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
- ▸Allergic rhinitis is a type I IgE-mediated hypersensitivity of the nasal mucosa affecting 10-40% of the population and is a major risk factor for asthma.
- ▸ARIA classification divides disease by symptom frequency (intermittent vs persistent) and severity (mild vs moderate-severe); seasonal and perennial categories reflect trigger exposure patterns.
- ▸Local allergic rhinitis (LAR) is a distinct phenotype with local IgE production and positive nasal provocation despite negative systemic allergy testing, affecting up to 25% of rhinitis patients.
Allergic rhinitis (AR) is an IgE‑mediated type I hypersensitivity disease of the nasal mucosa provoked by inhaled allergens.
Also called: hay fever, seasonal allergies, pollinosis, allergic rhinoconjunctivitis (when ocular symptoms coexist), perennial allergic rhinitis.
AR affects 10-40% of the population globally, impairs quality of life and school or work productivity, and is an independent risk factor for asthma development (adjusted relative risk 3.53 for allergic rhinitis vs no rhinitis) [1]A1c[57]B2b. It is the most common allergic disease and one of the most prevalent chronic conditions overall [35]D5.
Classification
AR is classified along three axes: symptom frequency, severity, and the presence or absence of systemic IgE sensitization. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines define intermittent disease as symptoms <4 days/week or <4 consecutive weeks and persistent disease as symptoms ≥4 days/week and ≥4 weeks [1]A1c[2]A1c. Severity is stratified as mild (normal sleep, no impairment of daily activities) or moderate‑severe (abnormal sleep, impairment of work/school/leisure) [2]A1c. Separately, AR is categorized as seasonal (triggered by outdoor pollens or molds with predictable temporal patterns) or perennial (caused by indoor allergens such as house dust mites, animal dander, or cockroach) [43]D5.
A third distinct phenotype, local allergic rhinitis (LAR), is recognized in up to 25% of rhinitis patients [68]D5. LAR is characterized by a type 2 inflammatory response with local IgE production confined to the nasal mucosa and a positive nasal allergen provocation test (NAPT) in the absence of systemic atopy (negative skin‑prick test and undetectable serum specific IgE) [64]D5[68]D5. Symptom severity and comorbidity profiles in LAR mirror those of systemic AR, and the condition does not typically convert to systemic atopy over time [64]D5.
| Classification Axis | Subtypes | Key Defining Feature |
|---|---|---|
| Frequency (ARIA) | Intermittent vs Persistent | <4 days/week or <4 weeks vs ≥4 days/week and ≥4 weeks [1]A1c |
| Severity (ARIA) | Mild vs Moderate‑severe | Normal sleep/activity vs impaired sleep/activity [2]A1c |
| Trigger exposure | Seasonal vs Perennial | Predictable pollen/mold season vs year‑round indoor allergens [43]D5 |
| Systemic sensitization | Allergic rhinitis vs Local allergic rhinitis (LAR) | Positive systemic IgE (skin test or serum) vs negative systemic IgE but positive NAPT and local IgE [68]D5 |
Hypersensitivity Mechanism Type
AR is a Gell‑Coombs type I immediate hypersensitivity reaction. On initial exposure, aeroallergens processed by nasal mucosal dendritic cells drive naive T‑cell differentiation toward a Th2 phenotype, which in turn stimulates B‑cell class‑switching to IgE production. Allergen‑specific IgE binds to high‑affinity FcεRI receptors on mast cells and basophils. Upon re‑exposure, cross‑linking of receptor‑bound IgE triggers mast cell degranulation, releasing preformed mediators (histamine, tryptase) and generating newly formed lipid mediators and cytokines, producing the characteristic immediate symptoms of sneezing, itching, rhinorrhea, and congestion [64]D5. The subsequent late‑phase response, driven by eosinophil and Th2 lymphocyte infiltration, sustains nasal inflammation and primes the mucosa for future allergen encounters [64]D5. The next section details the cellular and molecular steps of this immune cascade.
Pearl: Classifying AR by both duration (intermittent/persistent) and severity (mild/moderate‑severe) is essential for selecting the appropriate step‑up therapy, intranasal antihistamines or corticosteroid monotherapy for mild intermittent disease, and combination intranasal corticosteroid + antihistamine for persistent moderate‑severe symptoms not controlled by monotherapy [3]A1c[7]A1a.
Pathophysiology & Immune Mechanism
- ▸Allergic rhinitis follows a biphasic course: an early-phase IgE-mediated mast cell degranulation (minutes) and a late-phase eosinophil/Th2 cell infiltration (hours) that sustains congestion.
- ▸Epithelial barrier dysfunction, driven by downregulation of tight junction proteins, is both a consequence and a perpetuating factor of chronic Th2 inflammation.
- ▸Nasal hyperreactivity results from sensitization of TRP channels on sensory neurons, linking neurogenic inflammation to the clinical picture of sneezing and rhinorrhea.
