytology, nasal-fluid cytokines, and nasal airflow-related features. [578] Persistent obstruction despite appropriate anti-inflammatory treatment should prompt examination for structural disease rather than automatic escalation of allergy therapy.
Dental health should be included in long-term review because a systematic review, meta-analysis, and Mendelian-randomization investigation examined associations between AR and dental caries, including prevalence and severity outcomes. [61]B2a The evidence concerns association and potential causality, not a proven AR-prevention intervention; oral-hygiene counseling and dental referral remain appropriate components of comprehensive care. [61]B2a
Practical surveillance priorities
At each review, document symptom control, medication use, sleep, school or work impact, exposure changes, asthma symptoms, exercise limitation, and treatment adverse effects. Environmental-control knowledge and adherence may be limited: a Chinese KAP survey of 393 patients evaluated knowledge, attitudes, and practices regarding environmental control and AR treatment, including relationships among these domains. [579] Reassess counseling comprehension rather than assuming that written advice has been implemented. AR has also been studied in relation to androgenetic alopecia and second-generation antihistamine exposure in a Taiwanese cohort using national insurance data; this is an exploratory association and does not alter AR surveillance recommendations. [514]B2b Recurrent wheezing after lower respiratory infection in children aged ≤5 years may signal later respiratory disease and warrants follow-up, although the cited study addressed recurrent wheezing rather than AR directly. [589]
| Clinical situation | Suggested focus | Evidence |
|---|---|---|
| Infant with food allergy | Follow for later AR and other atopic manifestations; avoid assuming inevitable atopic march | Prospective cohort followed children to 6 years [334]B2b |
| Persistent or severe AR | Screen clinically for asthma, exercise limitation, sleep disruption, and cumulative allergic burden | [558][540][515]B2b |
| Cat exposure or sensitization | Review asthma symptoms and exposure-control options | Cat sensitization associated with comorbid asthma, OR 3.743 [542] |
| Starting or receiving SCIT | Monitor efficacy, adherence, local/systemic reactions, and respiratory status | Age-comparative real-world SCIT data [588] |
| Persistent unilateral or refractory obstruction | Examine for septal deviation or other structural disease | Pediatric ARHINASD study [578] |
| Regionally variable exposure | Use local sensitization and pollen data to guide testing and counseling | [60]D5[529][587][591] |
References
- [1]
Brożek JL, Bousquet J, Agache I et al.. “Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision.” The Journal of allergy and clinical immunology (2017). PMID: 28602936 ↗
L1GUIDELINECited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks - [2]
Brozek JL, Bousquet J, Baena-Cagnani CE et al.. “Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision.” The Journal of allergy and clinical immunology (2010). PMID: 20816182 ↗
L1GUIDELINECited in: Definition, Classification & Hypersensitivity Mechanism Type, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Prevention, Screening & Surveillance - [3]
Sousa-Pinto B, Bousquet J, Vieira RJ et al.. “Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part I-Guidelines on Intranasal Treatments.” Allergy (2025). PMID: 41324154 ↗
L1GUIDELINECited in: Definition, Classification & Hypersensitivity Mechanism Type, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment - [4]
Roberts G, Pfaar O, Akdis CA et al.. “EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis.” Allergy (2017). PMID: 28940458 ↗
L1GUIDELINECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [5]
Vieira RJ, Sousa-Pinto B, Bousquet J et al.. “Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part II-Guidelines on Oral and Ocular Treatments.” Allergy (2026). PMID: 41877472 ↗
L1GUIDELINECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment - [6]
Arshad H, Lack G, Durham SR et al.. “Prevention Is Better than Cure: Impact of Allergen Immunotherapy on the Progression of Airway Disease.” The journal of allergy and clinical immunology. In practice (2023). PMID: 37844847 ↗
L5RCTCited in: Definition, Classification & Hypersensitivity Mechanism Type, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Prognosis & Natural History, Prevention, Screening & Surveillance - [7]
Sousa-Pinto B, Vieira RJ, Brozek J et al.. “Intranasal antihistamines and corticosteroids in allergic rhinitis: A systematic review and meta-analysis.” The Journal of allergy and clinical immunology (2024). PMID: 38685482 ↗
L1SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [8]
Xu X, Li S, Chen Y et al.. “Association between allergic diseases and mental health conditions: An umbrella review.” The Journal of allergy and clinical immunology (2024). PMID: 39521284 ↗
L2SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type - [9]
Sousa-Pinto B, Vieira RJ, Bognanni A et al.. “Efficacy and safety of intranasal medications for allergic rhinitis: Network meta-analysis.” Allergy (2024). PMID: 39548801 ↗
L1SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway - [10]
Licari A, Magri P, De Silvestri A et al.. “Epidemiology of Allergic Rhinitis in Children: A Systematic Review and Meta-Analysis.” The journal of allergy and clinical immunology. In practice (2023). PMID: 37236349 ↗
L2SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Special Populations & Pregnancy - [11]
Torres MI, Gil-Mata S, Bognanni A et al.. “Intranasal Versus Oral Treatments for Allergic Rhinitis: A Systematic Review With Meta-Analysis.” The journal of allergy and clinical immunology. In practice (2024). PMID: 39251016 ↗
L1SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Complications, Comorbidities & Iatrogenic Risks - [12]
Gil-Mata S, Vieira RJ, Borowiack E et al.. “Intranasal Treatments for Allergic Rhinitis in Preschool- and School-Age Children: Network Meta-Analysis.” The journal of allergy and clinical immunology. In practice (2025). PMID: 40675325 ↗
L1SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [13]
Scadding GK, Kariyawasam HH, Scadding G et al.. “BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007).” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2017). PMID: 30239057 ↗
L1GUIDELINECited in: Definition, Classification & Hypersensitivity Mechanism Type, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks, Special Populations & Pregnancy - [14]
Walker SM, Durham SR, Till SJ et al.. “Immunotherapy for allergic rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2011). PMID: 21848757 ↗
L1GUIDELINECited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [15]
Creticos PS, Schroeder JT, Hamilton RG et al.. “Immunotherapy with a ragweed-toll-like receptor 9 agonist vaccine for allergic rhinitis.” The New England journal of medicine (2006). PMID: 17021320 ↗
L1RCTCited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks - [16]
Liu QD, Pan GX, Yan YJ et al.. “Metabolomic profiles in allergic rhinitis: A systematic review and meta-analysis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2025). PMID: 39824455 ↗
L3SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks - [17]
Knudgaard MH, Andreasen TH, Ravnborg N et al.. “Rhinitis prevalence and association with atopic dermatitis: A systematic review and meta-analysis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2021). PMID: 33684526 ↗
L2SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [18]
Chalmers JR, Haines RH, Bradshaw LE et al.. “Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial.” Lancet (London, England) (2020). PMID: 32087126 ↗
L1RCTCited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Prognosis & Natural History, Prevention, Screening & Surveillance - [19]
Mårtensson A, Nordström FU, Cervin-Hoberg C et al.. “Nasal administration of a probiotic assemblage in allergic rhinitis: A randomised placebo-controlled crossover trial.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2022). PMID: 35075723 ↗
L1RCTCited in: Definition, Classification & Hypersensitivity Mechanism Type, Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks - [20]
Srivastava D, Singh BP, Arora N et al.. “Clinico-immunologic study on immunotherapy with mixed and single insect allergens.” Journal of clinical immunology (2009). PMID: 19533313 ↗
L1RCTCited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [21]
Berni Canani R, Carucci L, Coppola S et al.. “Ultra-processed foods, allergy outcomes and underlying mechanisms in children: An EAACI task force report.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2024). PMID: 39254357 ↗
L2SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Special Populations & Pregnancy - [22]
Venter C, Tan W, Pickett-Nairne K et al.. “Systematic review on maternal dietary patterns during pregnancy and offspring allergy.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2024). PMID: 39673331 ↗
L5SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Severity, Grading & Risk Stratification, Special Populations & Pregnancy - [23]
Venter C, Agostoni C, Arshad SH et al.. “Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2020). PMID: 32524677 ↗
L2SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Special Populations & Pregnancy, Prevention, Screening & Surveillance - [24]
Lisik D, Ermis SSÖ, Ioannidou A et al.. “Siblings and risk of allergic rhinitis: A systematic review and meta-analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2023). PMID: 37492922 ↗
L2SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Prognosis & Natural History - [25]
Bousquet J, Schünemann HJ, Togias A et al.. “Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence.” The Journal of allergy and clinical immunology (2019). PMID: 31627910 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Severity, Grading & Risk Stratification - [26]
Hellings PW, Steelant B. “Epithelial barriers in allergy and asthma.” The Journal of allergy and clinical immunology (2020). PMID: 32507228 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism - [27]
Matricardi PM, van Hage M, Custovic A et al.. “Molecular allergy diagnosis enabling personalized medicine.” The Journal of allergy and clinical immunology (2025). PMID: 39855360 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [28]
Pacheco SE, Guidos-Fogelbach G, Annesi-Maesano I et al.. “Climate change and global issues in allergy and immunology.” The Journal of allergy and clinical immunology (2021). PMID: 34688774 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Severity, Grading & Risk Stratification - [29]
Zhang Y, Lan F, Zhang L. “Advances and highlights in allergic rhinitis.” Allergy (2021). PMID: 34379805 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Clinical Presentation, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [30]
Zhang Y, Lan F, Zhang L. “Update on pathomechanisms and treatments in allergic rhinitis.” Allergy (2022). PMID: 35892225 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [31]
Ogulur I, Pat Y, Ardicli O et al.. “Advances and highlights in biomarkers of allergic diseases.” Allergy (2021). PMID: 34519063 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [32]
Datsi A, Steinhoff M, Ahmad F et al.. “Interleukin-31: The "itchy" cytokine in inflammation and therapy.” Allergy (2021). PMID: 33629401 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism - [33]
Ponda P, Carr T, Rank MA et al.. “Nonallergic Rhinitis, Allergic Rhinitis, and Immunotherapy: Advances in the Last Decade.” The journal of allergy and clinical immunology. In practice (2022). PMID: 36152989 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Complications, Comorbidities & Iatrogenic Risks - [34]
Conway AE, Verdi M, Kartha N et al.. “Allergic Diseases and Mental Health.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38851487 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Complications, Comorbidities & Iatrogenic Risks - [35]
Klimek L, Mullol J, Ellis AK et al.. “Current Management of Allergic Rhinitis.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38851250 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [36]
Akar-Ghibril N, Casale T, Custovic A et al.. “Allergic Endotypes and Phenotypes of Asthma.” The journal of allergy and clinical immunology. In practice (2020). PMID: 32037107 ↗
L5OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [37]
Bielory L, Delgado L, Katelaris CH et al.. “ICON: Diagnosis and management of allergic conjunctivitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2019). PMID: 31759180 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks - [38]
Linton S, Hossenbaccus L, Ellis AK. “Evidence-based use of antihistamines for treatment of allergic conditions.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2023). PMID: 37517656 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Acute Management & Anaphylaxis Pathway, Complications, Comorbidities & Iatrogenic Risks, Special Populations & Pregnancy - [39]
Scelo G, Torres-Duque CA, Maspero J et al.. “Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2023). PMID: 37640263 ↗
L2OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Complications, Comorbidities & Iatrogenic Risks - [40]
Bensch GW. “Safety of intranasal corticosteroids.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2016). PMID: 27979016 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment, Prevention, Screening & Surveillance - [41]
Linton S, Burrows AG, Hossenbaccus L et al.. “Future of allergic rhinitis management.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2021). PMID: 33971355 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [42]
Arshad SH. “Does allergen immunotherapy for allergic rhinitis prevent asthma?” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2022). PMID: 35500864 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Prognosis & Natural History - [43]
D'Amato G, Murrieta-Aguttes M, D'Amato M et al.. “Pollen respiratory allergy: Is it really seasonal?” The World Allergy Organization journal (2023). PMID: 37520612 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Complications, Comorbidities & Iatrogenic Risks - [44]
Morais-Almeida M, Canonica GW, Giavina-Bianchi P et al.. “Clinical remission in allergy and clinical immunology practice: State of the art and World Allergy Organization (WAO) call to action.” The World Allergy Organization journal (2026). PMID: 42058161 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type - [45]
Di Cara G, Carelli A, Latini A et al.. “Severity of allergic rhinitis and asthma development in children.” The World Allergy Organization journal (2015). PMID: 26023322 ↗
L2OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type, Severity, Grading & Risk Stratification - [46]
Wang H, Tu J, Zhang J et al.. “Integrated multi-omics profiling reveals shared mechanistic pathways in asthma-allergic rhinitis comorbidity: A hybrid machine learning framework leveraging Mendelian randomization for precision diagnostics.” The World Allergy Organization journal (2025). PMID: 41049388 ↗
L2OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation - [47]
Xu Z, Lai M, Luo X et al.. “The clinical characteristics and inflammatory endotypes of chronic rhinosinusitis with nasal polyps in Southern China: A multi-center, cross sectional study.” The World Allergy Organization journal (2025). PMID: 40822746 ↗
L2OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type - [48]
Larenas-Linnemann DE, Mayorga-Butrón JL, Maza-Solano J et al.. “Global expert views on the diagnosis, classification and pharmacotherapy of allergic rhinitis in clinical practice using a modified Delphi panel technique.” The World Allergy Organization journal (2023). PMID: 37520611 ↗
L5OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type - [49]
Zhao Z, Chen H, Liu T et al.. “Efficacy predictions for omalizumab treatment based on basophil CD203c expression in patients with allergic rhinitis by basophil activation test -- a real-life, pilot study.” The World Allergy Organization journal (2026). PMID: 42058162 ↗
L4OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type - [50]
Justicia JL, Padró C, Roger A et al.. “Immunological parameters as biomarkers of response to MicroCrystalline Tyrosine-adjuvanted mite immunotherapy.” The World Allergy Organization journal (2021). PMID: 34178239 ↗
L2OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type - [51]
Wheatley LM, Togias A. “Clinical practice. Allergic rhinitis.” The New England journal of medicine (2015). PMID: 25629743 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment - [52]
Guttman-Yassky E, Renert-Yuval Y, Brunner PM. “Atopic dermatitis.” Lancet (London, England) (2025). PMID: 39955121 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Complications, Comorbidities & Iatrogenic Risks - [53]
Langan SM, Irvine AD, Weidinger S. “Atopic dermatitis.” Lancet (London, England) (2020). PMID: 32738956 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Acute Management & Anaphylaxis Pathway, Prevention, Screening & Surveillance - [54]
Greiner AN, Hellings PW, Rotiroti G et al.. “Allergic rhinitis.” Lancet (London, England) (2011). PMID: 21783242 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [55]
Weidinger S, Novak N. “Atopic dermatitis.” Lancet (London, England) (2015). PMID: 26377142 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Prognosis & Natural History, Prevention, Screening & Surveillance - [56]
Huang K, Yang T, Xu J et al.. “Prevalence, risk factors, and management of asthma in China: a national cross-sectional study.” Lancet (London, England) (2019). PMID: 31230828 ↗
L2OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment, Special Populations & Pregnancy - [57]
Shaaban R, Zureik M, Soussan D et al.. “Rhinitis and onset of asthma: a longitudinal population-based study.” Lancet (London, England) (2008). PMID: 18805333 ↗
L2OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, History and Evolution of Treatment, Prevention, Screening & Surveillance - [58]
Caldaria E, Iorio R, Marziali D et al.. “Exploratory pilot trial of a multicomponent immunonutritional supplement in children with allergic asthma and rhinitis: The INAPRA study.” International immunopharmacology (2026). PMID: 42202393 ↗
L1RCTCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Special Populations & Pregnancy - [59]
Kerdkaew K, Rattanathamma P, Tongtako W et al.. “Effects of Moderate-Intensity Aerobic Exercise on Clinical Symptoms and Physiological Outcomes in Young Adults with Persistent Allergic Rhinitis: A Randomized Controlled Trial.” International journal of environmental research and public health (2026). PMID: 42196705 ↗
L1RCTCited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks - [60]
Dubovets A, Lukashevichus A, Artemova V et al.. “Towards Sensitization Profiling for Allergy Prevention in Russia: A Systematic Review.” International journal of molecular sciences (2026). PMID: 42353054 ↗
L5SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Acute Management & Anaphylaxis Pathway, Complications, Comorbidities & Iatrogenic Risks, Prevention, Screening & Surveillance - [61]
Yu Q, Lan L, Li Y et al.. “Association between asthma, allergic rhinitis, atopic dermatitis, and dental caries: evidence from systematic review with meta-analysis and Mendelian randomisation investigation.” Journal of global health (2026). PMID: 42246314 ↗
L2SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification, Complications, Comorbidities & Iatrogenic Risks, Prevention, Screening & Surveillance - [62]
Bakhshi A, Poursadegh F, Salari M et al.. “Effect of probiotics on allergic rhinitis in children; A systematic review and meta-analysis.” European journal of pediatrics (2026). PMID: 42209809 ↗
L1SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Complications, Comorbidities & Iatrogenic Risks, Special Populations & Pregnancy - [63]
Inpan R, Kantasa T, Hanprasertpong N et al.. “Ginger-based formulations for allergic rhinitis disease: a systematic review and meta-analysis of experimental studies in animals and humans.” Pharmaceutical biology (2026). PMID: 42183789 ↗
L1SR_OBSCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Complications, Comorbidities & Iatrogenic Risks - [64]
Eifan AO, Durham SR. “Pathogenesis of rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2016). PMID: 27434218 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [65]
Wang N, Yao Y, Liu YH et al.. “Allergic Rhinitis in China: Trends, Challenges and Implications Over the Past Two Decades.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2025). PMID: 40676746 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prevention, Screening & Surveillance - [66]
Moitra S, Mahesh PA, Moitra S. “Allergic rhinitis in India.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2023). PMID: 36856159 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [67]
Page C, Pitchford S. “Platelets and allergic inflammation.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2014). PMID: 24708345 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors - [68]
Campo P, Rondón C, Gould HJ et al.. “Local IgE in non-allergic rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2015). PMID: 25495772 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [69]
Liao EC, Ho CM, Lin MY et al.. “Dermatophagoides pteronyssinus and Tyrophagus putrescentiae allergy in allergic rhinitis caused by cross-reactivity not dual-sensitization.” Journal of clinical immunology (2010). PMID: 20683648 ↗
L4OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Prevention, Screening & Surveillance - [70]
Qiu S, Du Y, Duan X et al.. “B cell immunity in allergic nasal mucosa induces T helper 2 cell differentiation.” Journal of clinical immunology (2012). PMID: 22454245 ↗
L3OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [71]
Dobrakowski Ł, Kalisiak M, Majak J et al.. “Predicting the course of chronic rhinosinusitis in young children-5-year prospective study.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42418237 ↗
L2COHORTCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [72]
Zou P, Fan Y, Xie C et al.. “Allergen Sensitization Profiles and Co-Sensitization Networks in Children with Allergic Rhinitis and Asthma: A Propensity Score-Matched Retrospective Study.” Journal of asthma and allergy (2026). PMID: 42333264 ↗
L4COHORTCited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Clinical Presentation, Severity, Grading & Risk Stratification, Prognosis & Natural History, Special Populations & Pregnancy - [73]
Kalb B, Khaleva E, Giovannini M et al.. “Trajectories of allergic diseases in children: Destination unknown?” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2025). PMID: 40589146 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History, Prevention, Screening & Surveillance - [74]
Papadopoulos NG, Aggelides X, Stamataki S et al.. “New concepts in pediatric rhinitis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2021). PMID: 33475171 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Complications, Comorbidities & Iatrogenic Risks, Special Populations & Pregnancy - [75]
Zicari AM, De Castro G, Leonardi L et al.. “Update on rhinitis and rhinosinusitis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2020). PMID: 32017218 ↗
L5OTHERCited in: Definition, Classification & Hypersensitivity Mechanism Type, Epidemiology, Etiology & Risk Factors, Special Populations & Pregnancy - [76]
Schoos AM. “Atopic diseases-Diagnostics, mechanisms, and exposures.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2024). PMID: 39016386 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification & Hypersensitivity Mechanism Type, Pathophysiology & Immune Mechanism, Severity, Grading & Risk Stratification, Prevention, Screening & Surveillance - [77]
Corren J, Larson D, Altman MC et al.. “Effects of combination treatment with tezepelumab and allergen immunotherapy on nasal responses to allergen: A randomized controlled trial.” The Journal of allergy and clinical immunology (2022). PMID: 36223848 ↗
L1RCTCited in: Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Prognosis & Natural History - [78]
Xiao Z, Luo H, Liu H et al.. “Probiotic supplementation during pregnancy or infancy for the prevention of allergic rhinitis in infants: A systematic review and meta-analysis of Randomized controlled trials.” The World Allergy Organization journal (2025). PMID: 41079137 ↗
L1SR_MA_RCTCited in: Pathophysiology & Immune Mechanism, Special Populations & Pregnancy, Prevention, Screening & Surveillance - [79]
Liu X, Zhou J, Chen J et al.. “Risk of Asthma and Allergies in Children Delivered by Cesarean Section: A Comprehensive Systematic Review.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38908434 ↗
L2SR_OBSCited in: Pathophysiology & Immune Mechanism - [80]
Chokevittaya P, Jirattikanwong N, Thongngarm T et al.. “Factors Associated With Dupilumab Response in Atopic Dermatitis: A Systematic Review and Meta-Analysis.” The journal of allergy and clinical immunology. In practice (2024). PMID: 39265658 ↗
L2SR_OBSCited in: Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Prognosis & Natural History - [81]
Halken S, Larenas-Linnemann D, Roberts G et al.. “EAACI guidelines on allergen immunotherapy: Prevention of allergy.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2017). PMID: 28902467 ↗
L1GUIDELINECited in: Pathophysiology & Immune Mechanism, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Prevention, Screening & Surveillance - [82]
Patou J, De Smedt H, van Cauwenberge P et al.. “Pathophysiology of nasal obstruction and meta-analysis of early and late effects of levocetirizine.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2006). PMID: 16911353 ↗
L5SR_OBSCited in: Pathophysiology & Immune Mechanism, Complications, Comorbidities & Iatrogenic Risks - [83]
Tan W, Amara S, Venter M et al.. “Systematic review of maternal dietary patterns during pregnancy and offspring allergy.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2025). PMID: 41054961 ↗
L2SR_OBSCited in: Pathophysiology & Immune Mechanism, Prognosis & Natural History, Special Populations & Pregnancy - [84]
Pacheco-González RM, García-Marcos L, Morales E. “Prenatal vitamin D status and respiratory and allergic outcomes in childhood: A meta-analysis of observational studies.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2018). PMID: 29444346 ↗
L2SR_OBSCited in: Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Special Populations & Pregnancy - [85]
Oh Y, Hong SJ, Park YJ et al.. “Association between phthalate exposure and risk of allergic rhinitis in children: A systematic review and meta-analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2024). PMID: 39229646 ↗
L2SR_OBSCited in: Pathophysiology & Immune Mechanism, Prevention, Screening & Surveillance - [86]
Kristiansen M, Dhami S, Netuveli G et al.. “Allergen immunotherapy for the prevention of allergy: A systematic review and meta-analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2016). PMID: 27653623 ↗
L2SR_OBSCited in: Pathophysiology & Immune Mechanism, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History, Prevention, Screening & Surveillance - [87]
Paller AS, Spergel JM, Mina-Osorio P et al.. “The atopic march and atopic multimorbidity: Many trajectories, many pathways.” The Journal of allergy and clinical immunology (2018). PMID: 30458183 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification, History and Evolution of Treatment, Prognosis & Natural History - [88]
Lawson LP, Parameswaran S, Panganiban RA et al.. “Update on the genetics of allergic diseases.” The Journal of allergy and clinical immunology (2025). PMID: 40139464 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors - [89]
Fang ZF, Fu Y, Yi F et al.. “Neural control of the pathophysiology of allergic airway disease and its clinical implications: A focus on allergic rhinitis and asthma.” The Journal of allergy and clinical immunology (2025). PMID: 40447196 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism - [90]
Iinuma T, Kiuchi M, Hirahara K et al.. “Single-cell immunoprofiling after immunotherapy for allergic rhinitis reveals functional suppression of pathogenic TH2 cells and clonal conversion.” The Journal of allergy and clinical immunology (2022). PMID: 35863510 ↗
L4OTHERCited in: Pathophysiology & Immune Mechanism, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [91]
Spergel J, Aceves SS. “Allergic components of eosinophilic esophagitis.” The Journal of allergy and clinical immunology (2018). PMID: 29980277 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [92]
Matricardi PM, Dramburg S, Potapova E et al.. “Molecular diagnosis for allergen immunotherapy.” The Journal of allergy and clinical immunology (2019). PMID: 30850070 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [93]
Siracusa MC, Kim BS, Spergel JM et al.. “Basophils and allergic inflammation.” The Journal of allergy and clinical immunology (2013). PMID: 24075190 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, History and Evolution of Treatment - [94]
Bousquet J, Melén E, Haahtela T et al.. “Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis.” Allergy (2023). PMID: 36799120 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Clinical Presentation, Severity, Grading & Risk Stratification - [95]
Hellings PW, Klimek L, Cingi C et al.. “Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology.” Allergy (2017). PMID: 28474799 ↗
L1REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Severity, Grading & Risk Stratification, Special Populations & Pregnancy - [96]
Huang ZQ, Liu J, Sun LY et al.. “Updated epithelial barrier dysfunction in chronic rhinosinusitis: Targeting pathophysiology and treatment response of tight junctions.” Allergy (2024). PMID: 38372149 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, History and Evolution of Treatment, Prognosis & Natural History - [97]
Gao YD, Wang ZJ, Ogulur I et al.. “The Evolution, Immunopathogenesis and Biomarkers of Type 2 Inflammation in Common Allergic Disorders.” Allergy (2025). PMID: 40586319 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution, History and Evolution of Treatment - [98]
Moldaver D, Larché M. “Immunotherapy with peptides.” Allergy (2011). PMID: 21507007 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [99]
Fernández-Gallego N, Castillo-González R, Méndez-Barbero N et al.. “The impact of type 2 immunity and allergic diseases in atherosclerosis.” Allergy (2022). PMID: 35781885 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [100]
Stevens WW, Schleimer RP, Kern RC. “Chronic Rhinosinusitis with Nasal Polyps.” The journal of allergy and clinical immunology. In practice (2016). PMID: 27393770 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism - [101]
Wise SK, Damask C, Greenhawt M et al.. “A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023.” The journal of allergy and clinical immunology. In practice (2023). PMID: 36894277 ↗
L1REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Special Populations & Pregnancy - [102]
Baroody FM, Gevaert P, Smith PK et al.. “Nonallergic Rhinopathy: A Comprehensive Review of Classification, Diagnosis, and Treatment.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38467330 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [103]
Smallwood D, Ledford D, Kennedy D et al.. “Postnasal Drip.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38677587 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Prognosis & Natural History - [104]
Campo P, Canonica GW. “Local Allergic Rhinitis.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38641133 ↗
L5OTHERCited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [105]
Diver S, Russell RJ, Brightling CE. “Cough and Eosinophilia.” The journal of allergy and clinical immunology. In practice (2019). PMID: 31279462 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Prognosis & Natural History - [106]
Bose S, Grammer LC, Peters AT. “Infectious Chronic Rhinosinusitis.” The journal of allergy and clinical immunology. In practice (2016). PMID: 27393772 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [107]
Ellis AK, Tenn MW. “Advances in rhinitis: Models and mechanisms.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2017). PMID: 29157860 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway - [108]
Pierre Z, Mattos JL. “Smell and the sinuses.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2026). PMID: 42219147 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [109]
Lowe AJ, Leung DYM, Tang MLK et al.. “The skin as a target for prevention of the atopic march.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2018). PMID: 29413338 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Prevention, Screening & Surveillance - [110]
Dimou MV, Xepapadaki P, Lakoumentas J et al.. “Levels of IgE sensitization drive symptom thresholds in allergic rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2024). PMID: 38679157 ↗
L3OTHERCited in: Pathophysiology & Immune Mechanism - [111]
Ho JSS, Li CH, Wang A et al.. “It is no skin off my nose: The relationship between the skin and allergic rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2021). PMID: 33901674 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism - [112]
Howell MD, Fitzsimons C, Smith PA. “JAK/STAT inhibitors and other small molecule cytokine antagonists for the treatment of allergic disease.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2018). PMID: 29454096 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism - [113]
DeVore SB, Gonzalez T, Sherenian MG et al.. “On the surface: Skin microbial exposure contributes to allergic disease.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2020). PMID: 32853786 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Prevention, Screening & Surveillance - [114]
Rouadi PW, Idriss SA, Bousquet J et al.. “WAO - ARIA consensus on chronic cough: Executive summary.” The World Allergy Organization journal (2025). PMID: 40093560 ↗
L1REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [115]
Cheng Q, Fei J, Liao Y et al.. “Identification of immune-associated biomarkers in diagnosing allergic rhinitis.” The World Allergy Organization journal (2025). PMID: 40761581 ↗
L3OTHERCited in: Pathophysiology & Immune Mechanism, Prognosis & Natural History - [116]
Giulia D, Paola DF, Armando DL et al.. “Applications of basophil activation test in paediatric allergic diseases.” The World Allergy Organization journal (2024). PMID: 39734398 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Prognosis & Natural History, Special Populations & Pregnancy - [117]
Ridolo E, Nicoletta F, Lombardi C et al.. “Eosinophilic esophagitis and inhalant antigens: Pointing out the roles of allergic rhinitis, immunotherapy and biologic treatment.” The World Allergy Organization journal (2024). PMID: 39386073 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Prognosis & Natural History - [118]
Rouadi PW, Idriss SA, Naclerio RM et al.. “Immunopathological features of air pollution and its impact on inflammatory airway diseases (IAD).” The World Allergy Organization journal (2020). PMID: 33042360 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Prognosis & Natural History - [119]
Gelardi M, Guglielmi AV, Iannuzzi L et al.. “Local allergic rhinitis: entopy or spontaneous response?” The World Allergy Organization journal (2016). PMID: 27980704 ↗
L3OTHERCited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, History and Evolution of Treatment - [120]
Liu Z, Li Y, Zhao X et al.. “LncRNA PELATON regulates Th2 cell differentiation by miR-10b-5p/GATA3 axis in allergic rhinitis.” The World Allergy Organization journal (2025). PMID: 41048563 ↗
L3OTHERCited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [121]
Van Bever HP, Samuel ST, Lee BW. “Halting the allergic march.” The World Allergy Organization journal (2008). PMID: 23283392 ↗
L5OTHERCited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prevention, Screening & Surveillance - [122]
Dollner R, Taraldsrud E, Iversen K et al.. “Non-allergic, mastocytosis-associated rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2013). PMID: 23517036 ↗
L3OTHERCited in: Pathophysiology & Immune Mechanism - [123]
Campo P, Eguiluz-Gracia I, Bogas G et al.. “Local allergic rhinitis: Implications for management.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2018). PMID: 29900607 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Complications, Comorbidities & Iatrogenic Risks - [124]
Cao PP, Shi LL, Xu K et al.. “Dendritic cells in inflammatory sinonasal diseases.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2016). PMID: 27159777 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Clinical Presentation - [125]
Allan K, Kelly FJ, Devereux G. “Antioxidants and allergic disease: a case of too little or too much?” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2009). PMID: 19968654 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Special Populations & Pregnancy - [126]
Lopez DJ, Lodge CJ, Bui DS et al.. “Establishing subclasses of childhood eczema, their risk factors and prognosis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2022). PMID: 35347774 ↗
L2REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, History and Evolution of Treatment, Prevention, Screening & Surveillance - [127]
O'Regan GM, Irvine AD. “The role of filaggrin in the atopic diathesis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2010). PMID: 20642575 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Complications, Comorbidities & Iatrogenic Risks - [128]
Liu Y, Zeng M, Liu Z. “Th17 response and its regulation in inflammatory upper airway diseases.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2015). PMID: 25048954 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism - [129]
Liang X, Liu W, Qi H et al.. “Allergen Sensitization Characteristics and Temporal Trends in Allergic Rhinitis: A Single-Center Retrospective Study of 2,482 Patients in Beijing.” Respiratory medicine (2026). PMID: 42349726 ↗
L4COHORTCited in: Pathophysiology & Immune Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification - [130]
Marseglia G, Miraglia Del Giudice M, Licari A et al.. “Azelastine-fluticasone intranasal therapy: A paradigm shift in pediatric allergic rhinitis management. A point of view of the Italian Society of Pediatric Allergy and Immunology.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 41755501 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Complications, Comorbidities & Iatrogenic Risks - [131]
Sponholz W, Steinert C, Monnati F et al.. “IgE to cyclophilin Bet v 7 triggers mast cell activation and mediates cross-reactivity with Ara h 18 in children with seasonal allergic rhinitis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 41781362 ↗
L4OTHERCited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [132]
Li J, Zhang Y, Zhang L. “[Effects of baseline clinical characteristics on the efficacy of stapokibart in patients with seasonal allergic rhinitis: a post-hoc subgroup analysis].” Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery (2026). PMID: 42402684 ↗
L2RCTCited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [133]
Zhou Y, Wang T, Fan Y et al.. “Therapy of allergic rhinitis using ribavirin spray to clear nasal commensal viruses.” Signal transduction and targeted therapy (2026). PMID: 42350364 ↗
L4RCTCited in: Pathophysiology & Immune Mechanism, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [134]
Zhang W, Li P, Zhao S et al.. “Microbiome and metabolome integrated analysis reveals oral microbiota alterations and associated metabolic pathways in allergic rhinitis.” Journal of oral microbiology (2026). PMID: 42428783 ↗
L3OTHERCited in: Pathophysiology & Immune Mechanism - [135]
Li E, Shi M, Huang S. “New-onset allergic diseases after SARS-CoV-2 infection: mechanistic hypotheses and emerging strategies for risk stratification.” Frontiers in immunology (2026). PMID: 42421939 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology & Immune Mechanism, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [136]
Ní Chaoimh C, Lad D, Nico C et al.. “Early initiation of short-term emollient use for the prevention of atopic dermatitis in high-risk infants-The STOP-AD randomised controlled trial.” Allergy (2022). PMID: 35997592 ↗
L1RCTCited in: Epidemiology, Etiology & Risk Factors, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Prognosis & Natural History, Special Populations & Pregnancy, Prevention, Screening & Surveillance - [137]
Eapen AA, Shankhwar S, von Mutius E et al.. “Environmental risk factors and asthma primary prevention: From birth cohort studies to clinical trials.” The Journal of allergy and clinical immunology (2025). PMID: 40659121 ↗
L5TRIAL_NONRANDOMCited in: Epidemiology, Etiology & Risk Factors, History and Evolution of Treatment, Special Populations & Pregnancy, Prevention, Screening & Surveillance - [138]
Arrais M, Maricoto T, Nwaru BI et al.. “Helminth infections and allergic diseases: Systematic review and meta-analysis of the global literature.” The Journal of allergy and clinical immunology (2021). PMID: 34968529 ↗
L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors - [139]
Sun Y, Vonk JM, Kersten ETG et al.. “Genome-Wide Association Study Reveals a Causal Relationship Between Allergic Rhinitis and Hazelnut Allergy.” Allergy (2024). PMID: 39673378 ↗
L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors - [140]
Tsai SY, Gaffin JM, Hawryluk EB et al.. “Evaluation of dupilumab on the disease burden in children and adolescents with atopic dermatitis: A population-based cohort study.” Allergy (2024). PMID: 39166365 ↗
L2COHORTCited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Special Populations & Pregnancy - [141]
Pfaar O, Richter H, Müller T et al.. “Atopic dermatitis occurrence and progression and allergen immunotherapy: A real-world, retrospective cohort study in Germany.” The World Allergy Organization journal (2025). PMID: 40861800 ↗
L2COHORTCited in: Epidemiology, Etiology & Risk Factors, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [142]
Chang CL, Ali GB, Pham J et al.. “Childhood body mass index trajectories and asthma and allergies: A systematic review.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2023). PMID: 37401045 ↗
L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [143]
Conlan N, Maher GM, Al Khalaf SY et al.. “Association between hypertensive disorders of pregnancy and the risk of asthma, eczema and allergies in offspring: A systematic review and meta-analysis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2020). PMID: 33037716 ↗
L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification, Special Populations & Pregnancy - [144]
Kim YH, Kim KW, Kim MJ et al.. “Vitamin D levels in allergic rhinitis: a systematic review and meta-analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2016). PMID: 27188226 ↗
L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Prevention, Screening & Surveillance - [145]
Çelebi Sözener Z, Treffeisen ER, Özdel Öztürk B et al.. “Global warming and implications for epithelial barrier disruption and respiratory and dermatologic allergic diseases.” The Journal of allergy and clinical immunology (2023). PMID: 37689250 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification - [146]