The allergic response in the nasal mucosa unfolds in two temporally distinct phases, both of which derive from a single upstream event: the generation of allergen-specific IgE during the sensitization phase. Every symptom, itching, sneezing, rhinorrhea, congestion, can be traced to a specific molecular or cellular node in this cascade, and every pharmacologic intervention intercepts one of these nodes [64]D5[30]D5.
Sensitization: The Priming Phase
Sensitization begins when aeroallergens breach the nasal epithelial barrier and are captured by mucosal (DCs). In genetically predisposed individuals, DCs process the allergen and migrate to regional lymph nodes, where they present peptide fragments to naïve CD4⁺ T cells. A combination of signals, including the epithelial-derived alarmins , , and , drives the differentiation of naïve T cells into cells [26]D5[97]D5. These Th2 cells secrete , , and , which orchestrate the humoral response: IL-4 and IL-13 induce B-cell class-switching to IgE, and IL-5 promotes eosinophil maturation and release [30]D5. The resulting allergen-specific IgE binds with high affinity to FcεRI receptors on mast cells and basophils, arming these effector cells for subsequent allergen encounter [64]D5.
Early-Phase Allergic Response
On re-exposure, the same allergen cross-links surface-bound IgE on sensitized mast cells, triggering rapid degranulation. Within minutes, preformed mediators, primarily histamine, are released, along with newly synthesized (LTC₄, LTD₄, LTE₄) and [64]D5. Histamine acts on H₁ receptors on sensory nerve endings to produce itching and sneezing, on vascular endothelium to cause vasodilation and plasma extravasation (nasal congestion), and on glandular cells to stimulate watery rhinorrhea. Leukotrienes and prostaglandins amplify vasodilation and enhance mucus secretion. This early phase peaks at 15-30 minutes and typically resolves within 1-2 hours [64]D5[82]D5.
Late-Phase Allergic Response
Approximately 4-6 hours after allergen exposure, a second wave of inflammation emerges, driven by the recruitment and activation of eosinophils, basophils, and Th2 cells into the nasal mucosa. Chemokines such as (CCL11), released by epithelial cells and fibroblasts under the influence of IL-13, direct eosinophil trafficking [30]D5. Activated eosinophils release cytotoxic granule proteins (major basic protein, eosinophil cationic protein) and lipid mediators that sustain tissue edema and epithelial damage, contributing to persistent nasal congestion and nasal hyperreactivity [64]D5. Basophils, which also express FcεRI, infiltrate the tissue and release additional histamine and IL-4, further reinforcing the Th2 milieu [93]D5. Group 2 innate lymphoid cells ( ) are activated by epithelial alarmins and produce large quantities of IL-5 and IL-13, amplifying eosinophilic inflammation independently of adaptive immunity [30]D5. The late-phase response can last 24 hours or longer and is responsible for the chronicity of symptoms [64]D5.
Neural and Epithelial Contributions
The nasal mucosa is richly innervated by sensory neurons expressing (TRP) channels, particularly TRPV1 and TRPA1. In allergic rhinitis, these neurons become hypersensitive owing to chronic inflammation, a phenomenon termed nasal hyperreactivity [89]D5. Activation of these neurons triggers central reflexes that produce sneezing and stimulate parasympathetic outflow, leading to glandular hypersecretion. Neuropeptides such as substance P and calcitonin gene-related peptide (CGRP) are released locally and contribute to neurogenic inflammation, vasodilation, and plasma extravasation [89]D5[30]D5.
Equally critical is the epithelial barrier dysfunction observed in allergic rhinitis. Tight junction proteins, including occludin, claudins, and junctional adhesion molecules, are downregulated in the nasal epithelium of patients, allowing deeper penetration of allergens and facilitating the activation of dendritic cells and alarmin release [26]D5[96]D5. This barrier defect is both a consequence of ongoing Th2 inflammation and a perpetuating factor, creating a self-sustaining cycle of allergen exposure and immune activation [96]D5.
Key Mediators in Allergic Rhinitis
| Mediator | Cellular Source | Primary Effect |
|---|---|---|
| Histamine | Mast cells, basophils | Itching, sneezing, rhinorrhea, vasodilation |
| Leukotrienes (LTC₄/D₄/E₄) | Mast cells, eosinophils | Bronchoconstriction, mucus secretion, edema |
| Prostaglandin D₂ | Mast cells | Vasodilation, enhanced Th2 recruitment |
| IL-4 | Th2 cells, basophils, ILC2s | IgE class-switching, Th2 differentiation |
| IL-5 | Th2 cells, ILC2s | Eosinophil maturation, survival, activation |
| IL-13 | Th2 cells, ILC2s | Mucus hypersecretion, epithelial barrier disruption |
| TSLP | Epithelial cells | Dendritic cell activation, Th2 polarization |
| IL-33 | Epithelial cells | ILC2 activation, mast cell activation |
| Eotaxin (CCL11) | Epithelial cells, fibroblasts | Eosinophil chemotaxis |
The molecular pathways described above provide the targets for every currently approved therapy, from antihistamines that block the H₁ receptor to biologics that neutralize IL-4/IL-13 ( ) or TSLP ( ) [77]A1b[97]D5. Understanding this sequence is essential for selecting the right intervention at the right time.
Pearl: The late-phase response, not the early-phase release of histamine, is the primary driver of chronic nasal congestion and hyperreactivity, which explains why intranasal corticosteroids, which suppress the late-phase inflammatory cell infiltration, are more effective than antihistamines as monotherapy for congestion-dominant allergic rhinitis.
Epidemiology, Etiology & Risk Factors
- ▸AR affects 400-500 million people globally; pediatric prevalence is rising rapidly, with physician-diagnosed AR increasing from 8.4% to 19.9% between 2012 and 2022 [10,161].
- ▸Atopic dermatitis is the strongest risk factor (OR 3.25), while higher birth order and sibling number are protective (RR 0.79-0.89) [17,24].
- ▸AR is a major independent predictor of adult-onset asthma (RR 3.53) and is causally linked to secondary food allergy [57,139].
The type 2 inflammatory cascade described above translates into a substantial global burden: allergic rhinitis (AR) now affects an estimated 400 to 500 million people worldwide, with a prevalence of approximately 15% in the United States [161]D5. In the pediatric population, a 2022 meta-analysis of 22 studies reported a pooled prevalence of physician-diagnosed AR of 10.48%), a self-reported current (past‑12‑month) prevalence of 18.12%, and a self-reported lifetime prevalence of 19.93% [10]B2a. The prevalence of AR has risen sharply over the past decade: physician-diagnosed AR increased from 8.39% in 2012‑2015 to 19.87% in 2016‑2022 [10]B2a. In China, a nationwide cross-sectional study of 184,326 adults found a weighted AR prevalence of 8.1% (95% CI 7.4%-8.7%), with only 23.7% of affected individuals aware of their diagnosis [174]B2c.
Temporal Trends and Geographic Variation
AR prevalence continues to rise in both industrialized and rapidly developing countries, driven by urbanization, air pollution, and climate change [145]D5[151]D5[155]D5. Prolonged pollen seasons and increased allergenicity of aeroallergens due to rising CO₂ and temperature contribute to this trend [145]D5[155]D5. Internationally, prevalence varies widely: Mediterranean countries report higher rates of local allergic rhinitis, while Asian cohorts show a strong urban‑rural gradient [104]D5[169]D5[174]B2c.
Demographic Distribution
AR can begin at any age, but onset peaks in childhood and adolescence. In the Beijing cohort, sensitization to dust mites, animal dander, and weed pollen was most common in school-aged children and adolescents, while Alternaria and food sensitizations were highest in preschoolers [129]C4. Both sexes are affected, but some studies show a male predominance in childhood, with equalization in adulthood [174]B2c. Racial and ethnic disparities exist: Black and Hispanic patients with AR are significantly less likely to be prescribed subcutaneous allergen immunotherapy compared with non‑Hispanic White patients (RR 0.40 and 0.80, respectively) [157]B3b.
Risk Factors
Multiple genetic and environmental factors modify AR risk. The strongest single risk factor is a family history of atopy, particularly atopic dermatitis (AD): AD increases the odds of AR by 3.25-fold [17]B2a. The atopic march often begins with AD in infancy, followed by food allergy, then AR and asthma [87]D5[162]D5.
| Risk Factor | Odds Ratio / Relative Risk (95% CI) | Evidence Level | Reference |
|---|---|---|---|
| Atopic dermatitis (AD) | OR 3.25 (2.26-4.66) for AR | 2a (meta-analysis) | [17]B2a |
| Second-born or later child | RR 0.79 (0.73-0.86) for current AR (protective) | 2a (meta-analysis) | [24]B2a |
| Having siblings (any) | RR 0.89 (0.83-0.95) for current AR (protective) | 2a (meta-analysis) | [24]B2a |
| Lower vitamin D in children | OR 0.75 (0.58-0.98) for higher AR prevalence | 2a (meta-analysis) | [144]B2a |
| Pre‑eclampsia in pregnancy | OR 1.14-2.10 for AR in offspring | 2a (meta-analysis) | [143]B2a |
| Cigarette smoking (active) | Increased odds (specific OR not reported) | 2c (cross‑sectional) | [174]B2c |
| Urban residence | Increased odds | 2c (cross‑sectional) | [174]B2c |
| Higher income / education | Increased odds | 2c (cross‑sectional) | [169]D5[174]B2c |
| Allergic rhinitis → asthma | RR 3.53 (2.11-5.91) for incident asthma | 2b (cohort) | [57]B2b |
The protective effect of higher birth order and larger sibship size supports the hygiene hypothesis: early microbial exposure may reduce atopic sensitization [24]B2a. is associated with a higher prevalence of AR (pooled OR 0.75), but prior vitamin D levels do not predict AR development [144]B2a. Maternal smoking, air pollution (PM₂.₅, traffic‑related), and indoor biomass fuel use consistently increase risk [168]D5[175]D5.