Biagini JM, Kroner JW, Baatyrbek Kyzy A et al.. “Longitudinal atopic dermatitis endotypes: An atopic march paradigm that includes Black children.” The Journal of allergy and clinical immunology (2021). PMID: 34673050 ↗
L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Special Populations & Pregnancy - [147]
Perry TT, Grant TL, Dantzer JA et al.. “Impact of socioeconomic factors on allergic diseases.” The Journal of allergy and clinical immunology (2023). PMID: 37967769 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [148]
Rondón C, Campo P, Togias A et al.. “Local allergic rhinitis: concept, pathophysiology, and management.” The Journal of allergy and clinical immunology (2012). PMID: 22516477 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors - [149]
Shin YH, Hwang J, Kwon R et al.. “Global, regional, and national burden of allergic disorders and their risk factors in 204 countries and territories, from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019.” Allergy (2023). PMID: 37431853 ↗
L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Prevention, Screening & Surveillance - [150]
Arnau-Soler A, Tremblay BL, Sun Y et al.. “Food Allergy Genetics and Epigenetics: A Review of Genome-Wide Association Studies.” Allergy (2024). PMID: 39698764 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [151]
Celebi Sozener Z, Ozdel Ozturk B, Cerci P et al.. “Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease.” Allergy (2022). PMID: 35108405 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification - [152]
Berni Canani R, Caminati M, Carucci L et al.. “Skin, gut, and lung barrier: Physiological interface and target of intervention for preventing and treating allergic diseases.” Allergy (2024). PMID: 38439599 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors - [153]
Yang L, Lin Z, Gao T et al.. “The Role of Skin-Gut-Lung Microbiome in Allergic Diseases.” The journal of allergy and clinical immunology. In practice (2025). PMID: 40320144 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Complications, Comorbidities & Iatrogenic Risks - [154]
Thien F, Davies JM, Douglass JA et al.. “Thunderstorm Asthma: Current Perspectives and Emerging Trends.” The journal of allergy and clinical immunology. In practice (2025). PMID: 40199421 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors - [155]
Kim J, Rouadi PW. “The Relationship of Climate Change to Rhinitis.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38636591 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors - [156]
Conroy ER, Banzon TM, Simoneau T et al.. “An Overview of Adherence-What It Is and Why It Is Important.” The journal of allergy and clinical immunology. In practice (2024). PMID: 39074603 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors - [157]
Modi S, Norris MR, Nguyen V et al.. “Racial and Ethnic Disparities in Allergen Immunotherapy Prescription for Allergic Rhinitis.” The journal of allergy and clinical immunology. In practice (2023). PMID: 36736954 ↗
L3OTHERCited in: Epidemiology, Etiology & Risk Factors, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [158]
Zeiger RS, Schatz M, Zhou B et al.. “Risk Factors for Moderate-Severe Asthma in Children Ages 5-11 Years With Early-Onset Atopic Dermatitis.” The journal of allergy and clinical immunology. In practice (2025). PMID: 40752737 ↗
L3OTHERCited in: Epidemiology, Etiology & Risk Factors - [159]
Chen M, Lu YW, Shi J et al.. “Efficacy and safety of Xiangju capsules for allergic rhinitis: a systematic review and meta-analysis of randomized controlled trials.” Frontiers in pharmacology (2026). PMID: 42292827 ↗
L1SR_MA_RCTCited in: Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [160]
Narla S, Silverberg JI. “Current updates in the epidemiology and comorbidities of atopic dermatitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2025). PMID: 40350074 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification - [161]
Rackerby N, Ahn C, Ball BD et al.. “Evolving paradigms of treatment of allergic and nonallergic rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2025). PMID: 40245980 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Complications, Comorbidities & Iatrogenic Risks - [162]
Gabryszewski SJ, Hill DA. “One march, many paths: Insights into allergic march trajectories.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2021). PMID: 33971364 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Prevention, Screening & Surveillance - [163]
Kazancioglu A, Ozdemiral C, Gur Cetinkaya P et al.. “Long-term risk of allergic diseases after allergic proctocolitis: A clinical perspective.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2025). PMID: 40701364 ↗
L3OTHERCited in: Epidemiology, Etiology & Risk Factors, Prognosis & Natural History - [164]
Spergel JM. “From atopic dermatitis to asthma: the atopic march.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2010). PMID: 20674819 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Prevention, Screening & Surveillance - [165]
Ker J, Hartert TV. “The atopic march: what's the evidence?” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2009). PMID: 19852191 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [166]
Chen C, Song X, Murdock DJ et al.. “Association between allergic conditions and COVID-19 susceptibility and outcomes.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2024). PMID: 38242353 ↗
L3OTHERCited in: Epidemiology, Etiology & Risk Factors, Severity, Grading & Risk Stratification - [167]
Cheng Y, Liu Q, Li M et al.. “First-in-human, phase 1 study of CM512, a TSLP/IL-13 bispecific antibody, in healthy volunteers: safety, tolerability, pharmacokinetics, pharmacodynamics, and immunogenicity.” Frontiers in immunology (2026). PMID: 42292382 ↗
L1RCTCited in: Epidemiology, Etiology & Risk Factors, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [168]
Rosário Filho NA, Urrutia-Pereira M, D'Amato G et al.. “Air pollution and indoor settings.” The World Allergy Organization journal (2021). PMID: 33510831 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Prevention, Screening & Surveillance - [169]
Chong SN, Chew FT. “Epidemiology of allergic rhinitis and associated risk factors in Asia.” The World Allergy Organization journal (2018). PMID: 30128063 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation - [170]
Higashida-Konishi M, Izumi K, Shimada T et al.. “Allergic disorders and their risk factors in primary Sjögren's syndrome.” The World Allergy Organization journal (2023). PMID: 36788991 ↗
L3OTHERCited in: Epidemiology, Etiology & Risk Factors - [171]
Gómez RM, Croce VH, Zernotti ME et al.. “Active smoking effect in allergic rhinitis.” The World Allergy Organization journal (2021). PMID: 33510834 ↗
L4OTHERCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Complications, Comorbidities & Iatrogenic Risks - [172]
Li H, Zong Y, He L et al.. “Mendelian randomization analysis reveals causal relationship between allergic diseases and influenza.” The World Allergy Organization journal (2025). PMID: 40529241 ↗
L2OTHERCited in: Epidemiology, Etiology & Risk Factors - [173]
Krishna MT, Mahesh PA, Vedanthan P et al.. “An appraisal of allergic disorders in India and an urgent call for action.” The World Allergy Organization journal (2020). PMID: 32774662 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [174]
Zhang X, Zhang M, Sui H et al.. “Prevalence and risk factors of allergic rhinitis among Chinese adults: A nationwide representative cross-sectional study.” The World Allergy Organization journal (2023). PMID: 37008533 ↗
L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Prevention, Screening & Surveillance - [175]
Mahesh PA, Moitra S, Mabalirajan U et al.. “Allergic diseases in India - Prevalence, risk factors and current challenges.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2022). PMID: 36181726 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors - [176]
Yue H, Umehara Y, Trujillo-Paez JV et al.. “Exogenous factors in the pathogenesis of atopic dermatitis: Irritants and cutaneous infections.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2021). PMID: 33394511 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors - [177]
Irmak S, Dedeoglu S, Toprak SF et al.. “Intranasal Corticosteroids Versus Second-Generation Antihistamines for Allergic Rhinitis in Adolescents: A Prospective Cohort Study of Quality of Life and School Attendance.” Journal of asthma and allergy (2026). PMID: 42305426 ↗
L2COHORTCited in: Epidemiology, Etiology & Risk Factors, Complications, Comorbidities & Iatrogenic Risks, Special Populations & Pregnancy - [178]
Peng C, Chen B, Chen Z et al.. “Associations of allergic diseases with incident hospital-recorded osteoporosis and major osteoporotic fracture in older adults: a prospective cohort study in the UK Biobank.” BMC geriatrics (2026). PMID: 42249315 ↗
L2COHORTCited in: Epidemiology, Etiology & Risk Factors, Prognosis & Natural History - [179]
Duse M, Caminiti S, Zicari AM. “Rhinosinusitis: prevention strategies.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2007). PMID: 17767614 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Prevention, Screening & Surveillance - [180]
Lee SY, Nakano T, Shimojo N et al.. “Asian birth cohort studies on allergic diseases: The A2BC network initiative.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2024). PMID: 39560177 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [181]
Mastrorilli C, Posa D, Cipriani F et al.. “Asthma and allergic rhinitis in childhood: what's new.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2016). PMID: 27862336 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, History and Evolution of Treatment, Prognosis & Natural History, Special Populations & Pregnancy, Prevention, Screening & Surveillance - [182]
Wong GWK, Li J, Bao YX et al.. “Pediatric allergy and immunology in China.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2017). PMID: 29047174 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors, Acute Management & Anaphylaxis Pathway, Special Populations & Pregnancy - [183]
De Filippo M, Votto M, Caminiti L et al.. “Safety of allergen-specific immunotherapy in children.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2022). PMID: 35080302 ↗
L5OTHERCited in: Epidemiology, Etiology & Risk Factors, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [184]
Li Q, Zhong Q, Kong X et al.. “Allergic rhinitis in children in relation to sleep breathing disorders: a meta-analysis.” International journal of pediatric otorhinolaryngology (2026). PMID: 42302637 ↗
L1SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Special Populations & Pregnancy - [185]
Vliagoftis H, Kouranos VD, Betsi GI et al.. “Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2008). PMID: 19119700 ↗
L1SR_MA_RCTCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Prevention, Screening & Surveillance - [186]
Oppenheimer J, Casale TB, Spergel JM et al.. “Pharmacokinetics and Pharmacodynamics Following Repeat Dosing of neffy (Epinephrine Nasal Spray) Versus Intramuscular Injection During Induced Allergic Rhinitis.” The journal of allergy and clinical immunology. In practice (2026). PMID: 41687867 ↗
L1RCTCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [187]
Li X, Wang X, Yang Q et al.. “A Randomized Comparison of Bencycloquidium Bromide, Mometasone Furoate, and a Combination for Persistent Allergic Rhinitis.” The journal of allergy and clinical immunology. In practice (2024). PMID: 39746515 ↗
L1RCTCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment, Complications, Comorbidities & Iatrogenic Risks - [188]
Durham SR, Penagos M. “Sublingual or subcutaneous immunotherapy for allergic rhinitis?” The Journal of allergy and clinical immunology (2016). PMID: 26853126 ↗
L2SR_OBSCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [189]
Vieira RJ, Gil-Mata S, Ferreira A et al.. “Efficacy and Safety of Oral Antihistamines for Allergic Rhinitis: Network Meta-Analysis.” The journal of allergy and clinical immunology. In practice (2026). PMID: 41707943 ↗
L2SR_OBSCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Complications, Comorbidities & Iatrogenic Risks - [190]
Caimmi D, Abouelfath A, Lassalle R et al.. “Patient-Perceived Benefits of Named-Patient Product Sublingual Immunotherapy in Allergic Rhinitis and Asthma: Primary Results From the ERAPP Real-World Cohort Study.” Allergy (2026). PMID: 41795228 ↗
L3COHORTCited in: Clinical Presentation, Prognosis & Natural History - [191]
Ridolo E, Montagni M, Incorvaia C et al.. “Orphan immunotherapies for allergic diseases.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2016). PMID: 26837608 ↗
L2SR_OBSCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [192]
Bielory L, Gross GN, Letierce A et al.. “Ocular symptoms improvement from intranasal triamcinolone compared with placebo and intranasal fluticasone propionate: A meta-analysis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2020). PMID: 32004698 ↗
L2SR_OBSCited in: Clinical Presentation - [193]
Gómez RM, Moreno P, Compalati E et al.. “Update meta-analysis on the efficacy and safety issues of fexofenadine.” The World Allergy Organization journal (2023). PMID: 37546236 ↗
L2SR_OBSCited in: Clinical Presentation, Prognosis & Natural History, Special Populations & Pregnancy - [194]
Wen YS, Lin CY, Yang KD et al.. “Nasal nitric oxide is a useful biomarker for acute unilateral maxillary sinusitis in pediatric allergic rhinitis: A prospective observational cohort study.” The World Allergy Organization journal (2019). PMID: 31193296 ↗
L3COHORTCited in: Clinical Presentation - [195]
Margaritte-Jeannin P, Budu-Aggrey A, Ege M et al.. “Identification of OCA2 as a novel locus for the co-morbidity of asthma-plus-eczema.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2021). PMID: 34155719 ↗
L2SR_OBSCited in: Clinical Presentation, Complications, Comorbidities & Iatrogenic Risks - [196]
Yeo BSY, Guan EJ, Ng K et al.. “Association of Abnormal Body Weight and Allergic Rhinitis-A Systematic Review and Meta-Analysis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2024). PMID: 39602830 ↗
L2SR_OBSCited in: Clinical Presentation, Severity, Grading & Risk Stratification - [197]
Barnes ML, Vaidyanathan S, Williamson PA et al.. “The minimal clinically important difference in allergic rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2009). PMID: 19895590 ↗
L2SR_OBSCited in: Clinical Presentation, Severity, Grading & Risk Stratification, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [198]
Dykewicz MS, Wallace DV, Amrol DJ et al.. “Rhinitis 2020: A practice parameter update.” The Journal of allergy and clinical immunology (2020). PMID: 32707227 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Special Populations & Pregnancy - [199]
Dykewicz MS, Hamilos DL. “Rhinitis and sinusitis.” The Journal of allergy and clinical immunology (2010). PMID: 20176255 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Complications, Comorbidities & Iatrogenic Risks - [200]
Ruysseveldt E, Steelant B, Wils T et al.. “The nasal basal cell population shifts toward a diseased phenotype with impaired barrier formation capacity in allergic rhinitis.” The Journal of allergy and clinical immunology (2024). PMID: 38705259 ↗
L5OTHERCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [201]
Augé J, Vent J, Agache I et al.. “EAACI Position paper on the standardization of nasal allergen challenges.” Allergy (2018). PMID: 29377177 ↗
L5OTHERCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [202]
Woehlk C, Stranzl T, Contoli M et al.. “Long-Term, Real-World Effectiveness of Allergen Immunotherapy in Children and Adolescents With Allergic Rhinitis and Asthma.” Allergy (2025). PMID: 41031547 ↗
L3OTHERCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prevention, Screening & Surveillance - [203]
Bousquet J, Sousa-Pinto B, Vieira RJ et al.. “Methodology for the Development of the Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI 2024-2025 Guidelines: From Evidence-to-Decision Frameworks to Digitalised Shared Decision-Making Algorithms.” Allergy (2025). PMID: 41268627 ↗
L5OTHERCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [204]
Okubo Y, Kuwabara Y, Sato S et al.. “Real-World Effectiveness for Sublingual Allergen Immunotherapy Among School-Aged Children and Adolescents.” Allergy (2025). PMID: 40631972 ↗
L3OTHERCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [205]
Mullol J, Del Cuvillo A, Lockey RF. “Rhinitis Phenotypes.” The journal of allergy and clinical immunology. In practice (2020). PMID: 32389274 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification - [206]
Blaiss MS, Steven GC, Bender B et al.. “Shared decision making for the allergist.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2018). PMID: 30201469 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [207]
Kaliner MA. “Azelastine and olopatadine in the treatment of allergic rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2009). PMID: 19927534 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway - [208]
Sacha JJ, Quinn JM. “The environment, the airway, and the athlete.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2011). PMID: 21277508 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation - [209]
He G, Meng Q, Yuan X et al.. “A multicenter randomized study: safety of an optimized accelerated house dust mite immunotherapy for patients with allergic rhinitis in China (PERFECT study).” Frontiers in immunology (2026). PMID: 42039184 ↗
L1RCTCited in: Clinical Presentation, Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment - [210]
Devillier P, Okano M, Canonica GW et al.. “Allergic rhinitis activity and efficacy of 300 IR house dust mite sublingual immunotherapy tablet in pediatrics.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 41968360 ↗
L2RCTCited in: Clinical Presentation, Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment - [211]
Braido F, Scichilone N, Lavorini F et al.. “Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA2LEN).” The World Allergy Organization journal (2016). PMID: 27800118 ↗
L5OTHERCited in: Clinical Presentation - [212]
El-Sayed ZA, El-Ghoneimy DH, Ortega-Martell JA et al.. “Allergic manifestations of inborn errors of immunity and their impact on the diagnosis: A worldwide study.” The World Allergy Organization journal (2022). PMID: 35783543 ↗
L4OTHERCited in: Clinical Presentation, Acute Management & Anaphylaxis Pathway, Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [213]
Huang Y, Wang C, Zhang Y et al.. “Developing nomograms for identifying allergic rhinitis among chronic rhinitis: A real-world study.” The World Allergy Organization journal (2021). PMID: 33912321 ↗
L4OTHERCited in: Clinical Presentation, History and Evolution of Treatment, Prevention, Screening & Surveillance - [214]
Rouadi PW, Idriss SA, Bousquet J et al.. “WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation - Updates in COVID-19.” The World Allergy Organization journal (2021). PMID: 34963794 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation - [215]
Feijen J, Seys SF, Steelant B et al.. “Prevalence and triggers of self-reported nasal hyperreactivity in adults with asthma.” The World Allergy Organization journal (2020). PMID: 32642023 ↗
L4OTHERCited in: Clinical Presentation - [216]
Rotiroti G, Roberts G, Scadding GK. “Rhinitis in children: common clinical presentations and differential diagnoses.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2015). PMID: 25616224 ↗
L5CASE_REPORTCited in: Clinical Presentation, Complications, Comorbidities & Iatrogenic Risks - [217]
Gane SB, Scadding GK. “Diseases mimicking allergic rhinitis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2009). PMID: 19744218 ↗
L4CASE_REPORTCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [218]
Jacob J, Fong A, Joyce C et al.. “Cost-Effectiveness of Allergen Immunotherapy for Allergic Rhinitis: A Systematic Review.” Allergy (2026). PMID: 42093212 ↗
L2SR_OBSCited in: Clinical Presentation, Acute Management & Anaphylaxis Pathway - [219]
Demidova A, Kiknavelidze N, Purtskhvanidze K et al.. “'What' and 'How' to Measure in Allergy and Clinical Immunology: A Systematic Review of Core Outcome Sets and Outcome Harmonisation Processes.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2026). PMID: 41974646 ↗
L2SR_OBSCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Prognosis & Natural History - [220]
Cianferoni A, Votto M. “COVID-19 and allergy: How to take care of allergic patients during a pandemic?” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2020). PMID: 33236431 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [221]
Anastasiou E, Xepapadaki P, Asllani J et al.. “Update on the treatment of allergic rhinitis in children.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 41918374 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Complications, Comorbidities & Iatrogenic Risks - [222]
Crestani E, Harb H, Benamar M et al.. “Metabolomic and immunological signatures of asthma severity in children.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2025). PMID: 41195700 ↗
L4OTHERCited in: Clinical Presentation, Severity, Grading & Risk Stratification - [223]
Xiao X, Feng G, Zhang Y et al.. “Young Children Allergic Rhinitis Questionnaire is a novel tool for allergy screening in children.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2022). PMID: 35212036 ↗
L4OTHERCited in: Clinical Presentation, Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [224]
Meyer R, Fox AT, Chebar Lozinsky A et al.. “Non-IgE-mediated gastrointestinal allergies-Do they have a place in a new model of the Allergic March.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2019). PMID: 30403301 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation, History and Evolution of Treatment - [225]