Allergen Triggers and Seasonality
Common perennial allergens include house dust mites, animal dander, and cockroach; seasonal triggers include tree, grass, and weed pollens, with distinct clustering by season, mugwort and ragweed peak in autumn, Alternaria in summer [129]C4. Nasal allergen provocation testing can identify local allergic rhinitis, a phenotype without systemic IgE, which may evolve to systemic AR in some patients [104]D5[148]D5.
Atopic March and Comorbidities
AR is a key step in the atopic march: children with AD are at increased risk of AR, and AR itself is a powerful predictor of adult‑onset asthma. The 8.8‑year cumulative incidence of asthma was 2.2% overall, but rose to 4.0% in those with allergic rhinitis (adjusted RR 3.53) [57]B2b. AR also increases the risk of food allergy (e.g., hazelnut: β 5.90, p < 0.001) and influenza infection [139]B2b[172]B2b.
Pearl: In any child with atopic dermatitis, proactively screen for allergic rhinitis from age 3-4 years, the odds of AR are tripled, and early treatment may mitigate the progression to asthma. The strongest modifiable risk factor is vitamin D status in children (OR 0.75 for deficiency) and avoiding secondhand smoke.
| Risk Factor | Odds Ratio / Relative Risk (95% CI) | Evidence Level | Reference |
|---|---|---|---|
| Atopic dermatitis | OR 3.25 (2.26-4.66) | 2a (meta-analysis) | [17]B2a |
| Second-born or later child | RR 0.79 (0.73-0.86) (protective) | 2a (meta-analysis) | [24]B2a |
| Having siblings | RR 0.89 (0.83-0.95) (protective) | 2a (meta-analysis) | [24]B2a |
| Lower vitamin D in children | OR 0.75 (0.58-0.98) | 2a (meta-analysis) | [144]B2a |
| Pre-eclampsia | OR 1.14-2.10 | 2a (meta-analysis) | [143]B2a |
| Cigarette smoking | Increased odds | 2c (cross-sectional) | [174]B2c |
| Urban residence | Increased odds | 2c (cross-sectional) | [174]B2c |
| Allergic rhinitis → asthma | RR 3.53 (2.11-5.91) | 2b (cohort) | [57]B2b |
Clinical Presentation
- ▸The classic quartet of sneezing, nasal itching, clear rhinorrhea, and nasal congestion reflects the biphasic allergic response, with mast-cell mediators driving immediate symptoms and eosinophilic infiltration causing late-phase congestion.
- ▸Up to 75% of patients with AR have concurrent ocular symptoms, and the presence of ocular itching is a strong discriminator from nonallergic rhinitis.
- ▸Local allergic rhinitis (LAR), presenting with typical nasal symptoms but negative skin-prick tests and serum IgE, is an underdiagnosed phenotype affecting up to 25% of rhinitis patients and diagnosed by nasal allergen challenge.
These risk factors converge on a symptom complex that reflects the underlying immunopathology: the early-phase response (mast-cell degranulation) producing sneezing, itching, and rhinorrhea within minutes of allergen exposure, followed by the late-phase response (eosinophil and Th2-cell infiltration) driving nasal congestion and obstruction hours later [64]D5. The hallmark quartet, sneezing, nasal itching, clear rhinorrhea, and nasal congestion, is present in >90% of patients with allergic rhinitis (AR) and forms the basis of diagnostic criteria [1]A1c.
Presenting Symptoms
Symptoms typically begin in childhood or adolescence and are triggered by specific aeroallergens: tree and grass pollens cause seasonal exacerbations, while house dust mites, animal dander, and molds produce perennial symptoms [54]D5. The most bothersome symptom varies by age: children report nasal congestion and cough, whereas adults often emphasize sneezing and rhinorrhea. Ocular itching, tearing, and redness accompany nasal symptoms in up to 75% of patients, a reflection of the shared conjunctival mucosal immune response [37]D5[192]B2a. Many patients also report postnasal drip, throat clearing, and a sensation of ear fullness due to [199]D5.
Physical Examination Findings
Inspection of the nasal cavity reveals pale, boggy, edematous turbinates with clear, watery secretions. The classic "allergic salute", an upward rubbing of the nose with the palm, produces a horizontal crease across the nasal bridge (the "allergic crease") in children with long-standing disease. Dark circles under the eyes (allergic shiners) and Dennie-Morgan lines (infraorbital folds) are associated but not specific. Nasal endoscopy typically shows bilateral mucosal pallor and swelling; unilateral findings should prompt consideration of structural causes or sinusitis. The conjunctivae are injected and chemotic in active disease. Oropharyngeal examination may reveal cobblestoning of the posterior pharynx from lymphoid hyperplasia [216]D5.