Briskey D, Pellow J, Beatson G et al.. “Efficacy and safety of a particulate yeast β-glucan preparation in the treatment of seasonal allergic rhinitis (BETALL): a randomised placebo-controlled crossover trial protocol.” Trials (2026). PMID: 41998746 ↗
L5TRIAL_NONRANDOMCited in: Clinical Presentation, History and Evolution of Treatment, Prognosis & Natural History - [226]
Lucas D, Greta G, Bygvraa DA et al.. “Occupational allergic diseases among harvesting fishermen on the open sea: A systematic review.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2023). PMID: 37116652 ↗
L2SR_OBSCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [227]
Hamed A, Preston DC, Eschenbacher W et al.. “Nasal IgE production in allergic rhinitis: Impact of rhinovirus infection.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2019). PMID: 30776162 ↗
L4TRIAL_NONRANDOMCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [228]
Li C, Zhou H, Zhang W et al.. “Bacterial lysate treatment in allergic disease: A systematic review and meta-analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2021). PMID: 34097747 ↗
L1SR_OBSCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [229]
Yuan X, Xie S, Liu L et al.. “Complement C3 links epithelial remodeling and macrophage metabolic reprogramming in allergic rhinitis.” The Journal of allergy and clinical immunology (2026). PMID: 41759749 ↗
L3OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [230]
Breiteneder H, Peng YQ, Agache I et al.. “Biomarkers for diagnosis and prediction of therapy responses in allergic diseases and asthma.” Allergy (2020). PMID: 32893900 ↗
L5REVIEW_NARRATIVECited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [231]
Fu QW, Liu P, Ruan Y et al.. “International Evidence-Based Guidelines for Traditional Chinese Medicine Management of Allergic Rhinitis.” Allergy (2025). PMID: 40944470 ↗
L1OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway - [232]
Asano K, Ueki S, Tamari M et al.. “Adult-onset eosinophilic airway diseases.” Allergy (2020). PMID: 33040364 ↗
L5REVIEW_NARRATIVECited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [233]
Richards M, Ferber J, Li DK et al.. “Cesarean delivery and the risk of allergic rhinitis in children.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2020). PMID: 32387533 ↗
L2OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Special Populations & Pregnancy - [234]
Potter PC. “Update on sublingual immunotherapy.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2006). PMID: 16496508 ↗
L5REVIEW_NARRATIVECited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [235]
Popov TA, Passalacqua G, González-Díaz SN et al.. “Medical devices in allergy practice.” The World Allergy Organization journal (2020). PMID: 33024482 ↗
L5REVIEW_NARRATIVECited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway, Prevention, Screening & Surveillance - [236]
Segal M, Stokes JR, Casale TB. “Anti-immunoglobulin e therapy.” The World Allergy Organization journal (2008). PMID: 23282676 ↗
L5OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [237]
Eckrich J, Hinkel J, Fischl A et al.. “Nasal IgE in subjects with allergic and non-allergic rhinitis.” The World Allergy Organization journal (2020). PMID: 32612737 ↗
L3OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [238]
Zeng Y, Xiao H, Gao S et al.. “Efficacy and immunological changes of sublingual immunotherapy in pediatric allergic rhinitis.” The World Allergy Organization journal (2023). PMID: 37520614 ↗
L4OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Special Populations & Pregnancy - [239]
Gherasim A, Dietsch F, Beck M et al.. “Birch-induced allergic rhinitis: Results of exposure during nasal allergen challenge, environmental chamber, and pollen season.” The World Allergy Organization journal (2023). PMID: 37520615 ↗
L2OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [240]
Sheha DS, El-Korashi LA, AbdAllah AM et al.. “Dyslipidemia among allergic rhinitis patients: Frequency and risk factors.” The World Allergy Organization journal (2021). PMID: 33747342 ↗
L4OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, History and Evolution of Treatment - [241]
Huang W, Chen X, Liu Z et al.. “Sphk1 regulates HMGB1 via HDAC4 and mediates epithelial pyroptosis in allergic rhinitis.” The World Allergy Organization journal (2024). PMID: 39295955 ↗
L5OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [242]
Gelardi M, Iannuzzi L, Quaranta N et al.. “NASAL cytology: practical aspects and clinical relevance.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2016). PMID: 27009397 ↗
L5REVIEW_NARRATIVECited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [243]
Stewart MG. “Identification and management of undiagnosed and undertreated allergic rhinitis in adults and children.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2008). PMID: 18419620 ↗
L5REVIEW_NARRATIVECited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, Acute Management & Anaphylaxis Pathway - [244]
Prieto A, Rondón C, Eguiluz-Gracia I et al.. “Systematic evaluation of allergic phenotypes of rhinitis in children and adolescents.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2021). PMID: 33598969 ↗
L4OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [245]
Soyak Aytekin E, Unsal H, Sahiner UM et al.. “IgE mediated legume allergy in east Mediterranean children: A reflection of multiple food allergies.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2022). PMID: 35470935 ↗
L4OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [246]
Malizia V, Cilluffo G, Fasola S et al.. “Endotyping allergic rhinitis in children: A machine learning approach.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2022). PMID: 35080305 ↗
L4OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup, History and Evolution of Treatment - [247]
Guo B, Xiong P, Zhang Z et al.. “Predictors of the Efficacy of Focused Ultrasound for Moderate-to-Severe Persistent Allergic Rhinitis: A Retrospective Cohort Study.” Ultrasound in medicine & biology (2026). PMID: 42144291 ↗
L4COHORTCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [248]
Gaddikeri R, Shah P. “Case 347: Tracheobronchial Smooth Muscle Atrophy and Separation.” Radiology (2026). PMID: 42377126 ↗
L4CASE_REPORTCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [249]
Shoup J, Sadle C, Buckley A et al.. “Oxytocin and RAGE signaling at the intersection of social neurodevelopment and inflammation.” Journal of translational medicine (2026). PMID: 42415063 ↗
L5REVIEW_NARRATIVECited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [250]
Ye F, Tao Y, Chen J et al.. “Pharmacological silencing of nasal TRPV1+ nociceptors ameliorates eosinophilic infiltration but exacerbates neutrophilic infiltration in murine models of allergic rhinitis.” Rhinology (2026). PMID: 42411335 ↗
L5OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [251]
Huang L, Zhao X, Zhou J et al.. “Pandemic-Associated Sensitization Patterns and Burden in Chinese Children with Allergic Rhinitis: A Retrospective Phase-Stratified Study.” Journal of asthma and allergy (2026). PMID: 42403887 ↗
L4OTHERCited in: Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup - [252]
Rosenzwajg M, Gherasim A, Dietsch F et al.. “Low-dose IL-2 in birch pollen allergy: A phase-2 randomized double-blind placebo-controlled trial.” The Journal of allergy and clinical immunology (2024). PMID: 39532189 ↗
L1RCTCited in: Severity, Grading & Risk Stratification, History and Evolution of Treatment, Prognosis & Natural History - [253]
Zhang J, Yang X, Chen G et al.. “Efficacy and safety of intratonsillar immunotherapy for allergic rhinitis: A randomized, double-blind, placebo-controlled clinical trial.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2023). PMID: 37913839 ↗
L1RCTCited in: Severity, Grading & Risk Stratification, Complications, Comorbidities & Iatrogenic Risks - [254]
Muhammad Danial Song HJJ, Min Lee CT, Ci Ng FY et al.. “Childhood Acid Suppressants May Increase Allergy Risk-A Systematic Review and Meta-Analysis.” The journal of allergy and clinical immunology. In practice (2022). PMID: 36257597 ↗
L2SR_OBSCited in: Severity, Grading & Risk Stratification, Special Populations & Pregnancy - [255]
Ambrosino P, Parrella P, Formisano R et al.. “Clinical application of nasal nitric oxide measurement in allergic rhinitis: A systematic review and meta-analysis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2020). PMID: 32663599 ↗
L3SR_OBSCited in: Severity, Grading & Risk Stratification - [256]
Lee MS, Pittler MH, Shin BC et al.. “Acupuncture for allergic rhinitis: a systematic review.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2009). PMID: 19441597 ↗
L1SR_OBSCited in: Severity, Grading & Risk Stratification, Prevention, Screening & Surveillance - [257]
Guo R, Pittler MH, Ernst E. “Herbal medicines for the treatment of allergic rhinitis: a systematic review.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2007). PMID: 18219828 ↗
L1SR_OBSCited in: Severity, Grading & Risk Stratification - [258]
Ahlbeck L, Ahlberg E, Björkander J et al.. “Intralymphatic immunotherapy with one or two allergens renders similar clinical response in patients with allergic rhinitis due to birch and grass pollen.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2022). PMID: 35332591 ↗
L1RCTCited in: Severity, Grading & Risk Stratification, Prognosis & Natural History - [259]
Mullol J, Bartra J, del Cuvillo A et al.. “Specialist-based treatment reduces the severity of allergic rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2013). PMID: 23786279 ↗
L2TRIAL_NONRANDOMCited in: Severity, Grading & Risk Stratification - [260]
Calderon MA, Penagos M, Sheikh A et al.. “Sublingual immunotherapy for allergic conjunctivitis: Cochrane systematic review and meta-analysis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2011). PMID: 21848759 ↗
L1SR_OBSCited in: Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [261]
Walter S, Ho J, Alvarado R et al.. “Effect of monoclonal antibody drug therapy on mucosal biomarkers in airway disease: A systematic review.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2020). PMID: 32808380 ↗
L2SR_OBSCited in: Severity, Grading & Risk Stratification - [262]
Liu W, Zeng Q, He C et al.. “Compliance, efficacy, and safety of subcutaneous and sublingual immunotherapy in children with allergic rhinitis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2020). PMID: 32810884 ↗
L2TRIAL_NONRANDOMCited in: Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [263]
Kuniyoshi Y, Tsujimoto Y, Banno M et al.. “Neonatal jaundice, phototherapy and childhood allergic diseases: An updated systematic review and meta-analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2021). PMID: 33475191 ↗
L2SR_OBSCited in: Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Prognosis & Natural History, Special Populations & Pregnancy - [264]
Mitselou N, Hallberg J, Stephansson O et al.. “Adverse pregnancy outcomes and risk of later allergic rhinitis-Nationwide Swedish cohort study.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2020). PMID: 32060962 ↗
L2COHORTCited in: Severity, Grading & Risk Stratification - [265]
Bousquet J, Schünemann HJ, Sousa-Pinto B et al.. “Concepts for the Development of Person-Centered, Digitally Enabled, Artificial Intelligence-Assisted ARIA Care Pathways (ARIA 2024).” The journal of allergy and clinical immunology. In practice (2024). PMID: 38971567 ↗
L5REVIEW_NARRATIVECited in: Severity, Grading & Risk Stratification - [266]
Gonzalez-Diaz SN, Martin B, Villarreal-Gonzalez RV et al.. “Psychological impact of the COVID-19 pandemic on patients with allergic diseases.” The World Allergy Organization journal (2021). PMID: 33520081 ↗
L4OTHERCited in: Severity, Grading & Risk Stratification - [267]
Carpagnano GE, Bonini M, Latorre M et al.. “Profile of mild/moderate asthma patients: Baseline data from the MANI cohort.” The World Allergy Organization journal (2025). PMID: 40689384 ↗
L2OTHERCited in: Severity, Grading & Risk Stratification, Acute Management & Anaphylaxis Pathway, Complications, Comorbidities & Iatrogenic Risks - [268]
Meng Y, Lu H, Wang C et al.. “Naso-ocular neuropeptide interactions in allergic rhinoconjunctivitis, rhinitis, and conjunctivitis.” The World Allergy Organization journal (2021). PMID: 34035875 ↗
L3OTHERCited in: Severity, Grading & Risk Stratification - [269]
Rogkakou A, Villa E, Garelli V et al.. “Persistent Allergic Rhinitis and the XPERT Study.” The World Allergy Organization journal (2011). PMID: 23282334 ↗
L5OTHERCited in: Severity, Grading & Risk Stratification, Complications, Comorbidities & Iatrogenic Risks - [270]
Sima Y, Wang X, Zhang T et al.. “Efficacy and safety of olopatadine-mometasone combination nasal spray for the treatment of seasonal allergic rhinitis.” The World Allergy Organization journal (2026). PMID: 41732343 ↗
L1OTHERCited in: Severity, Grading & Risk Stratification - [271]
Kurita J, Yonekura S, Iinuma T et al.. “Evaluation of shoseiryuto for seasonal allergic rhinitis, using an environmental challenge chamber.” The World Allergy Organization journal (2022). PMID: 35399817 ↗
L1OTHERCited in: Severity, Grading & Risk Stratification - [272]
Sih T, Mion O. “Allergic rhinitis in the child and associated comorbidities.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2009). PMID: 19664013 ↗
L5CASE_REPORTCited in: Severity, Grading & Risk Stratification - [273]
Shi Y, Pan Z, Tian X et al.. “Multiallergen Immunotherapy for Polysensitized Patients with Allergic Rhinitis: A Systematic Review and Meta-Analysis.” Journal of asthma and allergy (2026). PMID: 42403890 ↗
L2SR_OBSCited in: Severity, Grading & Risk Stratification, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [274]
Wang H, Zhang Q, Hu M et al.. “Periostin in allergic rhinitis: from pathogenic mediator to predictive biomarker and therapeutic target.” Frontiers in pharmacology (2026). PMID: 42394977 ↗
L5SR_OBSCited in: Severity, Grading & Risk Stratification - [275]
Ma J, Peng M, Song YG et al.. “Efficacy and safety of acupuncture-related therapies in the treatment of allergic rhinitis: a systematic review and meta-analysis.” Frontiers in medicine (2026). PMID: 42245938 ↗
L5SR_OBSCited in: Severity, Grading & Risk Stratification, Complications, Comorbidities & Iatrogenic Risks, Prognosis & Natural History - [276]
Worm M, Demoly P, Okamoto Y et al.. “Safety of 300IR house dust mite sublingual tablet from pooled clinical trial and post-marketing data.” The World Allergy Organization journal (2024). PMID: 39035788 ↗
L2TRIAL_NONRANDOMCited in: Acute Management & Anaphylaxis Pathway - [277]
Ahlbeck L, Ahlberg E, Stuivers L et al.. “Intralymphatic immunotherapy with birch and grass pollen extracts. A randomized double-blind placebo-controlled clinical trial.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2023). PMID: 37013723 ↗
L1RCTCited in: Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment, Prognosis & Natural History - [278]
Kulalert P, Phinyo P, Lao-Araya M. “Efficacy and safety of house dust mite sublingual immunotherapy tablets in allergic rhinitis: A systematic review and meta-analysis.” The World Allergy Organization journal (2022). PMID: 36119654 ↗
L1SR_OBSCited in: Acute Management & Anaphylaxis Pathway - [279]
Das RR, Naik SS. “Neonatal hyperbilirubinemia and childhood allergic diseases: a systematic review.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2014). PMID: 25229699 ↗
L2SR_OBSCited in: Acute Management & Anaphylaxis Pathway - [280]
Shamji MH, Sharif H, Layhadi JA et al.. “Diverse immune mechanisms of allergen immunotherapy for allergic rhinitis with and without asthma.” The Journal of allergy and clinical immunology (2022). PMID: 35093483 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [281]
Frew AJ. “Allergen immunotherapy.” The Journal of allergy and clinical immunology (2010). PMID: 20176266 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [282]
Creticos PS, Gunaydin FE, Nolte H et al.. “Allergen Immunotherapy: The Evidence Supporting the Efficacy and Safety of Subcutaneous Immunotherapy and Sublingual Forms of Immunotherapy for Allergic Rhinitis/Conjunctivitis and Asthma.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38685477 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [283]
Larenas-Linnemann D, Diamant Z, Jesenak M et al.. “Combination of Allergen-Specific Immunotherapy With Biologics in Severe Asthma: Counterintuitive or Rational?” The journal of allergy and clinical immunology. In practice (2025). PMID: 40349962 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Prognosis & Natural History - [284]
Oppenheimer JJ, Dinakar C, Fineman SM. “AllergyWatch.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2019). PMID: 31247305 ↗
L5OTHERCited in: Acute Management & Anaphylaxis Pathway - [285]
Zhang S, Chen Y, Zhao J et al.. “Neurectomy Versus Ablation of Posterior Nasal and Anterior Ethmoidal Nerve for Allergic Rhinitis: A Prospective Randomized Comparative Study.” American journal of rhinology & allergy (2026). PMID: 41847828 ↗
L1RCTCited in: Acute Management & Anaphylaxis Pathway - [286]
Gawlik R, Pitsch T, Dubuske L. “Anaphylaxis as a manifestation of horse allergy.” The World Allergy Organization journal (2009). PMID: 23283110 ↗
L5OTHERCited in: Acute Management & Anaphylaxis Pathway - [287]
Machnes-Maayan D, Yahia SH, Frizinsky S et al.. “A clinical pathway for the diagnosis of sesame allergy in children.” The World Allergy Organization journal (2022). PMID: 36440465 ↗
L4OTHERCited in: Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment - [288]
Florido-López JF, Andreu-Balaguer C, Escudero C et al.. “Effectiveness and safety of a glutaraldehyde-modified, L-tyrosine-adsorbed and monophosphoryl lipid A-Adjuvanted allergen immunotherapy in patients with allergic asthma sensitized to olive pollen: A retrospective, controlled real-world study.” The World Allergy Organization journal (2020). PMID: 33376572 ↗
L2OTHERCited in: Acute Management & Anaphylaxis Pathway - [289]
Alzughaibi BH, Michaelis LJ, Pearce MS et al.. “Pediatric IgE mediated food allergies and ethnic group inequalities: A scoping review.” The World Allergy Organization journal (2026). PMID: 42179758 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway - [290]
Chua NYM, Tay E, Chua RL et al.. “Pharmacotherapeutic Medication Adherence in Patients With Allergic Rhinitis: A Systematic Review and Meta-Analysis.” Current allergy and asthma reports (2026). PMID: 42133217 ↗
L2SR_OBSCited in: Acute Management & Anaphylaxis Pathway - [291]
Gupta N, Mohan RK, Reddy UN et al.. “Rational Allergy Practice Guidelines by the Indian Academy of Pediatrics (IAP) and IAP-Allergy and Applied Immunology Chapter.” Indian pediatrics (2026). PMID: 41949750 ↗
L1GUIDELINECited in: Acute Management & Anaphylaxis Pathway, History and Evolution of Treatment - [292]
Dantzer JA, Wood RA. “The use of omalizumab in allergen immunotherapy.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2018). PMID: 29315922 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [293]
Saranz RJ, Lozano A, Lozano NA et al.. “Subclinical lower airways correlates of chronic allergic and non-allergic rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2017). PMID: 28421631 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [294]
Salib RJ, Harries PG, Nair SB et al.. “Mechanisms and mediators of nasal symptoms in non-allergic rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2008). PMID: 18201248 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway - [295]
Passalacqua G, Baiardini I, Senna G et al.. “Adherence to pharmacological treatment and specific immunotherapy in allergic rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2013). PMID: 23278877 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway - [296]
Wraith DC, Krishna MT. “Peptide allergen-specific immunotherapy for allergic airway diseases-State of the art.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2021). PMID: 33529435 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway, Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [297]
Castagnoli R, Votto M, Taietti I et al.. “Bridging Rare to Common Diseases: Precision Medicine and the Transforming Landscape of Pediatric Allergy and Immunology.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42324659 ↗
L5REVIEW_NARRATIVECited in: Acute Management & Anaphylaxis Pathway, Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [298]
Shang X, Yang Y, Deng W. “Thunderstorm-Associated Asthma in Shenzhen, China: A Retrospective Case-Control Study of Risk Factors, Clinical Characteristics, and Management Approaches.” Journal of asthma and allergy (2026). PMID: 41970277 ↗
L3CASE_CONTROLCited in: Acute Management & Anaphylaxis Pathway - [299]
Wan WJ, Xu QY, Lu MP et al.. “Patient compliance to sublingual immunotherapy for mite-induced allergic rhinitis: A retrospective study.” The World Allergy Organization journal (2024). PMID: 39040084 ↗
L4COHORTCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [300]
Schutzmeier P, Kutzora S, Mittermeier I et al.. “Non-pharmacological interventions for pollen-induced allergic symptoms: Systematic literature review.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2021). PMID: 34717016 ↗
L2SR_OBSCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [301]
de Bot CM, Moed H, Berger MY et al.. “Sublingual immunotherapy in children with allergic rhinitis: quality of systematic reviews.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2011). PMID: 21919934 ↗
L5SR_OBSCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [302]
Jutel M, Agache I, Bonini S et al.. “International consensus on allergy immunotherapy.” The Journal of allergy and clinical immunology (2015). PMID: 26162571 ↗