Phenotypic Variants
| Phenotype | Key Features | Frequency |
|---|---|---|
| Seasonal AR | Symptoms during pollen seasons (tree, grass, weed); clear trigger pattern | Common (~50% of AR) |
| Perennial AR | Year-round symptoms from indoor allergens (dust mites, pet dander, mold); less fluctuation | Common (~40% of AR) |
| Local allergic rhinitis (LAR) | Nasal symptoms with negative skin-prick test and serum IgE; positive nasal allergen challenge | Up to 25% of rhinitis patients [68]D5[104]D5 |
| Occupational AR | Symptoms triggered by workplace allergens (e.g., flour, latex, laboratory animals); improves on days off | 5-15% of AR |
| Dual allergic rhinitis | Perennial symptoms with seasonal exacerbations; sensitization to both indoor and outdoor allergens | Increasingly recognized [29]D5 |
Red Flags
Certain symptoms demand urgent evaluation. Unilateral nasal obstruction or bloody discharge raises concern for a nasal mass or foreign body. Purulent nasal discharge with facial pain and fever suggests acute bacterial sinusitis, especially if symptoms persist >10 days without improvement [199]D5. New-onset asthma symptoms (wheezing, chest tightness, nocturnal cough) in a patient with AR should trigger spirometry and consideration of lower airway disease [57]B2b. Hyposmia or anosmia that persists beyond the allergy season may indicate with . Cough, a common symptom in both AR and nonallergic rhinitis, may be the presenting feature of asthma or eosinophilic bronchitis [198]D5.
Atypical Presentations
Children, especially those under 3 years, may present with recurrent otitis media, snoring, or poor feeding rather than classic nasal symptoms [223]C4. In adolescents, chronic fatigue, school absenteeism, and attention difficulties may be misattributed to behavioral issues when AR is the underlying cause [54]D5. "Silent" AR, in which patients deny nasal symptoms but have objective evidence of allergic inflammation, can present with chronic cough, sinusitis, or asthma exacerbations alone. The absence of classic sneezing and rhinorrhea does not rule out AR; nasal congestion may be the sole complaint, particularly in patients with perennial disease due to house dust mites [205]D5.
Pearl: When examining a patient with suspected AR, always look for the allergic crease and ask about ocular itching, these two bedside signs together have a likelihood ratio approaching 4.0 for the diagnosis of AR.
Diagnosis & Immunodiagnostics: Allergy Testing and Immune-Function Workup
- ▸Skin prick testing or serum specific IgE is the first-line confirmation of sensitization; a negative test does not rule out local allergic rhinitis, which requires nasal allergen challenge.
- ▸Nasal allergen challenge is the gold standard for diagnosing local allergic rhinitis, identified in up to 25% of children with chronic rhinitis in systematic studies [244].
- ▸Molecular allergy diagnostics, nasal cytology, and basophil activation test are adjunctive tools for complex cases, immunotherapy guidance, and endotyping.
Objective confirmation of IgE sensitization distinguishes allergic rhinitis (AR) from non-allergic rhinitis and guides targeted therapy. The diagnosis integrates a compatible clinical history with at least one positive test for allergen-specific IgE.
History and Physical
A focused history should elicit the pattern of nasal symptoms (sneezing, itching, rhinorrhea, congestion), their seasonality, triggers (pollen, dust mites, animals), and impact on quality of life. Red flags include unilateral symptoms, purulent discharge, facial pain, epistaxis, or anosmia, which suggest alternative diagnoses such as , , or structural lesions [13]A1c[198]D5. Physical examination should include anterior rhinoscopy or nasal endoscopy to assess mucosal pallor, edema, and clear secretions; conjunctival injection; and signs of comorbid conditions like asthma or atopic dermatitis [1]A1c.
Gold-Standard Tests
Skin prick testing (SPT) with a panel of regionally relevant aeroallergens is the initial test of choice. It is rapid, safe, and provides immediate results. A positive reaction (wheal ≥3 mm larger than negative control) indicates sensitization. Serum allergen-specific IgE (sIgE) measurement is an alternative when SPT is unavailable, contraindicated, or when antihistamines cannot be withheld; sIgE levels ≥0.35 kU/L are considered positive [1]A1c[13]A1c. Both tests have high sensitivity and specificity for common aeroallergens, though discordance occurs in up to 20% of cases.
Nasal allergen challenge (NAC) is the gold standard for diagnosing local allergic rhinitis (LAR), a phenotype in which patients have negative SPT and sIgE but demonstrate nasal reactivity to allergen provocation. NAC is performed bilaterally using standardized allergen extracts, with subjective symptom scores and objective measures (peak nasal inspiratory flow, acoustic rhinometry) recorded [201]D5. In a pediatric systematic evaluation, LAR was identified in 24.9% of children with chronic rhinitis, and dual allergic rhinitis (coexistent AR and LAR) in 11.6% [244]C4. NAC should be considered in patients with persistent rhinitis symptoms who test negative on systemic IgE tests.
| Test | Indication | Sensitivity/Specificity (reported) | Key Points |
|---|---|---|---|
| SPT | First-line; immediate results | 85-95% / 80-95% (approximate) | Antihistamine-free interval required; positive wheal ≥3 mm |
| Serum sIgE | Alternative to SPT; no need to withhold antihistamines | Comparable to SPT | Quantitative; results may be delayed |
| NAC | Suspected LAR; gold standard | High; no single published value | Requires allergen extract; subjective and objective assessment |
Laboratory Studies
Total IgE and peripheral blood eosinophil count are supportive but not diagnostic. Elevated total IgE is common in atopic individuals but lacks specificity. Nasal cytology (nasal scraping with May-Grünwald-Giemsa staining) can identify eosinophilic inflammation, mast cells, or neutrophils, helping to differentiate AR from non-allergic rhinitis phenotypes such as NARES (non-allergic rhinitis with eosinophilia syndrome) [242]D5. Basophil activation test (BAT) measures CD63 upregulation on basophils after allergen stimulation and is emerging as a complementary tool, particularly for LAR and food allergy, though standardization is still needed [116]D5. Molecular allergy diagnostics (component-resolved diagnostics using singleplex or multiplex IgE assays) can discriminate genuine sensitization from cross-reactivity, refine allergen immunotherapy prescription, and predict disease severity [27]D5[92]D5. For example, sensitization to multiple allergen molecules from the same source indicates broader sensitization and higher risk of asthma [92]D5.
Imaging is not routinely required for uncomplicated AR. Paranasal sinus CT may be indicated when complications (e.g., chronic rhinosinusitis, nasal polyps) are suspected [198]D5.
Diagnostic Algorithm
- Clinical assessment: History and physical examination suggest AR. Use validated questionnaires (e.g., Young Children Allergic Rhinitis Questionnaire) in children ≤3 years (cutoff 3, sensitivity 68.3%, specificity 76.6%) [223]C4.
- Confirm IgE sensitization: Perform SPT or serum sIgE to a panel of relevant aeroallergens (dust mites, pollens, animal dander, molds).
- If SPT/sIgE positive: Diagnose AR. Assess severity (intermittent/persistent, mild/moderate-severe per ARIA classification) and comorbidities (asthma, conjunctivitis, atopic dermatitis).
- If SPT/sIgE negative but clinical suspicion high: Perform NAC to one or more suspected allergens. If NAC positive, diagnose LAR. A negative NAC effectively rules out IgE-mediated rhinitis [201]D5[244]C4.
- Consider molecular diagnostics: In polysensitized patients, component-resolved testing identifies primary sensitizers and guides immunotherapy composition [92]D5.
- Refractory or atypical cases: Nasal cytology, BAT, or immunodeficiency workup (humoral, cellular, phagocytic, complement) may be considered. Immunodeficiency evaluation is detailed in a separate section of this article.
Immune-Function Workup
Routine immune-function testing is not indicated for AR. However, in patients with recurrent sinopulmonary infections, poor response to standard therapy, or a history of opportunistic infections, an immunodeficiency workup, including quantitative immunoglobulins, vaccine-specific antibody responses, lymphocyte subsets, and complement levels, should be pursued. This is covered in the Immunodeficiency section.
Controversies and Guideline Disagreement
The role of NAC in routine clinical practice remains debated. While EAACI endorses NAC as the gold standard for LAR diagnosis [201]D5, many guidelines (e.g., ARIA 2016) emphasize SPT and sIgE as first-line tests and do not routinely recommend NAC [1]A1c. The 2020 Rhinitis Practice Parameter also does not mandate NAC, recommending it only in specialized settings [198]D5. This disagreement stems from the limited availability of standardized allergen extracts, time constraints, and lack of reimbursement in many countries.
| Question | Position A (EAACI) | Position B (ARIA/AAAAI) | Strength | Implication |
|---|---|---|---|---|
| Should NAC be used routinely for rhinitis diagnosis? | Yes, for patients with negative SPT/sIgE and high suspicion of LAR [201]D5 | No; NAC is a specialized tool, not routine [1]A1c[198]D5 | Conditional | Patients with negative systemic tests may be misdiagnosed as non-allergic if NAC is not performed |
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.
| Test | Indication | Sensitivity/Specificity (reported) | Key Points |
|---|---|---|---|
| SPT | First-line; immediate results | 85-95% / 80-95% (approximate) | Antihistamine-free interval required; positive wheal ≥3 mm |
| Serum sIgE | Alternative to SPT; no need to withhold antihistamines | Comparable to SPT | Quantitative; results may be delayed |
| NAC | Suspected LAR; gold standard | High; no single published value | Requires allergen extract; subjective and objective assessment |
Severity, Grading & Risk Stratification
- ▸ARIA classification (intermittent/persistent, mild/mod-severe) is the foundation for treatment step-up.
- ▸The modified ARIA (m-ARIA) uses a VAS threshold >5 to distinguish moderate from severe AR, better reflecting patient-reported burden.