L1REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [303]
Casale TB, Stokes JR. “Immunotherapy: what lies beyond.” The Journal of allergy and clinical immunology (2014). PMID: 24581428 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [304]
Penagos M, Durham SR. “Allergen immunotherapy for long-term tolerance and prevention.” The Journal of allergy and clinical immunology (2022). PMID: 35085663 ↗
L5OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prevention, Screening & Surveillance - [305]
Casale TB, Stokes JR. “Future forms of immunotherapy.” The Journal of allergy and clinical immunology (2010). PMID: 21094518 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [306]
Zhang Y, Li J, Li X et al.. “Chinese Position Paper on Biologic Therapy for Allergic Rhinitis.” Allergy (2026). PMID: 41872701 ↗
L1REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [307]
Layhadi JA, Lalioti A, Palmer E et al.. “Mechanisms and Predictive Biomarkers of Allergen Immunotherapy in the Clinic.” The journal of allergy and clinical immunology. In practice (2023). PMID: 37996041 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [308]
Kappen JH, Agache I, Jutel M et al.. “Allergen Immunotherapy for Asthma.” The journal of allergy and clinical immunology. In practice (2023). PMID: 38013158 ↗
L5OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [309]
Nelson HS. “The Art of Immunotherapy.” The journal of allergy and clinical immunology. In practice (2023). PMID: 37898175 ↗
L5OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [310]
Sotoudeh S, Choudhry H, Cantillo JF et al.. “Cat, Dog, and Exotic Animal Allergy.” The journal of allergy and clinical immunology. In practice (2025). PMID: 40848832 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [311]
Carnés J, Iraola V, Cho SH et al.. “Mite allergen extracts and clinical practice.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2017). PMID: 28284531 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [312]
Wagenmann M, Gehrt F, Scheckenbach K. “Remission and Meaningful Outcomes in Chronic Rhinitis and Rhinosinusitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2026). PMID: 42364847 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [313]
Bonini M, Di Maria G, Paggiaro P et al.. “Potential benefit of omalizumab in respiratory diseases.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2014). PMID: 25442695 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [314]
Waserman S, Shah A, Avilla E. “Recent development on the use of sublingual immunotherapy tablets for allergic rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2021). PMID: 34029713 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [315]
Nelson HS. “Efficacy and safety of allergen immunotherapy in children.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2006). PMID: 16496504 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [316]
Steven GC. “Shared decision making in allergic rhinitis: An approach to the patient.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2020). PMID: 32615266 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [317]
Cox L, Cohn JR. “Duration of allergen immunotherapy in respiratory allergy: when is enough, enough?” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2007). PMID: 17521025 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [318]
Sekkidou M, Karglani E, Pancheva R et al.. “Nutritional intervention with a partially hydrolyzed formula during the first 6 months of life may reduce the risk of food allergy and atopic dermatitis up to the age of 5 years.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42154372 ↗
L2RCTCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment, Special Populations & Pregnancy, Prevention, Screening & Surveillance - [319]
Furci F, Caminati M, Crisafulli E et al.. “The intriguing possibility of using probiotics in allergen-specific immunotherapy.” The World Allergy Organization journal (2023). PMID: 36852412 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History - [320]
Yu L, Zhang H, Pan J et al.. “Pediatric usage of Omalizumab: A promising one.” The World Allergy Organization journal (2021). PMID: 34963793 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prognosis & Natural History, Special Populations & Pregnancy - [321]
Larenas-Linnemann D, Rodríguez-Pérez N, Luna-Pech JA et al.. “Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines.” The World Allergy Organization journal (2020). PMID: 32884611 ↗
L1REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [322]
Jordakieva G, Jensen-Jarolim E. “The impact of allergen exposure and specific immunotherapy on circulating blood cells in allergic rhinitis.” The World Allergy Organization journal (2018). PMID: 30128065 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [323]
Cardona-Villa R, Del Pozo S, Uribe-García S et al.. “Clinical outcomes of allergen immunotherapy in children in Latin America: Treatment with polymerized allergen extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae.” The World Allergy Organization journal (2025). PMID: 40822748 ↗
L4OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [324]
Koca Kalkan I, Ates H, Aksu K et al.. “Real-life adherence to subcutaneous immunotherapy: What has changed in the era of the COVID-19 pandemic.” The World Allergy Organization journal (2021). PMID: 34122718 ↗
L4OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [325]
Varghese M, Glaum MC, Lockey RF. “Drug-induced rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2010). PMID: 20210811 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, History and Evolution of Treatment - [326]
Pechsrichuang P, Jacquet A. “Molecular approaches to allergen-specific immunotherapy: Are we so far from clinical implementation?” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2020). PMID: 32078207 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [327]
Smith SA, Stone CA, Jacquet A. “Allergen-Specific Human Monoclonal IgG Antibodies for Use in Passive Allergy Immunotherapy.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2025). PMID: 41061743 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [328]
Votto M, De Filippo M, Caminiti L et al.. “Eosinophilic gastrointestinal disorders and allergen immunotherapy: Lights and shadows.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2021). PMID: 33503273 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Complications, Comorbidities & Iatrogenic Risks - [329]
Liour SS, Tom A, Chan YH et al.. “Treating IgE-mediated diseases via targeting IgE-expressing B cells using an anti-CεmX antibody.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2016). PMID: 27090058 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [330]
Huoman J, Papapavlou G, Pap A et al.. “Sublingual immunotherapy alters salivary IgA and systemic immune mediators in timothy allergic children.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2019). PMID: 30803044 ↗
L2OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [331]
Tsai YG, Yang KD, Wen YS et al.. “Allergen-specific immunotherapy enhances CD8+ CD25+ CD137+ regulatory T cells and decreases nasal nitric oxide.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2019). PMID: 30968455 ↗
L4OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [332]
Liu Q, Zhu W, Sun Y et al.. “A meta-analysis of acupuncture at the sphenopalatine ganglion for the treatment of allergic rhinitis.” Frontiers in allergy (2026). PMID: 42211436 ↗
L1SR_OBSCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [333]
Tharpe C, Davidson J, Mardaga K et al.. “Real-world outcomes of personalized sublingual immunotherapy for environmental allergies delivered through a telemedicine platform: a retrospective longitudinal cohort study.” Frontiers in allergy (2026). PMID: 42358593 ↗
L2COHORTCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [334]
Jia X, Tao Q, Hu H et al.. “Prediction of future onset of allergic rhinitis and analysis of risk factors in children with food allergy during infancy.” European journal of pediatrics (2026). PMID: 42429983 ↗
L2OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics, Prevention, Screening & Surveillance - [335]
Huang L, Wang Y, Huang S. “Existential distress and social alienation in adolescents with allergic rhinitis: the serial mediating roles of psychological inflexibility and experiential avoidance.” Frontiers in public health (2026). PMID: 42415749 ↗
L4OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [336]
Wang L, Kang Z, Ma J et al.. “A Clinical Nomogram for Predicting Early Response to Biologics in Pediatric Allergic Asthma with Comorbid Allergic Rhinitis.” Journal of asthma and allergy (2026). PMID: 42403888 ↗
L2OTHERCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [337]
Liu X, Zhao W. “Advances in Nanotechnology-Based Immunomodulatory Strategies for the Treatment of Allergic Rhinitis.” International journal of nanomedicine (2026). PMID: 42368400 ↗
L5REVIEW_NARRATIVECited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [338]
Veskitkul J, Wongkaewpothong P, Thaweethamchareon T et al.. “Recurrent Acute Rhinosinusitis Prevention by Azithromycin in Children with Nonallergic Rhinitis.” The journal of allergy and clinical immunology. In practice (2017). PMID: 28438539 ↗
L1RCTCited in: Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution, Prevention, Screening & Surveillance - [339]
Han X, Krempski JW, Nadeau K. “Advances and novel developments in mechanisms of allergic inflammation.” Allergy (2020). PMID: 33068299 ↗
L5REVIEW_NARRATIVECited in: Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [340]
Nemet S, Elbirt D, Cohen R et al.. “IgE deficiency (<2.5 IU/mL) in children: Clinical insights from a population-based study of 123,393 subjects.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2025). PMID: 40285341 ↗
L2OTHERCited in: Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [341]
Gartenberg A, Petrie A. “Mixed connective tissue disease-myositis overlap syndrome presenting as an allergic disease process to the emergency department: A case report.” The American journal of emergency medicine (2023). PMID: 38142167 ↗
L4CASE_REPORTCited in: Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [342]
Marbet L, Gujer E, Münger MH et al.. “Allergic manifestations in inborn errors of immunity: a systematic scoping review.” Frontiers in immunology (2025). PMID: 41142799 ↗
L2REVIEW_NARRATIVECited in: Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [343]
Vaseghi-Shanjani M, Samra S, Yousefi P et al.. “Primary atopic disorders: inborn errors of immunity causing severe allergic disease.” Current opinion in immunology (2025). PMID: 40020536 ↗
L5REVIEW_NARRATIVECited in: Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [344]
Makary CA, Behnke J, Peppers B et al.. “Outcome of Immunoglobulin Replacement Therapy in Adults With Rhinosinusitis.” The Laryngoscope (2021). PMID: 34146351 ↗
L2OTHERCited in: Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [345]
Li G, Li S, Ye F et al.. “Construction of an Indole-induced Transgenic System and Its Therapeutic Effects on Allergic Rhinitis.” American journal of respiratory cell and molecular biology (2025). PMID: 40305665 ↗
L5OTHERCited in: Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution - [346]
Blaiss MS. “Management of rhinitis and asthma in pregnancy.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2003). PMID: 12839108 ↗
L5GUIDELINECited in: History and Evolution of Treatment - [347]
Bai L, Xu Y, Pan T et al.. “Leukotriene Receptor Antagonists and Risk of Neuropsychiatric Entities: A Meta-Analysis of Observational Studies.” The journal of allergy and clinical immunology. In practice (2022). PMID: 36473625 ↗
L2SR_OBSCited in: History and Evolution of Treatment - [348]
Gappa M, Gagnon R, Horak F et al.. “The SQ tree sublingual immunotherapy tablet is effective and well tolerated in children-A pivotal phase III trial.” Allergy (2024). PMID: 39495086 ↗
L1RCTCited in: History and Evolution of Treatment - [349]
Holzmann C, Karg J, Reiger M et al.. “Clinical Benefits of a Randomized Allergy App Intervention in Grass Pollen Sufferers: A Controlled Trial.” Allergy (2025). PMID: 40242867 ↗
L1RCTCited in: History and Evolution of Treatment - [350]
Scadding GK, Durham SR, Mirakian R et al.. “BSACI guidelines for the management of allergic and non-allergic rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2008). PMID: 18081563 ↗
L1GUIDELINECited in: History and Evolution of Treatment, Special Populations & Pregnancy - [351]
Yonekura S, Gotoh M, Kaneko S et al.. “Disease-Modifying Effect of Japanese Cedar Pollen Sublingual Immunotherapy Tablets.” The journal of allergy and clinical immunology. In practice (2021). PMID: 34333190 ↗
L1RCTCited in: History and Evolution of Treatment - [352]
Lloyd M, Ashley S, Chawla SS et al.. “Impact of Participant Baseline Factors on Exposure-Adjusted Incidence of Treatment-Related Adverse Events During Peanut Oral Immunotherapy.” The journal of allergy and clinical immunology. In practice (2025). PMID: 40976354 ↗
L1RCTCited in: History and Evolution of Treatment - [353]
Creticos PS, Reed CE, Norman PS et al.. “Ragweed immunotherapy in adult asthma.” The New England journal of medicine (1996). PMID: 8559203 ↗
L1RCTCited in: History and Evolution of Treatment - [354]
Durham SR, Walker SM, Varga EM et al.. “Long-term clinical efficacy of grass-pollen immunotherapy.” The New England journal of medicine (1999). PMID: 10441602 ↗
L1RCTCited in: History and Evolution of Treatment - [355]
Knapp HR. “Reduced allergen-induced nasal congestion and leukotriene synthesis with an orally active 5-lipoxygenase inhibitor.” The New England journal of medicine (1990). PMID: 1701029 ↗
L1RCTCited in: History and Evolution of Treatment - [356]
Terreehorst I, Hak E, Oosting AJ et al.. “Evaluation of impermeable covers for bedding in patients with allergic rhinitis.” The New England journal of medicine (2003). PMID: 12867607 ↗
L1RCTCited in: History and Evolution of Treatment - [357]
Pipkorn U, Proud D, Lichtenstein LM et al.. “Inhibition of mediator release in allergic rhinitis by pretreatment with topical glucocorticosteroids.” The New England journal of medicine (1987). PMID: 2438553 ↗
L1RCTCited in: History and Evolution of Treatment - [358]
Kalliomäki M, Salminen S, Arvilommi H et al.. “Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial.” Lancet (London, England) (2001). PMID: 11297958 ↗
L1RCTCited in: History and Evolution of Treatment - [359]
Skoner DP. “Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis.” The Journal of allergy and clinical immunology (2001). PMID: 11449200 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [360]
Simons FE, Simons KJ. “Histamine and H1-antihistamines: celebrating a century of progress.” The Journal of allergy and clinical immunology (2011). PMID: 22035879 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [361]
Mullarkey MF. “Eosinophilic nonallergic rhinitis.” The Journal of allergy and clinical immunology (1988). PMID: 3057047 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [362]
Kaplan AP, Ferrer Puga M, Sabate-Bresco M. “Endotypes in chronic spontaneous urticaria.” The Journal of allergy and clinical immunology (2026). PMID: 42134608 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment, Prevention, Screening & Surveillance - [363]
Corren J. “Allergic rhinitis and asthma: how important is the link?” The Journal of allergy and clinical immunology (1997). PMID: 9042071 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [364]
Pratt C, Brown AM, Rampe D et al.. “Cardiovascular safety of fexofenadine HCl.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (1999). PMID: 10444240 ↗
L5RCTCited in: History and Evolution of Treatment - [365]
Bousquet J. “Rapid symptom relief in rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (1999). PMID: 10209702 ↗
L5RCTCited in: History and Evolution of Treatment - [366]
Tohidinik HR, Mallah N, Takkouche B. “History of allergic rhinitis and risk of asthma; a systematic review and meta-analysis.” The World Allergy Organization journal (2019). PMID: 31660100 ↗
L1SR_OBSCited in: History and Evolution of Treatment - [367]
Zuberbier T. “Urticaria.” Allergy (2003). PMID: 14616095 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [368]
Bachert C. “Persistent rhinitis - allergic or nonallergic?” Allergy (2004). PMID: 14984551 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [369]
Tubita V, Callejas-Díaz B, Roca-Ferrer J et al.. “Role of microRNAs in inflammatory upper airway diseases.” Allergy (2020). PMID: 33314198 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [370]
Dykewicz MS, Wallace DV, Bandi S et al.. “Patient-Reported Outcome Measures in Rhinitis and Chronic Rhinosinusitis.” The journal of allergy and clinical immunology. In practice (2024). PMID: 39004415 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [371]
Nelson HS, Sowers T, Plunkett G et al.. “The Art of Dosing for Subcutaneous Immunotherapy in North America.” The journal of allergy and clinical immunology. In practice (2023). PMID: 37385447 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [372]
Bousquet J, Ansotegui IJ, Anto JM et al.. “Mobile Technology in Allergic Rhinitis: Evolution in Management or Revolution in Health and Care?” The journal of allergy and clinical immunology. In practice (2019). PMID: 31445223 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [373]
Calderon MA, Casale TB, Nelson HS et al.. “Extrapolating Evidence-Based Medicine of AIT Into Clinical Practice in the United States.” The journal of allergy and clinical immunology. In practice (2022). PMID: 36343885 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [374]
Skoner DP, Golant AK, Norton AE et al.. “Is This Medication Safe for My Child? How to Discuss Safety of Commonly Used Medications With Parents.” The journal of allergy and clinical immunology. In practice (2022). PMID: 35963511 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [375]
Lieberman P. “The basics of histamine biology.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2010). PMID: 21277530 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [376]
Slavin RG. “Occupational rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2003). PMID: 12772943 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [377]
Sly RM. “Changing prevalence of allergic rhinitis and asthma.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (1999). PMID: 10094214 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [378]
Berger WE. “Overview of allergic rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2003). PMID: 12839106 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [379]
Bousquet J, Demoly P, Michel FB. “Specific immunotherapy in rhinitis and asthma.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2001). PMID: 11476474 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [380]
Keil T, Bockelbrink A, Reich A et al.. “The natural history of allergic rhinitis in childhood.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2010). PMID: 20487364 ↗
L2TRIAL_NONRANDOMCited in: History and Evolution of Treatment, Prognosis & Natural History - [381]
Song KB, Park MJ, Choi EJ et al.. “Food allergy in early childhood increases the risk of oral allergy syndrome in schoolchildren: A birth cohort study.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2022). PMID: 35616894 ↗
L2COHORTCited in: History and Evolution of Treatment - [382]
Lund V. “Allergic rhinitis--making the correct diagnosis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (1998). PMID: 9988431 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [383]
Lundbäck B. “Epidemiology of rhinitis and asthma.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (1998). PMID: 9678821 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [384]
Xu X, Li J, Zhang X et al.. “Blood and local eosinophil levels in chronic rhinitis: Observations during seasonal allergen exposure and non-exposure.” The World Allergy Organization journal (2024). PMID: 39157197 ↗
L4OTHERCited in: History and Evolution of Treatment - [385]
Devillier P, Saf S, Rolland C et al.. “Respiratory allergic diseases and allergen immunotherapy: A French patient survey before and during the COVID-19 pandemic.” The World Allergy Organization journal (2024). PMID: 38623320 ↗
L4OTHERCited in: History and Evolution of Treatment - [386]
Alnahas S, Abouammoh N, Althagafi W et al.. “Prevalence, severity, and risk factors of allergic rhinitis among schoolchildren in Saudi Arabia: A national cross-sectional study, 2019.” The World Allergy Organization journal (2023). PMID: 37859757 ↗
L4OTHERCited in: History and Evolution of Treatment - [387]
Bernstein JA. “Characteristics of nonallergic vasomotor rhinitis.” The World Allergy Organization journal (2009). PMID: 24228982 ↗
L5OTHERCited in: History and Evolution of Treatment - [388]
Gabet S, Rancière F, Just J et al.. “Asthma and allergic rhinitis risk depends on house dust mite specific IgE levels in PARIS birth cohort children.” The World Allergy Organization journal (2019). PMID: 31641405 ↗
L2OTHERCited in: History and Evolution of Treatment - [389]
Sayyeda F, Hyder Ali IA, Harun SN et al.. “Asthma and chronic obstructive disease overlap (ACO), a systematic review of prevalence and co-morbidity factors based on diagnostic criteria.” Journal of pharmaceutical policy and practice (2026). PMID: 42052098 ↗
L2SR_OBSCited in: History and Evolution of Treatment - [390]
Sears MR, Burrows B, Flannery EM et al.. “Relation between airway responsiveness and serum IgE in children with asthma and in apparently normal children.” The New England journal of medicine (1991). PMID: 1891008 ↗
L2OTHERCited in: History and Evolution of Treatment - [391]
Agosti JM, Sprenger JD, Lum LG et al.. “Transfer of allergen-specific IgE-mediated hypersensitivity with allogeneic bone marrow transplantation.” The New England journal of medicine (1988). PMID: 3059190 ↗
L4OTHERCited in: History and Evolution of Treatment - [392]
Huggins KG, Brostoff J. “Local production of specific IgE antibodies in allergic-rhinitis patients with negative skin tests.” Lancet (London, England) (1975). PMID: 49744 ↗
L4OTHERCited in: History and Evolution of Treatment - [393]
Schwartz LB, Bradford TR, Rouse C et al.. “Development of a new, more sensitive immunoassay for human tryptase: use in systemic anaphylaxis.” Journal of clinical immunology (1994). PMID: 7929694 ↗
L5OTHERCited in: History and Evolution of Treatment - [394]
Weissmann S, Amitai N, Honig E et al.. “Gestational Diabetes Mellitus Increases the Risk of Atopic Dermatitis in Children: A National Retrospective Study with Analysis by Treatment Modality.” Dermatology and therapy (2026). PMID: 41975143 ↗
L3COHORTCited in: History and Evolution of Treatment - [395]
Hu L, He W, Li J et al.. “The role of adenoid immune phenotype in polysensitized children with allergic rhinitis and adenoid hypertrophy.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2024). PMID: 38822736 ↗
L4OTHERCited in: History and Evolution of Treatment - [396]
Arasi S, Pajno GB, Lau S et al.. “Local allergic rhinitis: A critical reappraisal from a paediatric perspective.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2016). PMID: 27098888 ↗
L5OTHERCited in: History and Evolution of Treatment - [397]
Dondi A, Tripodi S, Panetta V et al.. “Pollen-induced allergic rhinitis in 1360 Italian children: comorbidities and determinants of severity.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2013). PMID: 24236692 ↗
L4OTHERCited in: History and Evolution of Treatment - [398]
Yavuz ST, Oksel Karakus C, Custovic A et al.. “Four subtypes of childhood allergic rhinitis identified by latent class analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2021). PMID: 34310772 ↗
L4OTHERCited in: History and Evolution of Treatment - [399]
Jiang X, Shen C, Dai Y et al.. “Early food allergy and respiratory allergy symptoms and attention-deficit/hyperactivity disorder in Chinese children: A cross-sectional study.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2018). PMID: 29524252 ↗
L4OTHERCited in: History and Evolution of Treatment - [400]
Nakanishi M, Carbone LFB, Aggarwal V et al.. “Olopatadine plus mometasone for seasonal allergic rhinitis treatment: A pooled analysis of clinical trials.” Brazilian journal of otorhinolaryngology (2026). PMID: 41985293 ↗
L1TRIAL_NONRANDOMCited in: History and Evolution of Treatment - [401]
Weinstein SF, Katial R, Jayawardena S et al.. “Efficacy and safety of dupilumab in perennial allergic rhinitis and comorbid asthma.” The Journal of allergy and clinical immunology (2018). PMID: 29355679 ↗
L1RCTCited in: Complications, Comorbidities & Iatrogenic Risks - [402]
Stuck BA, Hummel T. “Olfaction in allergic rhinitis: A systematic review.” The Journal of allergy and clinical immunology (2015). PMID: 26409662 ↗
L2SR_OBSCited in: Complications, Comorbidities & Iatrogenic Risks - [403]
Dretzke J, Meadows A, Novielli N et al.. “Subcutaneous and sublingual immunotherapy for seasonal allergic rhinitis: a systematic review and indirect comparison.” The Journal of allergy and clinical immunology (2013). PMID: 23557834 ↗
L1SR_OBSCited in: Complications, Comorbidities & Iatrogenic Risks - [404]
Calderón MA, Casale TB, Demoly P. “Validation of Patient-Reported Outcomes for Clinical Trials in Allergic Rhinitis: A Systematic Review.” The journal of allergy and clinical immunology. In practice (2019). PMID: 30797777 ↗
L2TRIAL_NONRANDOMCited in: Complications, Comorbidities & Iatrogenic Risks - [405]
Lai YR, Liao YH, Huang L et al.. “Clinical Effects of Polyphenolic Compounds on Allergic Rhinitis: A Systematic Review and Meta-Analysis.” The journal of allergy and clinical immunology. In practice (2025). PMID: 40618891 ↗
L1SR_OBSCited in: Complications, Comorbidities & Iatrogenic Risks - [406]
Rodrigo GJ, Yañez A. “The role of antileukotriene therapy in seasonal allergic rhinitis: a systematic review of randomized trials.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2006). PMID: 16802764 ↗
L1SR_OBSCited in: Complications, Comorbidities & Iatrogenic Risks - [407]
De Corso E, Cantone E, Galli J et al.. “Otitis media in children: Which phenotypes are most linked to allergy? A systematic review.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2021). PMID: 33336435 ↗
L2SR_OBSCited in: Complications, Comorbidities & Iatrogenic Risks - [408]
Bachert C, Gevaert E. “Advances in rhinitis and rhinosinusitis in 2015.” The Journal of allergy and clinical immunology (2016). PMID: 27817798 ↗
L5REVIEW_NARRATIVECited in: Complications, Comorbidities & Iatrogenic Risks, Prevention, Screening & Surveillance - [409]
Koinis-Mitchell D, Craig T, Esteban CA et al.. “Sleep and allergic disease: a summary of the literature and future directions for research.” The Journal of allergy and clinical immunology (2012). PMID: 22867694 ↗
L5REVIEW_NARRATIVECited in: Complications, Comorbidities & Iatrogenic Risks - [410]
Blaiss MS, Hammerby E, Robinson S et al.. “The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: A literature review.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2018). PMID: 29626629 ↗
L5REVIEW_NARRATIVECited in: Complications, Comorbidities & Iatrogenic Risks - [411]
Santos CB, Pratt EL, Hanks C et al.. “Allergic rhinitis and its effect on sleep, fatigue, and daytime somnolence.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2006). PMID: 17165263 ↗
L5REVIEW_NARRATIVECited in: Complications, Comorbidities & Iatrogenic Risks - [412]
Naclerio RM, Ansotegui IJ, Canonica GW et al.. “Twenty-five years: The fexofenadine clinical experience.” The World Allergy Organization journal (2024). PMID: 39252789 ↗
L5REVIEW_NARRATIVECited in: Complications, Comorbidities & Iatrogenic Risks - [413]
Paoletti G, Giua C, Marti A et al.. “ARIA-Italy managing allergic rhinitis and asthma in a changing world: The role of the Pharmacist.” The World Allergy Organization journal (2025). PMID: 40642300 ↗
L5REVIEW_NARRATIVECited in: Complications, Comorbidities & Iatrogenic Risks, Prevention, Screening & Surveillance - [414]
Guida G, Scelo G, Friston DA et al.. “Longitudinal observation of severe asthma comorbidities and oral corticosteroids use from SANI and ISAR registries.” The World Allergy Organization journal (2026). PMID: 41783626 ↗
L2OTHERCited in: Complications, Comorbidities & Iatrogenic Risks - [415]
Cvetkovski B, Muscat D, Bousquet J et al.. “The future of allergic rhinitis management: A partnership between healthcare professionals and patients.” The World Allergy Organization journal (2024). PMID: 38463017 ↗
L5OTHERCited in: Complications, Comorbidities & Iatrogenic Risks - [416]
Passalacqua G, Canonica GW, Baiardini I. “Rhinitis, rhinosinusitis and quality of life in children.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2007). PMID: 17767607 ↗
L5REVIEW_NARRATIVECited in: Complications, Comorbidities & Iatrogenic Risks - [417]
Georgalas C, Terreehorst I, Fokkens W. “Current management of allergic rhinitis in children.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2009). PMID: 19744219 ↗
L5OTHERCited in: Complications, Comorbidities & Iatrogenic Risks - [418]
Ng CSY, Chan CHY, Fung YL et al.. “Impact of comorbid allergic diseases on health-related quality of life of Hong Kong schoolchildren.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2023). PMID: 37232280 ↗
L2OTHERCited in: Complications, Comorbidities & Iatrogenic Risks - [419]
Wongsa C, Phinyo P, Sompornrattanaphan M et al.. “Efficacy and Safety of House Dust Mite Sublingual Immunotherapy Tablet in Allergic Asthma: A Systematic Review of Randomized Controlled Trials.” The journal of allergy and clinical immunology. In practice (2022). PMID: 35181547 ↗
L1SR_MA_RCTCited in: Prognosis & Natural History - [420]
Layhadi JA, Starchenka S, De Kam PJ et al.. “Modulation of Cellular, Molecular, and Humoral Responses by PQ Grass 27,600 SU for the Treatment of Seasonal Allergic Rhinitis: A Randomised Double Blind Placebo Control Exploratory Field Study.” Allergy (2025). PMID: 40626378 ↗
L1RCTCited in: Prognosis & Natural History - [421]
Bożek A, Kołodziejczyk K, Jarząb J. “Efficacy and safety of birch pollen immunotherapy for local allergic rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2018). PMID: 29273130 ↗
L1RCTCited in: Prognosis & Natural History - [422]
Pastacaldi C, Lewis P, Howarth P. “Staphylococci and staphylococcal superantigens in asthma and rhinitis: a systematic review and meta-analysis.” Allergy (2010). PMID: 21087214 ↗
L2SR_OBSCited in: Prognosis & Natural History - [423]
Anolik R, Schwartz AM, Sajjan S et al.. “Patient initiation and persistence with allergen immunotherapy.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2014). PMID: 24814759 ↗
L2TRIAL_NONRANDOMCited in: Prognosis & Natural History - [424]
Rosario Filho NA, Satoris RA, Scala WR. “Allergic rhinitis aggravated by air pollutants in Latin America: A systematic review.” The World Allergy Organization journal (2021). PMID: 34471459 ↗
L2SR_OBSCited in: Prognosis & Natural History - [425]
Bager P, Wohlfahrt J, Westergaard T. “Caesarean delivery and risk of atopy and allergic disease: meta-analyses.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2008). PMID: 18266879 ↗
L2SR_OBSCited in: Prognosis & Natural History - [426]
Kuper P, Hasenpusch C, Proebstl S et al.. “Timing of complementary feeding for early childhood allergy prevention: An overview of systematic reviews.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2023). PMID: 37779264 ↗
L2SR_OBSCited in: Prognosis & Natural History, Prevention, Screening & Surveillance - [427]
Campbell BE, Lodge CJ, Lowe AJ et al.. “Exposure to 'farming' and objective markers of atopy: a systematic review and meta-analysis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2015). PMID: 25270644 ↗
L2SR_OBSCited in: Prognosis & Natural History, Prevention, Screening & Surveillance - [428]
El Didi HS, Pereira AM, Jácome C et al.. “Control of Allergic Rhinitis and Asthma Test for Children (CARATkids): A systematic review and meta-analysis of its measurement properties.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2025). PMID: 40898383 ↗
L2SR_OBSCited in: Prognosis & Natural History - [429]
Zhang GQ, Liu B, Li J et al.. “Fish intake during pregnancy or infancy and allergic outcomes in children: A systematic review and meta-analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2016). PMID: 27590571 ↗
L2SR_OBSCited in: Prognosis & Natural History - [430]
Rondón C, Bogas G, Barrionuevo E et al.. “Nonallergic rhinitis and lower airway disease.” Allergy (2016). PMID: 27439024 ↗
L5REVIEW_NARRATIVECited in: Prognosis & Natural History - [431]
Bousquet J, Pfaar O, Togias A et al.. “2019 ARIA Care pathways for allergen immunotherapy.” Allergy (2019). PMID: 30955224 ↗
L1REVIEW_NARRATIVECited in: Prognosis & Natural History - [432]
Van Gerven L, Steelant B, Hellings PW. “Nasal hyperreactivity in rhinitis: A diagnostic and therapeutic challenge.” Allergy (2018). PMID: 29624710 ↗
L5REVIEW_NARRATIVECited in: Prognosis & Natural History - [433]
Miliordos K, Triga M, Tranou MK et al.. “Natural history and clinical characteristics of fish-induced food protein-induced enterocolitis syndrome (FPIES) in Greek children.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2026). PMID: 41763605 ↗
L4OTHERCited in: Prognosis & Natural History - [434]
Neuman-Sunshine DL, Eckman JA, Keet CA et al.. “The natural history of persistent peanut allergy.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2011). PMID: 22541403 ↗
L4OTHERCited in: Prognosis & Natural History - [435]
Zhou J, Margiotta FM, Duca ED et al.. “Comorbidities of atopic dermatitis: Emerging evidence and clinical considerations.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2026). PMID: 42009218 ↗
L5REVIEW_NARRATIVECited in: Prognosis & Natural History - [436]
Lou Z, Yang H, Zhao C et al.. “Efficacy and Safety of Simultaneous Bilateral Nasal Cauterization in Pediatric Recurrent Anterior Epistaxis: A Prospective Randomized Controlled Trial.” American journal of rhinology & allergy (2026). PMID: 41940820 ↗
L1RCTCited in: Prognosis & Natural History - [437]
Hansen S, Strøm M, Maslova E et al.. “Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring.” The Journal of allergy and clinical immunology (2016). PMID: 27246522 ↗
L1RCTCited in: Special Populations & Pregnancy - [438]
Ma J, Palmer DJ, Geddes D et al.. “Maternal Allergic Disease Phenotype and Infant Birth Season Influence the Human Milk Microbiome.” Allergy (2024). PMID: 39723602 ↗
L4RCTCited in: Special Populations & Pregnancy - [439]
Prenner BM, Amar NJ, Hampel FC et al.. “Efficacy and safety of GSP301 nasal spray in children aged 6 to 11 years with seasonal allergic rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2022). PMID: 35926824 ↗
L1RCTCited in: Special Populations & Pregnancy - [440]
Storms WW, Segall N, Mansfield LE et al.. “Efficacy and safety of beclomethasone dipropionate nasal aerosol in pediatric patients with seasonal allergic rhinitis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2013). PMID: 24125150 ↗
L1RCTCited in: Special Populations & Pregnancy - [441]
Tareke AA, Hadgu AA, Ayana AM et al.. “Prenatal vitamin D supplementation and child respiratory health: A systematic review and meta-analysis of randomized controlled trials.” The World Allergy Organization journal (2020). PMID: 33294117 ↗
L1SR_MA_RCTCited in: Special Populations & Pregnancy - [442]
Cait A, Wedel A, Arntz JL et al.. “Prenatal antibiotic exposure, asthma, and the atopic march: A systematic review and meta-analysis.” Allergy (2022). PMID: 35689800 ↗
L2SR_OBSCited in: Special Populations & Pregnancy - [443]
Grabenhenrich LB, Keil T, Reich A et al.. “Prediction and prevention of allergic rhinitis: A birth cohort study of 20 years.” The Journal of allergy and clinical immunology (2015). PMID: 25976706 ↗
L2COHORTCited in: Special Populations & Pregnancy, Prevention, Screening & Surveillance - [444]
Penagos M, Compalati E, Tarantini F et al.. “Efficacy of sublingual immunotherapy in the treatment of allergic rhinitis in pediatric patients 3 to 18 years of age: a meta-analysis of randomized, placebo-controlled, double-blind trials.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2006). PMID: 16937742 ↗
L1SR_OBSCited in: Special Populations & Pregnancy - [445]
Bozek A, Ignasiak B, Filipowska B et al.. “House dust mite sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with allergic rhinitis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2013). PMID: 23331565 ↗
L2RCTCited in: Special Populations & Pregnancy - [446]
Yamamoto-Hanada K, Yang L, Ishitsuka K et al.. “Allergic profiles of mothers and fathers in the Japan Environment and Children's Study (JECS): a nationwide birth cohort study.” The World Allergy Organization journal (2017). PMID: 28811862 ↗
L2COHORTCited in: Special Populations & Pregnancy - [447]
Patil VK, Kurukulaaratchy RJ, Venter C et al.. “Changing prevalence of wheeze, rhinitis and allergic sensitisation in late childhood: findings from 2 Isle of Wight birth cohorts 12 years apart.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2015). PMID: 25809555 ↗
L2TRIAL_NONRANDOMCited in: Special Populations & Pregnancy - [448]
Flanigan C, Sheikh A, DunnGalvin A et al.. “Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: A systematic review and meta-analysis.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2018). PMID: 29331049 ↗
L2SR_OBSCited in: Special Populations & Pregnancy - [449]
Venter C, Pickett K, Starling A et al.. “Advanced glycation end product intake during pregnancy and offspring allergy outcomes: A Prospective cohort study.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2021). PMID: 34610188 ↗
L2COHORTCited in: Special Populations & Pregnancy - [450]
Konishi S, Ng CF, Stickley A et al.. “Pollinosis and all-cause mortality among middle-aged and elderly Japanese: a population-based cohort study.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2016). PMID: 26366720 ↗
L2COHORTCited in: Special Populations & Pregnancy - [451]
Lampi J, Canoy D, Jarvis D et al.. “Farming environment and prevalence of atopy at age 31: prospective birth cohort study in Finland.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2011). PMID: 21575087 ↗
L2COHORTCited in: Special Populations & Pregnancy - [452]
Abdel-Aziz MI, Hashimoto S, Neerincx AH et al.. “Metabotypes are linked to uncontrolled childhood asthma, gut microbiota, and systemic inflammation.” The Journal of allergy and clinical immunology (2025). PMID: 40280190 ↗
L2OTHERCited in: Special Populations & Pregnancy - [453]
Hamilos DL. “Chronic rhinosinusitis: epidemiology and medical management.” The Journal of allergy and clinical immunology (2011). PMID: 21890184 ↗
L5REVIEW_NARRATIVECited in: Special Populations & Pregnancy - [454]
Jensen SK, Fischer-Rasmussen K, Eliasen A et al.. “From genotype to phenotype in early childhood asthma.” The Journal of allergy and clinical immunology (2026). PMID: 41500470 ↗
L2OTHERCited in: Special Populations & Pregnancy - [455]
Sultan T, Brustad N, Kyvsgaard JN et al.. “Dominance of IL-5 and CCL17 in nasal cytokine profiles of children with type 2 inflammation.” The Journal of allergy and clinical immunology (2025). PMID: 41352441 ↗
L2OTHERCited in: Special Populations & Pregnancy - [456]
DeBrosse CW, Franciosi JP, King EC et al.. “Long-term outcomes in pediatric-onset esophageal eosinophilia.” The Journal of allergy and clinical immunology (2011). PMID: 21636117 ↗
L3OTHERCited in: Special Populations & Pregnancy - [457]
Pfaller B, Bendien S, Ditisheim A et al.. “Management of allergic diseases in pregnancy.” Allergy (2021). PMID: 34427919 ↗
L5REVIEW_NARRATIVECited in: Special Populations & Pregnancy - [458]
Sastre J. “Ebastine in allergic rhinitis and chronic idiopathic urticaria.” Allergy (2008). PMID: 19032340 ↗
L5REVIEW_NARRATIVECited in: Special Populations & Pregnancy - [459]
Straumann A, Aceves SS, Blanchard C et al.. “Pediatric and adult eosinophilic esophagitis: similarities and differences.” Allergy (2012). PMID: 22313241 ↗
L5REVIEW_NARRATIVECited in: Special Populations & Pregnancy - [460]
Dramburg S, Grittner U, Potapova E et al.. “Heterogeneity of sensitization profiles and clinical phenotypes among patients with seasonal allergic rhinitis in Southern European countries-The @IT.2020 multicenter study.” Allergy (2024). PMID: 38311961 ↗
L4OTHERCited in: Special Populations & Pregnancy - [461]
Leskien M, Thiering E, Yu Z et al.. “Childhood Asthma and Allergy Are Related to Accelerated Epigenetic Aging.” Allergy (2025). PMID: 40346984 ↗
L2OTHERCited in: Special Populations & Pregnancy - [462]
Mustafa SS, Huang J, Perrotta K et al.. “COVID-19 and Pregnancy: Interrelationships With Asthma and Allergy.” The journal of allergy and clinical immunology. In practice (2023). PMID: 37604428 ↗
L5OTHERCited in: Special Populations & Pregnancy - [463]
Gentile D, Bartholow A, Valovirta E et al.. “Current and future directions in pediatric allergic rhinitis.” The journal of allergy and clinical immunology. In practice (2013). PMID: 24565478 ↗
L5REVIEW_NARRATIVECited in: Special Populations & Pregnancy - [464]
Anderson HM, Wood RA, Busse WW. “Dust Mite-Induced Perennial Allergic Rhinitis in Pediatric Patients and Sublingual Immunotherapy.” The journal of allergy and clinical immunology. In practice (2016). PMID: 27665384 ↗
L5REVIEW_NARRATIVECited in: Special Populations & Pregnancy - [465]
Shusterman D, Baroody FM, Craig T et al.. “Role of the Allergist-Immunologist and Upper Airway Allergy in Sleep-Disordered Breathing.” The journal of allergy and clinical immunology. In practice (2016). PMID: 27923646 ↗
L4REVIEW_NARRATIVECited in: Special Populations & Pregnancy - [466]
Bousquet J, Ventura MT, Taborda-Barata L et al.. “Allergic rhinitis in the elderly. In collaboration with ARIA guidelines.” The journal of allergy and clinical immunology. In practice (2026). PMID: 42309322 ↗
L5OTHERCited in: Special Populations & Pregnancy - [467]
Wang HT, Warren CM, Gupta RS et al.. “Prevalence and Characteristics of Shellfish Allergy in the Pediatric Population of the United States.” The journal of allergy and clinical immunology. In practice (2020). PMID: 31917365 ↗
L4OTHERCited in: Special Populations & Pregnancy - [468]
Rachelefsky G, Farrar JR. “Are you comfortable with over-the-counter intranasal steroids for children? A call to action.” The journal of allergy and clinical immunology. In practice (2014). PMID: 24811016 ↗
L5REVIEW_NARRATIVECited in: Special Populations & Pregnancy - [469]
Bozek A, Ignasiak B, Kasperska-Zajac A et al.. “Local allergic rhinitis in elderly patients.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2015). PMID: 25744906 ↗
L4OTHERCited in: Special Populations & Pregnancy - [470]
Hussien H, Moore DL, Nimri S et al.. “The age of eczema onset and multiple food allergies.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2025). PMID: 41349694 ↗
L2OTHERCited in: Special Populations & Pregnancy - [471]
Larenas-Linnemann D, Blaiss M, Van Bever HP et al.. “Pediatric sublingual immunotherapy efficacy: evidence analysis, 2009-2012.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2013). PMID: 23706708 ↗
L1REVIEW_NARRATIVECited in: Special Populations & Pregnancy - [472]
Sherrey J, Biggs S, Dorrian J et al.. “Allergic disease, sleep problems, and psychological distress in children recruited from the general community.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2022). PMID: 35598883 ↗