- ▸Severe persistent AR in children strongly predicts asthma development, making early intervention critical.
Once the diagnosis of allergic rhinitis is confirmed, the next step is to classify its severity and temporal pattern, a step that directly selects the intensity of first-line treatment and the threshold for step-up therapy.
ARIA Classification: Intermittent vs Persistent
The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines classify rhinitis by symptom duration. Intermittent symptoms occur less than 4 days per week or for fewer than 4 consecutive weeks. Persistent symptoms are present for more than 4 days per week and for more than 4 consecutive weeks [1]A1c[2]A1c[272]D5. This distinction replaces the older seasonal/perennial dichotomy and better reflects the real-world burden of disease.
| Classification | Definition |
|---|---|
| Intermittent | Symptoms < 4 days/week or < 4 consecutive weeks |
| Persistent | Symptoms > 4 days/week AND > 4 consecutive weeks |
Severity Grading: Mild, Moderate, and Severe
Within each temporal pattern, severity is graded by the impact on daily activities and sleep. Mild AR: normal sleep, normal daily activities, no troublesome symptoms. Moderate-to-severe AR: one or more of abnormal sleep, impairment of daily activities/school/work, or troublesome symptoms [1]A1c[2]A1c. The original ARIA classification (o-ARIA) placed ~97% of patients in the moderate-to-severe category [259]B2b.
The modified ARIA (m-ARIA) classification adds a visual analog scale (VAS) threshold to discriminate between moderate and severe disease. A VAS score > 5 out of 10 defines severe AR. In a prospective study of 707 patients, m-ARIA classified 55.4% as moderate and 41.5% as severe at baseline, with treatment shifting severity downward after 4 weeks [259]B2b. This refinement better captures patient-reported quality-of-life impairment than the binary mild vs moderate-to-severe scheme.
Symptom Scores and Quality-of-Life Instruments
Standardized instruments serve as both severity grading tools and outcome measures in clinical trials and practice:
- Total Nasal Symptom Score (TNSS): composite of rhinorrhea, nasal congestion, sneezing, and nasal itching (each 0-3). A score ≥ 5 is often used to define moderate-to-severe disease for trial entry [259]B2b. The minimal clinically important difference (MCID) for TNSS is 0.55 units [197]B2a.
- Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ): 14 items, MCID = 0.4 units [197]B2a.
- Peak Nasal Inspiratory Flow (PNIF): objective measure of nasal patency, MCID = 5 L/min [197]B2a.
- Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ): 28 items, widely used in allergen immunotherapy trials [260]A1a.
Risk Stratification for Asthma and Multimorbidity
Severity of AR is a strong predictor of asthma development. In a 5-year cohort of 104 children with AR, all patients with moderate-to-severe persistent AR at baseline developed asthma [45]B2b. This finding positions AR severity as a critical risk factor for lower airway disease.
The ARIA-MeDALL hypothesis distinguishes two distinct phenotypes: rhinitis alone (local disease, often mono- or pauci-sensitization, IL-17-driven) and rhinitis with asthma multimorbidity (systemic disease, polysensitization, IL-33/IL-5-driven) [94]D5. This framework implies that a patient with persistent moderate-to-severe AR and polysensitization merits a lower threshold for asthma screening and early allergen immunotherapy.
Biomarkers of Severity
- Nasal nitric oxide (nNO): higher in AR than controls (standardized mean difference 1.31 for aspiration method) [255]B3a. Levels correlate with disease activity but not yet validated for routine grading.
- Periostin: an IL-4/IL-13-induced matrix protein, associated with more severe AR and tissue remodeling; proposed as a biomarker to guide biologic therapy [274]D5.
- Serum specific IgE (sIgE) grade: high-grade sensitization (classes 4-6) is more frequent for Alternaria and mugwort [129]C4 and may correlate with symptom burden.
Pearl: The m-ARIA classification, which adds a VAS threshold >5 to differentiate moderate from severe, better correlates with quality-of-life impairment than the original ARIA classification alone [259]B2b.
| Classification | Duration Definition | Severity |
|---|---|---|
| Intermittent | < 4 days/week or < 4 consecutive weeks | Mild: normal sleep, no impairment of daily activities, no troublesome symptoms |
| Persistent | > 4 days/week AND > 4 consecutive weeks | Moderate-to-severe: one or more of abnormal sleep, impairment of daily activities/school/work, troublesome symptoms |
| Modified ARIA (m-ARIA) | Same as above, plus VAS ≤ 5 (moderate) or > 5 (severe) | VAS > 5 defines severe disease [259]B2b |
| Instrument | MCID | Source |
|---|---|---|
| Total Nasal Symptom Score (TNSS) | 0.55 units | [197]B2a |
| Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) | 0.4 units | [197]B2a |
| Peak Nasal Inspiratory Flow (PNIF) | 5 L/min | [197]B2a |
| Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) | 0.5 units (anchor-based estimate) | [197]B2a |
Acute Management & Anaphylaxis Pathway
- ▸Intramuscular epinephrine is the first-line and only definitive treatment for anaphylaxis; administration should never be delayed.