L4OTHERCited in: Special Populations & Pregnancy - [473]
Ventura MT, Gelardi M, D'Amato A et al.. “Clinical and cytologic characteristics of allergic rhinitis in elderly patients.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2012). PMID: 22374194 ↗
L4OTHERCited in: Special Populations & Pregnancy - [474]
Della Giustina A, Landi M, Bellini F et al.. “Vitamin D, allergies and asthma: focus on pediatric patients.” The World Allergy Organization journal (2014). PMID: 25829979 ↗
L5REVIEW_NARRATIVECited in: Special Populations & Pregnancy, Prevention, Screening & Surveillance - [475]
Imoto Y, Sakashita M, Tokunaga T et al.. “Recent prevalence of allergic rhinitis caused by house dust mites among the pediatric population in Fukui, Japan.” The World Allergy Organization journal (2024). PMID: 39114286 ↗
L4OTHERCited in: Special Populations & Pregnancy - [476]
Lu HY, Chiu CW, Kao PH et al.. “Association between maternal age at delivery and allergic rhinitis in schoolchildren: A population-based study.” The World Allergy Organization journal (2020). PMID: 32612736 ↗
L2OTHERCited in: Special Populations & Pregnancy - [477]
Weissmann S, Amitai N, Honig E et al.. “Maternal type 1 diabetes mellitus and atopic dermatitis in offspring: A nationwide cohort study.” JAAD international (2026). PMID: 42100114 ↗
L2COHORTCited in: Special Populations & Pregnancy - [478]
Merkle T, Curley C, Wambold D et al.. “Association of Nasal and Inhalant Corticosteroids With Pediatric Perioral Dermatitis: A TriNetX Retrospective Cohort Study.” Pediatric dermatology (2026). PMID: 42107964 ↗
L2COHORTCited in: Special Populations & Pregnancy - [479]
Smiley K, Galli L, Grippen Goddard A et al.. “Clinical characteristics, type 2 comorbidities, and treatment responses in pediatric and adult chronic spontaneous urticaria: A multicenter retrospective cohort study.” Allergy and asthma proceedings (2026). PMID: 42050840 ↗
L2COHORTCited in: Special Populations & Pregnancy - [480]
Chia XY, Cai J, Dai D et al.. “Efficacy and safety of Tuina therapy for children with combined allergic rhinitis and asthma syndrome in remission: a randomized controlled trial protocol.” Frontiers in medicine (2026). PMID: 42415810 ↗
L5OTHERCited in: Special Populations & Pregnancy - [481]
Wheatley LM, Wood R, Nadeau K et al.. “Mind the gaps: Clinical trial concepts to address unanswered questions in aeroallergen immunotherapy-An NIAID/AHRQ Workshop.” The Journal of allergy and clinical immunology (2019). PMID: 30731123 ↗
L5TRIAL_NONRANDOMCited in: Prevention, Screening & Surveillance - [482]
Jaakkola MS, Quansah R, Hugg TT et al.. “Association of indoor dampness and molds with rhinitis risk: a systematic review and meta-analysis.” The Journal of allergy and clinical immunology (2013). PMID: 24028857 ↗
L1SR_OBSCited in: Prevention, Screening & Surveillance - [483]
Yepes-Nuñez JJ, Brożek JL, Fiocchi A et al.. “Vitamin D supplementation in primary allergy prevention: Systematic review of randomized and non-randomized studies.” Allergy (2017). PMID: 28675776 ↗
L2SR_OBSCited in: Prevention, Screening & Surveillance - [484]
Venter C, Meyer RW, Greenhawt M et al.. “Role of dietary fiber in promoting immune health-An EAACI position paper.” Allergy (2022). PMID: 35801383 ↗
L5SR_OBSCited in: Prevention, Screening & Surveillance - [485]
Anandan C, Nurmatov U, Sheikh A. “Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis.” Allergy (2009). PMID: 19392990 ↗
L1SR_OBSCited in: Prevention, Screening & Surveillance - [486]
Brick T, Hettinga K, Kirchner B et al.. “The Beneficial Effect of Farm Milk Consumption on Asthma, Allergies, and Infections: From Meta-Analysis of Evidence to Clinical Trial.” The journal of allergy and clinical immunology. In practice (2019). PMID: 31770653 ↗
L2TRIAL_NONRANDOMCited in: Prevention, Screening & Surveillance - [487]
Schmitt J, Schwarz K, Stadler E et al.. “Allergy immunotherapy for allergic rhinitis effectively prevents asthma: Results from a large retrospective cohort study.” The Journal of allergy and clinical immunology (2015). PMID: 26371838 ↗
L2COHORTCited in: Prevention, Screening & Surveillance - [488]
Lo JE, Huang YH, Bhattacharyya N et al.. “Allergic Rhinitis and Keratoconus: A Systematic Review and Meta-Analysis.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38851486 ↗
L2SR_OBSCited in: Prevention, Screening & Surveillance - [489]
Arroyave WD, Rabito FA, Carlson JC et al.. “Impermeable dust mite covers in the primary and tertiary prevention of allergic disease: a meta-analysis.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2014). PMID: 24484971 ↗
L1SR_OBSCited in: Prevention, Screening & Surveillance - [490]
Ellis AK, Tsitoura DC, Quint D et al.. “Safety and pharmacodynamics of intranasal GSK2245035, a TLR7 agonist for allergic rhinitis: A randomized trial.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2017). PMID: 28681506 ↗
L1RCTCited in: Prevention, Screening & Surveillance - [491]
Baumann LM, Romero KM, Robinson CL et al.. “Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2015). PMID: 25059756 ↗
L4TRIAL_NONRANDOMCited in: Prevention, Screening & Surveillance - [492]
Nwaru BI, Ohlsson C, Bygdell M et al.. “Pubertal BMI change and adult-onset asthma in men: Population-based cohort study in Sweden.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2019). PMID: 31732997 ↗
L2COHORTCited in: Prevention, Screening & Surveillance - [493]
Rosas-Salazar C, Gebretsadik T, Seibold MA et al.. “Impact of nasal and inhaled corticosteroids on SARS-CoV-2 infection susceptibility.” The Journal of allergy and clinical immunology (2025). PMID: 40701496 ↗
L2OTHERCited in: Prevention, Screening & Surveillance - [494]
Hong H, Liao S, Chen F et al.. “Role of IL-25, IL-33, and TSLP in triggering united airway diseases toward type 2 inflammation.” Allergy (2020). PMID: 32737888 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [495]
Biedermann T, Winther L, Till SJ et al.. “Birch pollen allergy in Europe.” Allergy (2019). PMID: 30829410 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [496]
Ordak M, Zemelka-Wiacek M, Kosowska A et al.. “Trace Elements in Allergy: Narrative Review.” Allergy (2026). PMID: 42083298 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [497]
Cardona V, Luengo O, Labrador-Horrillo M. “Immunotherapy in allergic rhinitis and lower airway outcomes.” Allergy (2016). PMID: 27439141 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [498]
Schatz M, Sicherer SH, Zeiger RS. “The Journal of Allergy and Clinical Immunology: In Practice 2017 Year in Review.” The journal of allergy and clinical immunology. In practice (2018). PMID: 29397373 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [499]
Pepper AN, Calderón MA, Casale TB. “Sublingual Immunotherapy for the Polyallergic Patient.” The journal of allergy and clinical immunology. In practice (2016). PMID: 27452888 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [500]
Fiocchi A, Cabana MD, Mennini M. “Current Use of Probiotics and Prebiotics in Allergy.” The journal of allergy and clinical immunology. In practice (2022). PMID: 35792336 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [501]
Shaker M, Mauger D, Fuhlbrigge AL. “Value-Based, Cost-Effective Care: The Role of the Allergist-Immunologist.” The journal of allergy and clinical immunology. In practice (2022). PMID: 35944893 ↗
L5OTHERCited in: Prevention, Screening & Surveillance - [502]
Kyvsgaard JN, Hesselberg LM, Sunde RB et al.. “Burden and Subtypes of Early Life Infections Increase the Risk of Asthma.” The journal of allergy and clinical immunology. In practice (2024). PMID: 38609018 ↗
L2OTHERCited in: Prevention, Screening & Surveillance - [503]
Chipps BE, Murphy KR, Oppenheimer J. “2020 NAEPP Guidelines Update and GINA 2021-Asthma Care Differences, Overlap, and Challenges.” The journal of allergy and clinical immunology. In practice (2021). PMID: 34718214 ↗
L5OTHERCited in: Prevention, Screening & Surveillance - [504]
Lau S, Matricardi PM, Wahn U et al.. “Allergy and atopy from infancy to adulthood: Messages from the German birth cohort MAS.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2018). PMID: 29803707 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [505]
Sugita K, Soyka MB, Wawrzyniak P et al.. “Outside-in hypothesis revisited: The role of microbial, epithelial, and immune interactions.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2020). PMID: 32454094 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [506]
Xu H, Wen Y, Zheng H et al.. “Allergic disease and keratoconus: A two-sample univariable and multivariable Mendelian randomization study.” The World Allergy Organization journal (2024). PMID: 39650195 ↗
L2OTHERCited in: Prevention, Screening & Surveillance - [507]
Xu Y, Li Y. “Association between lipid-lowering drugs and allergic diseases: A Mendelian randomization study.” The World Allergy Organization journal (2024). PMID: 38623319 ↗
L2OTHERCited in: Prevention, Screening & Surveillance - [508]
Ai Y, Zhu T, Gan J. “Parental autoimmune diseases and offspring's allergic disease: A systematic review and meta-analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 41930403 ↗
L2SR_OBSCited in: Prevention, Screening & Surveillance - [509]
Islam N, Chu AWL, Sheriff F et al.. “Risk Factors for the Development of Food Allergy in Infants and Children: A Systematic Review and Meta-Analysis.” JAMA pediatrics (2026). PMID: 41661638 ↗
L2SR_OBSCited in: Prevention, Screening & Surveillance - [510]
Liu Y, Ge J, Xu G et al.. “Burden and risk of asthma and rhinitis in people with atopic dermatitis: global estimates from a hierarchical Bayesian model.” The British journal of dermatology (2026). PMID: 41641462 ↗
L2SR_OBSCited in: Prevention, Screening & Surveillance - [511]
Sousa-Pinto B, Jankin S, Vieira RJ et al.. “English tweets on allergy: Content analysis and association with surveillance data.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2024). PMID: 38567657 ↗
L2OTHERCited in: Prevention, Screening & Surveillance - [512]
Shifti DM, Pitt E, Versteegh L et al.. “Mapping the Burden and Risk Factors of Allergic Diseases and Asthma Among Aboriginal and Torres Strait Islander People: A Scoping Review.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2025). PMID: 40836867 ↗
L2REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [513]
Valbert F, Neusser S, Pfaar O et al.. “Care with allergen immunotherapy for allergic respiratory diseases in Germany-Predictors and deficits.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2022). PMID: 35524545 ↗
L4OTHERCited in: Prevention, Screening & Surveillance - [514]
Zhang HW, Chang YT, Kuo YJ et al.. “Androgenetic alopecia risk in allergic rhinitis: A cohort study of immune and antihistamine effects.” The World Allergy Organization journal (2026). PMID: 42028243 ↗
L2COHORTCited in: Prevention, Screening & Surveillance - [515]
Lyu W, Wen Y, Chen L et al.. “Unhealthy sleep patterns and irregular night shift work are associated with increased risk of allergic rhinitis: a large prospective cohort study.” BMC public health (2026). PMID: 41776521 ↗
L2COHORTCited in: Prevention, Screening & Surveillance - [516]
Tham EH, Rajakulendran M, Lee BW et al.. “Epicutaneous sensitization to food allergens in atopic dermatitis: What do we know?” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2019). PMID: 31541586 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening & Surveillance - [517]
Kaplan F, Gülyüz A. “Mucous Stools in Infancy as an Early Marker of the Atopic March: A Four-Year Cohort Study of Respiratory Atopy Risk.” Children (Basel, Switzerland) (2026). PMID: 41749622 ↗
L2COHORTCited in: Prevention, Screening & Surveillance - [518]
Thomander T, Gil-Mata S, Riera-Serra P et al.. “Efficacy and safety of oral treatments for allergic rhinitis in children: A network meta-analysis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42596864 ↗
L1aCited in: Definition, Classification & Hypersensitivity Mechanism Type - [519]
Esmaeel SE, Alanazi RIS, Albladi OOA et al.. “Efficacy and safety of nasal saline irrigation for allergic rhinitis in children and adolescents: A systematic review and meta-analysis with GRADE assessment.” International journal of pediatric otorhinolaryngology (2026). PMID: 42579992 ↗
L1aCited in: Definition, Classification & Hypersensitivity Mechanism Type - [520]
Ranasinghe S, Berger X, Kimita W et al.. “A Novel Device to Improve the Tolerability of Intranasal Corticosteroid Sprays for Allergic Rhinitis and Postoperative Chronic Rhinosinusitis: A Crossover Trial.” Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (2026). PMID: 42363677 ↗
L1bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [521]
Teng ZP, Han QQ, Shen XF. “Haemophilus abundance is associated with response to sublingual immunotherapy in children with allergic rhinitis.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42487293 ↗
L4Cited in: Definition, Classification & Hypersensitivity Mechanism Type - [522]
Lee JK, Lee HW, Lee CH et al.. “Persistent Airflow Limitation in Asthma: Clinical Characteristics, Risk Factors, and Long-term Outcomes from a Multicenter Cohort Study.” Journal of asthma and allergy (2026). PMID: 42445813 ↗
L2bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [523]
Kan D, Cheng H, Zhou Q. “Prevalence and Associated Factors of Eustachian Tube Dysfunction in Allergic Rhinitis with Middle-Ear Disease-Related Outcomes: A Systematic Review and Meta-analysis.” International archives of allergy and immunology (2026). PMID: 42579640 ↗
L2aCited in: Definition, Classification & Hypersensitivity Mechanism Type - [524]
Petre AM, Costin R, Anghel I. “Allergic Rhinitis and Allergic Sensitization in Pediatric Otitis Media with Effusion: A Systematic Review and Meta-Analysis with Narrative Synthesis of Eustachian Tube Dysfunction.” Children (Basel, Switzerland) (2026). PMID: 42509917 ↗
L2aCited in: Definition, Classification & Hypersensitivity Mechanism Type - [525]
Gonzalez-Uribe V, Prieto-Gomez J, Moreno-Castro S et al.. “Early and longitudinal response to sublingual immunotherapy across pediatric allergic multimorbidity patterns: A 3-year real-world cohort study.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42596760 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [526]
Berkun Y, Magen E, Merzon E et al.. “Allergic but not autoimmune comorbidities in children with PFAPA: A nationwide matched case-control cohort study.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42452886 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [527]
Choudhary H, Kaur H, R S et al.. “Fractional Exhaled Nitric Oxide Cut-off Values for Discriminating Asthma Exacerbation and Control in Indian Children with Coexisting Allergic Rhinitis: A Prospective Observational Cohort Study.” Indian journal of pediatrics (2026). PMID: 42536317 ↗
L2bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [528]
Pu S, Zhu Y, Zhou J et al.. “Nasopharyngeal swab transcriptomics identifies divergent molecular signatures in adenoid hypertrophy and allergic rhinitis comorbidity.” Frontiers in immunology (2026). PMID: 42591655 ↗
L4Cited in: Definition, Classification & Hypersensitivity Mechanism Type - [529]
Cui L, Li L, Li J et al.. “Relative contributions of environmental pollen exposure and host susceptibility to Artemisia-related sensitisation and allergy in a high-exposure region of Northern China: a population-based cross-sectional study.” Frontiers in immunology (2026). PMID: 42564215 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [530]
Sha L, Ye S, Li T et al.. “Clinical characteristics and associated factors of airway allergic diseases among children: a cross-sectional study in a district of Beijing.” Frontiers in public health (2026). PMID: 42535047 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [531]
Torun T, Baris HE, Us MC et al.. “Allergic diseases and early childhood insomnia: A cross-sectional study.” Sleep medicine (2026). PMID: 42531837 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [532]
Dumycz K, Zygadło J, Panczyk M et al.. “Phenotypes of atopic dermatitis in Polish children-Latent class analysis of cross-sectional questionnaire-based study.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42400111 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [533]
Yang J, Ma N, Tian F et al.. “Development and validation of the childhood allergy comprehensive screening questionnaire and Its application in a cross-sectional survey of allergic diseases among children aged 0-6 Years in Shanghai, China.” Frontiers in public health (2026). PMID: 42591591 ↗
L4Cited in: Definition, Classification & Hypersensitivity Mechanism Type - [534]
Yan B, Fang H. “Low-temperature plasma adenoidectomy versus conservative treatment for children with adenoid hypertrophy and allergic rhinitis: A non-randomized observational study.” Science progress (2026). PMID: 42549919 ↗
L1bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [535]
Du H, Lu S, Cai D et al.. “Efficacy and safety of press-needle therapy for allergic rhinitis in children: A systematic review and meta-analysis.” International journal of pediatric otorhinolaryngology (2026). PMID: 42503260 ↗
L1aCited in: Pathophysiology & Immune Mechanism - [536]
Deng B, Zhao Y, Liu J. “Impact of sublingual immunotherapy with dust mite drops on ECP, TARC, VCAM-1 inflammatory status in patients with allergic rhinitis.” Immunotherapy (2026). PMID: 42550205 ↗
L1bCited in: Pathophysiology & Immune Mechanism - [537]
Altamirano-Jara JB, Acosta-España JD, Zambrano LI et al.. “The Dermatologic Burden of Flooding: A Systematic Review of Epidemiology, Clinical Manifestations, and Management in a Warming World.” International journal of dermatology (2026). PMID: 42467553 ↗
L2aCited in: Pathophysiology & Immune Mechanism - [538]
Zhu KZ, He C, Zhu SZ et al.. “Enhanced Early Detection of Allergic Rhinitis: A Prospective Study on a Symptom-Based Predictive Model.” World journal of otorhinolaryngology - head and neck surgery (2026). PMID: 42500099 ↗
L2bCited in: Pathophysiology & Immune Mechanism - [539]
Koyama K, Kidoguchi M, Adachi N et al.. “Nasal Corynebacterium depletion is associated with polysensitization to inhalant allergens in adults.” Allergology international : official journal of the Japanese Society of Allergology (2026). PMID: 42595650 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [540]
Yılmaz E, Köker Özer N, Topal E. “Exercise-Induced Bronchoconstriction in Non-Asthmatic Children with Moderate-to-Severe Persistent Allergic Rhinitis Undergoing Subcutaneous Allergen Immunotherapy: Prevalence and Risk Factors.” Journal of clinical medicine (2026). PMID: 42590047 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [541]
Al-Ahmad M, Ali A, Talat W. “Impact of Overweight and Obesity in Severe Asthma Patients and Its Influence on Achieving Clinical Remission.” Journal of asthma and allergy (2026). PMID: 42518874 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [542]
Wang WH, Luo X, Xiao ZH et al.. “Association of Cat Sensitization With Comorbid Asthma in Patients With Allergic Rhinitis: A Real-World Study.” World journal of otorhinolaryngology - head and neck surgery (2026). PMID: 42500084 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [543]
Yılmaz E, Topal E. “Small Airway Dysfunction Assessed by Impulse Oscillometry in Non-Asthmatic Children with Moderate-to-Severe Persistent Allergic Rhinitis During the Early Phase of Allergen Immunotherapy.” Journal of clinical medicine (2026). PMID: 42513532 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [544]
Wang Z, Lu Y. “Efficacy of probiotics on immunological and clinical outcomes in allergic rhinitis: an umbrella review and updated meta-analysis of RCTs in children and adults.” BMC immunology (2026). PMID: 42469658 ↗
L1aCited in: Pathophysiology & Immune Mechanism - [545]
Çelik E, Yüksel Bulut H. “Respiratory Pathogens and Clinical Characteristics of Asthma Exacerbations in Hospitalized Children at a Tertiary Hospital in Türkiye.” Children (Basel, Switzerland) (2026). PMID: 42509879 ↗
L4Cited in: Pathophysiology & Immune Mechanism - [546]
Tang Z, Zhao Y. “Case Report: Bullous erythema multiforme induced by omalizumab.” Frontiers in medicine (2026). PMID: 42539369 ↗
L4Cited in: Pathophysiology & Immune Mechanism - [547]
Bhatnagar K, Bartho M, Pua E et al.. “The Impact of Septorhinoplasty on Work Productivity and Activity Impairment: A Multi-Institutional, Prospective Cohort.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2026). PMID: 42549734 ↗
L2bCited in: Epidemiology, Etiology & Risk Factors - [548]
Liu J, Lodge CJ, Perret JL et al.. “FEF25-75% trajectories from age 7 to 53 years, associations with childhood and parental preconception factors, and midlife COPD risk: a prospective cohort study.” The Lancet. Respiratory medicine (2026). PMID: 42480573 ↗
L2bCited in: Epidemiology, Etiology & Risk Factors - [549]
Walker K, Valencia-Sanchez BA, Wilson P et al.. “Incidence of Chronic Rhinosinusitis in Patients Who Receive Rituximab.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2026). PMID: 42605935 ↗
L3bCited in: Epidemiology, Etiology & Risk Factors - [550]
Su JA, Chang SJ, Yang YH et al.. “Association of maternal depression and antidepressant use during pregnancy with child allergic risk: A nationwide cohort study.” Psychiatry research (2026). PMID: 42585799 ↗
L3bCited in: Epidemiology, Etiology & Risk Factors - [551]
Silverberg JI, Martins B, Du M et al.. “Healthcare resource utilization and costs in pediatric patients under 6 years old with atopic dermatitis in the United States: A retrospective, observational, cross-sectional study.” JAAD international (2026). PMID: 42564562 ↗
L3bCited in: Epidemiology, Etiology & Risk Factors - [552]
Koriyama M, Okamoto Y, Kurokawa T et al.. “Real-world clinical practice and economic burden of seasonal allergic rhinitis in Japan: A nationwide claims database study.” Allergology international : official journal of the Japanese Society of Allergology (2026). PMID: 42538191 ↗
L3bCited in: Epidemiology, Etiology & Risk Factors - [553]
Azzi A, Alotaibi AS, Alamri MS et al.. “The Efficacy of Probiotics in Treating Upper Respiratory Tract Infections, Allergic Rhinitis, and Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.” Microorganisms (2026). PMID: 42197372 ↗
L1aCited in: Clinical Presentation - [554]
Wang J, Zhu X, Ding Z. “Predicting sublingual immunotherapy efficacy in allergic rhinitis.” BMC pulmonary medicine (2026). PMID: 42265665 ↗
L1bCited in: Clinical Presentation - [555]
Ripp AT, Patel PA, Nguyen SA et al.. “Variations in the Severity of Rhinitis Symptoms: A Systematic Review and Meta-Analysis.” World journal of otorhinolaryngology - head and neck surgery (2025). PMID: 42500067 ↗
L4Cited in: Clinical Presentation - [556]
O'Connor MB, Patel RD, Soltani H et al.. “Congenital Ichthyosis is Associated with Increased Risk of Allergic Disorders.” The Journal of allergy and clinical immunology (2026). PMID: 42562187 ↗
L3bCited in: Clinical Presentation - [557]
Aremu S. “Chronic Humidity and Nasal Mucosal Dysfunction in Tropical Climates: Implications for Sinonasal Health in Sub-Saharan Africa and the Developing World - A Systematic Review.” Nigerian journal of physiological sciences : official publication of the Physiological Society of Nigeria (2026). PMID: 42537028 ↗
L1aCited in: Clinical Presentation - [558]
Zhao J, Wang Z, Wang Y et al.. “Allergy burden score and lung function impairment in children with asthma: a dose-response cross-sectional study.” European journal of pediatrics (2026). PMID: 42337151 ↗
L3bCited in: Clinical Presentation - [559]
Wang W, Wang J, Song G et al.. “Trends in Asthma-Rhinitis Allergic Multimorbidity and Polysensitization in China: The CARRAD Study.” MedComm (2026). PMID: 42253935 ↗
L3bCited in: Clinical Presentation - [560]
Pfaar O, Demoly P, Gevaert P et al.. “Steroid Sparing Effect of 300IR House Dust Mite Sublingual Immunotherapy Tablet in Mite Allergic Rhinitis.” Clinical and translational allergy (2026). PMID: 42579775 ↗
L1bCited in: Severity, Grading & Risk Stratification - [561]
Siewert J, Cramer H, Ortiz M et al.. “Homeopathic medication for seasonal allergic rhinitis-a randomised placebo-controlled trial.” Frontiers in allergy (2026). PMID: 42539590 ↗
L1bCited in: Severity, Grading & Risk Stratification - [562]
Gagnon R, Dalgaard T, Ortving GS et al.. “Efficacy and safety of the tree sublingual immunotherapy tablet in the subpopulation of Canadian children with allergic rhinitis and/or conjunctivitis: phase III trial results.” Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology (2026). PMID: 42432760 ↗
L1bCited in: Severity, Grading & Risk Stratification - [563]
Salimi S, Amiri S, Karimi SA et al.. “Effect of glucocorticoids on smell sensation in patients with non-traumatic olfactory disorders: a systematic review and meta-analysis.” European journal of clinical pharmacology (2026). PMID: 42507165 ↗
L2aCited in: Severity, Grading & Risk Stratification - [564]
Hou Y, Zhang Q, Xu X et al.. “Effects of vitamin D levels and vitamin D supplementation on allergic diseases: an umbrella review.” Frontiers in allergy (2026). PMID: 42445461 ↗
L2aCited in: Severity, Grading & Risk Stratification - [565]
Olsen RF, Svendsen K, Graf T et al.. “Birch Rust Spore Exposure and Upper Airway Symptom Dynamics in a Subarctic Region: Indications for a Novel Seasonal Allergen.” Clinical and translational allergy (2026). PMID: 42572169 ↗
L3bCited in: Severity, Grading & Risk Stratification - [566]
Liu B, Hu S, Xiao M. “Improvement in nasal signs and eosinophils following 3 years of sublingual immunotherapy for allergic rhinitis.” Frontiers in immunology (2026). PMID: 42131321 ↗
L3bCited in: Acute Management & Anaphylaxis Pathway - [567]
Lourenço-Silva N, Sousa-Pinto B, Bognanni A et al.. “Comparison of Allergic Rhinitis Treatments on Utilities and Quality of Life: A MASK-air Study.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2026). PMID: 42087806 ↗
L3bCited in: Acute Management & Anaphylaxis Pathway - [568]
Magen E, Magen I, Merzon E et al.. “Comorbidity burden in patients with anaphylaxis: A 25-year nationwide population-based matched case-control study.” Allergy and asthma proceedings (2026). PMID: 42050834 ↗
L2bCited in: Acute Management & Anaphylaxis Pathway - [569]
Lim MN, Park JS, Kwon JW. “How Pregnancy Affects Asthma in Korea: Risk Factors and Adherence Decline.” Allergy, asthma & immunology research (2026). PMID: 42223035 ↗
L3bCited in: Acute Management & Anaphylaxis Pathway - [570]
Zhang H, Li X, Guo T et al.. “Knowledge, attitudes, and practices regarding intranasal corticosteroid use in adult outpatients with allergic rhinitis: a cross-sectional study in Sichuan Province, China.” Frontiers in public health (2026). PMID: 42205446 ↗
L3bCited in: Acute Management & Anaphylaxis Pathway - [571]
Liu J, Pang S, Lu Y et al.. “Multi-target mechanisms of Chinese herbal medicine in the treatment of allergic rhinitis.” Journal of ethnopharmacology (2026). PMID: 42061564 ↗
L1aCited in: Acute Management & Anaphylaxis Pathway - [572]
Nurpeissov T, Tabynov K, Zhubanturliyeva A et al.. “Ultra-short recombinant Art v 1 immunotherapy induces rapid immune modulation in mugwort allergy: A Phase I trial.” Allergology international : official journal of the Japanese Society of Allergology (2026). PMID: 42336691 ↗
L4Cited in: Acute Management & Anaphylaxis Pathway - [573]
Li L, Xu Y, Bian S et al.. “Comparison of the efficacy of different doses of omalizumab (150 mg vs 300 mg) in patients with seasonal allergic rhinitis and low total IgE: A randomized, double-blind, controlled study.” The World Allergy Organization journal (2026). PMID: 42256022 ↗
L1bCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [574]
Luan H, Gao S, Ma Y et al.. “Interleukin-Mediated Macrophage Polarization in Allergic Rhinitis Inflammation: A Systematic Review.” Journal of inflammation research (2026). PMID: 42445359 ↗
L2aCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [575]
Zhou W, Guo X, Ding B et al.. “Impact of Allergen-Specific Subcutaneous Immunotherapy on 12-Month Health-Related Quality of Life in Children and Their Parental Caregivers.” Allergy, asthma & immunology research (2026). PMID: 42547470 ↗
L3bCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [576]
Wang Q, Dong X, Zhu S et al.. “Comorbidity of Allergic Asthma and Rhinitis and High Allergen-Specific IgE are Risk Factors for Systemic Reactions to House Dust Mite Immunotherapy in Children.” Journal of asthma and allergy (2026). PMID: 42326971 ↗
L4Cited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [577]
Máspero JF, Arnaout RK, Vargas-Ramírez L et al.. “Baseline Characteristics of Patients with Asthma Initiating Dupilumab in a Real-World Setting: The REVEAL Registry.” Advances in therapy (2026). PMID: 42268495 ↗
L3bCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [578]
Carucci L, Nocerino R, Cantone E et al.. “Allergic rhinitis and nasal septum deviation in children: cause, consequence, or bidirectional relationship? Insights from the ARHINASD study.” Frontiers in medicine (2026). PMID: 42328578 ↗
L3bCited in: History and Evolution of Treatment - [579]
Yu L, Zhang P, Shang X et al.. “Knowledge, Attitudes, and Practices on Allergic Rhinitis Environmental Control and Treatment in China.” Journal of asthma and allergy (2026). PMID: 42403891 ↗
L3bCited in: History and Evolution of Treatment - [580]
Atar Bese S, Mercan A, Koksal ZG et al.. “Medium-term pulmonary outcomes (<6 months) after pediatric COVID-19 infection evaluated using impulse oscillometry and spirometry.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42086504 ↗
L4Cited in: History and Evolution of Treatment - [581]
Janeczek K, Grzegorzewska W, Zarobkiewicz M et al.. “Intervention with Polyvalent Bacterial Lysate Modulates T Helper Cell Subsets in Polish Children with Grass Pollen-Induced Allergic Rhinitis.” Biomedicines (2026). PMID: 42512095 ↗
L1bCited in: Complications, Comorbidities & Iatrogenic Risks - [582]
Ovadia A, Gavze RP, Lev-Shalem L et al.. “Familial Mediterranean Fever Is Associated with Higher Atopic Morbidity: Evidence from a Country-Wide Case-Control Study.” The journal of allergy and clinical immunology. In practice (2026). PMID: 42492811 ↗
L3bCited in: Complications, Comorbidities & Iatrogenic Risks - [583]
Goh SLE, Yang JX, Kan SJ et al.. “Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on allergic rhinitis - diagnosis and management.” Singapore medical journal (2026). PMID: 42434879 ↗
L1cCited in: Complications, Comorbidities & Iatrogenic Risks - [584]
Song Z, He J, Li S et al.. “Persistence and Reasons for Discontinuation of Subcutaneous Immunotherapy in Children with Dust Mite Allergy: A Real-World Cohort from Hangzhou, China.” Journal of asthma and allergy (2026). PMID: 42109536 ↗
L3bCited in: Prognosis & Natural History - [585]
Simamura A, Sato S, Matsuoka T et al.. “Skin symptoms during the pollen seasons and their association with the severity of seasonal allergic rhinitis in Yamanashi, Japan.” Allergology international : official journal of the Japanese Society of Allergology (2026). PMID: 42309866 ↗
L3bCited in: Prognosis & Natural History - [586]
Zou H, Han P, Yin J et al.. “Follow-up study on factors influencing the persistence of asthma in discharged children.” BMC pediatrics (2026). PMID: 42471639 ↗
L3bCited in: Prognosis & Natural History - [587]
Tu J, Li J, Xie Q et al.. “Hospital-based patterns of allergen sensitization among 19,787 patients with suspected allergic diseases in Ningbo, China.” Frontiers in public health (2026). PMID: 42110272 ↗
L3bCited in: Prevention, Screening & Surveillance - [588]
Jia J, Yuan X, Liu L et al.. “Age-Related Differences in Efficacy and Safety of Subcutaneous Immunotherapy in Allergic Rhinitis: A Real-World Study.” OTO open (2026). PMID: 41948692 ↗
L3bCited in: Prevention, Screening & Surveillance - [589]
Kiatvitchukul T, Dokkham P, Jeephet K et al.. “Understanding recurrent wheezing: A parent's guide.” World journal of clinical pediatrics (2026). PMID: 41884034 ↗
L3bCited in: Prevention, Screening & Surveillance - [590]
Zhou Z, Ren Q, Tang H et al.. “Associations of mixed exposure to family hygiene practices, indoor ventilation, and device use with childhood allergic diseases: A cross-sectional study in Wuhan, China.” Journal of exposure science & environmental epidemiology (2026). PMID: 42082716 ↗
L3bCited in: Prevention, Screening & Surveillance - [591]
Xu Q, Zhao H, Dong Y et al.. “Polysensitization Patterns and Age-Dependent Allergen Profiles in Children from Suzhou, China: A Component-Resolved Cross-Sectional Study.” Journal of asthma and allergy (2026). PMID: 41868538 ↗
L3bCited in: Prevention, Screening & Surveillance - [592]
Guo S, Wang K, Shi Y et al.. “Efficacy of house dust mite allergen immunotherapy in allergic rhinitis: a network meta-analysis based on component-resolved classification.” Frontiers in immunology (2026). PMID: 42755948 ↗
L1aCited in: Definition, Classification & Hypersensitivity Mechanism Type - [593]
Oh J, Choi JH. “Efficacy of Histaglobulin in Allergic Diseases: A Systematic Review and Meta-Analysis with Implications for Allergic Rhinitis.” International journal of molecular sciences (2026). PMID: 42737649 ↗
L1aCited in: Definition, Classification & Hypersensitivity Mechanism Type - [594]
Yang M, Wang Y, Hu DD et al.. “Clinical characteristics and epidemiology of pediatric cow's milk protein allergy: a multicenter cohort study in urban China.” World journal of pediatrics : WJP (2026). PMID: 42631899 ↗
L2bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [595]
Sokay A, Burke S, Iatan M et al.. “Atopic outcomes at 5 years in the CORAL cohort born during the 2020 COVID-19 lockdown.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42748042 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [596]
Álvaro-Lozano M, Martínez-Cañavate AM, Carballada F et al.. “Exposome-driven molecular sensitization signatures in pediatric rhinitis and asthma across Spanish regions.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42748005 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [597]
Dramburg S, Hernandez Toro CJ, Grittner U et al.. “Classification of Seasonal Allergic Rhinitis Patients by Prospective Patient-Recorded Symptoms: The @IT.2020 Project.” Allergy (2026). PMID: 42684055 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [598]
Chacón P, Domínguez-Cereijo L, Doukkali B et al.. “Elucidating molecular mechanisms of allergic sensitization to olive pollen through transcriptomics.” Frontiers in immunology (2026). PMID: 42761069 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [599]
Zheng P, Zhang Y, Bian X et al.. “A circulating odd-chain fatty acid biomarker signature discriminates pediatric allergic rhinitis with asthma from related allergic airway phenotypes.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42748054 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [600]
Heo Y, Lee S, Kim OJ et al.. “Urinary metal concentrations in Korean preschool children: Elevated levels and associations with allergic rhinitis in the 5th Korean National Environmental Health Survey.” International journal of hygiene and environmental health (2026). PMID: 42546458 ↗
L3bCited in: Definition, Classification & Hypersensitivity Mechanism Type - [601]
Yang C, Yee SS, Feng H et al.. “Animal models of allergic rhinitis: current progress and advances in traditional Chinese medicine syndrome models.” Frontiers in allergy (2026). PMID: 42656229 ↗
L2aCited in: Pathophysiology & Immune Mechanism - [602]
Zeng Z, Gao R, Chen Y et al.. “A hidden risk factor for residual mouth breathing in children after adenotonsillectomy: airborne allergen sensitization.” Sleep & breathing = Schlaf & Atmung (2026). PMID: 42667328 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [603]
Chiner E, Boira I, Antón M et al.. “Real-World Effectiveness of Dupilumab in Severe Uncontrolled Asthma: Clinical Remission on Treatment, Predictors of Complete Response and Impact on Type-2 Comorbidities.” Journal of clinical medicine (2026). PMID: 42652833 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [604]
Zhang Y, Liu P, Yang F et al.. “Allergen extract-based sensitization patterns in mono-sensitized versus multi-sensitized patients with allergic rhinitis in Ningxia, China.” Frontiers in allergy (2026). PMID: 42741002 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [605]
Kuzucu FN, Genis C, Yorusun G et al.. “Correlation between IMMULITE-measured grass panel specific immunoglobulin E levels and grass pollen skin-prick test reactivity in children.” Allergy and asthma proceedings (2026). PMID: 42698165 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [606]
Jung S, Yoon J, Hong K et al.. “Associations of Comorbid Atopic Dermatitis, Food Allergy, and Respiratory Allergic Diseases with Somatic Problems in Children: A Birth Cohort Study.” Children (Basel, Switzerland) (2026). PMID: 42650357 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [607]
Cao RY, He WC, Yu YB et al.. “Pulmonary function and risk factors in pediatric chest tightness variant asthma: a case-control study.” Frontiers in pediatrics (2026). PMID: 42643582 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [608]
Li Q, Gao H, Wang Z et al.. “Correlation Analysis Between Increased CD63 Expression Detected by Eosinophil Activation Test and sIgE Levels.” Scandinavian journal of immunology (2026). PMID: 42713623 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [609]
Liu MY, Yao HB, Chen C. “Mechanism of RNA-Binding Protein ELAVL1 in Promoting Th2 Cell Differentiation Through Stabilizing CPA3 mRNA in Allergic Rhinitis.” The Kaohsiung journal of medical sciences (2026). PMID: 42687110 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [610]
Ye F, Ni M, Liu Y et al.. “Unveiling four sensitization patterns among sensitized U.S. participants: Associations with allergic disease outcomes.” Allergy and asthma proceedings (2026). PMID: 42698171 ↗
L3bCited in: Pathophysiology & Immune Mechanism - [611]
Guo CF, Wang Y, Wang YN et al.. “Advances in the role of house dust mite allergen components in the pathogenesis of allergic diseases.” Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi (2026). PMID: 42760190 ↗
L5Cited in: Pathophysiology & Immune Mechanism - [612]
Jung J, Lee H, Park S. “Rhinitis, sinusitis, and risk of dementia: A systematic review and meta-analysis.” Neuroepidemiology (2026). PMID: 42709657 ↗
L2aCited in: Epidemiology, Etiology & Risk Factors - [613]
Vroman F, Bacos-Cosma OI, Loman L et al.. “Long-Term Effectiveness, Safety, and Survival of Dupilumab in Pediatric Atopic Dermatitis.” JAMA dermatology (2026). PMID: 42747813 ↗
L2bCited in: Epidemiology, Etiology & Risk Factors - [614]
Butt FR, Dhivagaran T, Miller T et al.. “Cumulative Atopic Disease Burden and Keratoconus: Cross-Sectional and Longitudinal Associations in the All of Us Research Program.” American journal of ophthalmology (2026). PMID: 42700830 ↗
L2bCited in: Epidemiology, Etiology & Risk Factors - [615]
Kaplan F, Gülyüz A, Kurnaz Kaplan B. “Association of Parental Health Literacy with Treatment Adherence and Clinical Outcomes in Adolescents with Allergic Rhinitis: A Controlled Longitudinal Study.” Journal of clinical medicine (2026). PMID: 42739663 ↗
L3bCited in: Epidemiology, Etiology & Risk Factors - [616]
Jia X, Liu L, Yang Y. “Long-term intranasal corticosteroids vs. antihistamines and bone health in post-menopausal women with allergic rhinitis: a retrospective cohort study.” Frontiers in medicine (2026). PMID: 42639057 ↗
L3bCited in: Epidemiology, Etiology & Risk Factors - [617]
Uccella S, Casprini C, Scaggiante G et al.. “Hair Dyes in Pregnancy: A Systematic Review and Meta-Analysis.” Journal of pregnancy (2026). PMID: 42681959 ↗
L2aCited in: Clinical Presentation - [618]
Tran TTH, Dao TD, Doan XL. “Evidence Synthesis of Probiotic Supplementation for Allergic Rhinitis in Adults: A Systematic Review and Network Meta-Analysis.” American journal of rhinology & allergy (2026). PMID: 42658561 ↗
L1aCited in: Severity, Grading & Risk Stratification - [619]
Salimi S, Hamidi A, Babajani MM et al.. “Symptomatic Interventions for Allergic Rhinitis Without Comorbid Asthma: A Dose-Stratified Network Meta-analysis.” Clinical drug investigation (2026). PMID: 42763361 ↗
L1aCited in: Severity, Grading & Risk Stratification - [620]
Li J, Wang M, Zhang X et al.. “Efficacy, safety, and pharmacokinetics of pumecitinib nasal spray for moderate-to-severe seasonal allergic rhinitis: a multicentre, double-blind, randomised, placebo-controlled, phase 2 trial.” The Lancet regional health. Western Pacific (2026). PMID: 42656228 ↗
L2bCited in: Severity, Grading & Risk Stratification - [621]
Göker AE, Aksungur E, Çelik C et al.. “Effects of intranasal antihistaminic and corticosteroid therapies on olfactory dysfunction in adults with perennial allergic rhinitis: a prospective comparative study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026). PMID: 42642529 ↗
L2bCited in: Severity, Grading & Risk Stratification - [622]
Allen DZ, Skaribas EE, Bandi A et al.. “The Effect of Radiofrequency Ablation of Posterior Nasal Nerves on Inflammatory Cytokines, Peak Nasal Inspiratory Flow, and Subjective Symptom Scores in Chronic Rhinitis: A Prospective Clinical Trial.” The Annals of otology, rhinology, and laryngology (2026). PMID: 42105251 ↗
L2bCited in: Acute Management & Anaphylaxis Pathway - [623]
Bäuerle M, Maurer J, Pokryszka J et al.. “Prevalence of dysphagia and eosinophilic esophagitis in patients with inflammatory bowel disease or type 2 inflammation: a cross-sectional multicenter screening study.” Therapeutic advances in gastroenterology (2026). PMID: 42668855 ↗
L4Cited in: Acute Management & Anaphylaxis Pathway - [624]
Matsushita R, Tanaka-Mizuno S, Kawakami K. “Antidepressant initiation after sublingual immunotherapy in Japanese cedar pollinosis: a real-world propensity score-matched cohort study.” Current medical research and opinion (2026). PMID: 42669179 ↗
L3bCited in: Acute Management & Anaphylaxis Pathway - [625]
Smith SS, Kaefer SL, Duvvuru H et al.. “Biologics Adoption in CRSwNP and the Associated Decline in Endoscopic Sinus Surgery: A Longitudinal Claims Database Study.” International forum of allergy & rhinology (2026). PMID: 42643130 ↗
L3bCited in: Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics - [626]
Chatmaitri S, Boonnijasin O, Wisitsartkul A et al.. “As-needed vs regular intranasal corticosteroid therapy in pediatric perennial allergic rhinitis: A randomized double-dummy trial.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2026). PMID: 42617693 ↗
L1bCited in: Complications, Comorbidities & Iatrogenic Risks - [627]
Ciprandi G, La Mantia I, Varricchio A. “Azelastine-Fluticasone Intranasal Combination Therapy in Otorhinolaryngology: Clinical Evidence, Current Practice Patterns and Future Perspectives.” Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (2026). PMID: 42686353 ↗
L1bCited in: Complications, Comorbidities & Iatrogenic Risks - [628]
Kim MS, Jung HJ, Park SK et al.. “Clinical Factors Affecting the Surgical Outcomes of Endoscopic Dacryocystorhinostomy.” Journal of clinical medicine (2026). PMID: 42652615 ↗
L3bCited in: Complications, Comorbidities & Iatrogenic Risks - [629]
Kennedy DW, Cheng L, Wang DY. “Safety, Efficacy, and Mechanism of Action of Budesonide in Rhinitis and Rhinosinusitis: A Systematic Review.” World journal of otorhinolaryngology - head and neck surgery (2026). PMID: 42662515 ↗
L2aCited in: Prognosis & Natural History