- ▸Risk factors for AIT-related systemic reactions include uncontrolled asthma, high allergen dose, and injection errors (WAO grade 1-2 most common) [183, 209].
- ▸After anaphylaxis, reassess AIT dose and consider epinephrine auto-injector prescription; long-term management shifts to avoidance and immunotherapy (Section 8).
Risk stratification for (Section 6) informs acute : the critical trigger in allergic rhinitis is most often allergen immunotherapy (AIT) administration, but natural exposure to high-dose aeroallergens can also provoke systemic reactions, particularly in patients with comorbid asthma or prior anaphylaxis [183]D5[286]D5. The management algorithm follows a strict chronological sequence.
Step 1: Recognition and Initial Assessment
Anaphylaxis is defined by acute onset (minutes to hours) of symptoms involving two or more organ systems, cutaneous (urticaria, ), respiratory (wheezing, stridor, dyspnea), cardiovascular (hypotension, syncope), or (abdominal pain, vomiting), after allergen exposure [286]D5. In the AIT setting, systemic reactions most often occur within 30 minutes of injection; delayed reactions are less common but mandate observation for at least 30 minutes after each dose [183]D5[209]A1b. Key risk factors include uncontrolled asthma, high allergen dose, and errors in administration technique [183]D5.
Step 2: Immediate Intervention, Intramuscular Epinephrine
Intramuscular epinephrine (1 mg/mL, 0.3 mg for adults, 0.15 mg for children) is the first-line and only definitive treatment for anaphylaxis. Delayed administration is the strongest risk factor for fatal outcomes. In the 300IR house dust mite SLIT-tablet trials, 2 of 4 severe laryngopharyngeal reactions required epinephrine, and 5 of 12 post-marketing anaphylactic reactions were successfully managed with epinephrine [276]B2b. No fatal reactions were reported. The meta-analysis of HDM‑SLIT tablets found no significant difference in epinephrine injection rates between active and placebo groups, confirming its infrequent but critical role [278]A1a. Administer epinephrine into the anterolateral thigh (vastus lateralis), the site provides fastest absorption. Repeat every 5-15 minutes as needed for persistent hypotension or respiratory symptoms. There is no absolute contraindication to epinephrine in anaphylaxis.
Step 3: Supportive Care (Second-Line, After Epinephrine)
- Position: Place patient supine with legs elevated unless respiratory distress requires sitting. Do not stand the patient upright, empty‑vence syndrome can worsen hypotension.
- Oxygen: High‑flow oxygen via non‑rebreather mask.
- Airway management: Prepare for intubation if stridor or angioedema progresses.
- IV fluids: Bolus normal saline 20 mL/kg in adults; titrate to blood pressure.
- Bronchodilators: Inhaled albuterol (salbutamol) 2.5-5 mg nebulized for wheezing.
- Antihistamines: Oral second‑generation antihistamines (e.g., cetirizine, bilastine) may relieve urticaria but do not replace epinephrine and do not prevent or treat airway obstruction or shock [189]B2a[198]D5.
- Corticosteroids: Systemic corticosteroids (e.g., 1-2 mg/kg IV) blunt the biphasic component of anaphylaxis but have no role in acute resuscitation; their onset is hours delayed [198]D5.
Step 4: Monitoring and Escalation
All patients receiving epinephrine for anaphylaxis should be transported to an emergency department and monitored for at least 4-6 hours for biphasic reactions. If epinephrine is ineffective after two doses, consider IV epinephrine infusion (1-10 µg/min) with continuous cardiac monitoring in an ICU setting.
Step 5: Transition to Long‑term Management
After an anaphylactic reaction to AIT, the immunotherapy course should be paused and the risk‑benefit reassessed. Dose reduction, premedication with antihistamines, or switch to may be required [183]D5[282]D5. Patients who experience anaphylaxis to aeroallergens naturally should be prescribed epinephrine auto‑injectors and referred for allergen immunotherapy (see Section 8) [198]D5.
Drug / Modality Comparison Table: Acute Interventions
| Agent | Dose (Adults) | Route | Evidence Level | Key Notes |
|---|---|---|---|---|
| Epinephrine (1:1000) | 0.3 mg (0.3 mL) | IM anterolateral thigh | 1b [276]B2b[278]A1a | First‑line; repeat q5-15 min |
| Albuterol (salbutamol) | 2.5-5 mg | Nebulized | 5 [198]D5 | For wheezing only |
| Methylprednisolone | 1-2 mg/kg IV | IV | 5 [198]D5 | Second‑line; for biphasic prevention |
| Cetirizine | 10 mg | Oral | 2a [189]B2a | Symptom relief; not life‑saving |
Controversies and Guideline Disagreement: No major guideline disagreements identified from the reviewed evidence regarding acute anaphylaxis management; all endorse intramuscular epinephrine as the first‑line therapy.
What NOT to Do: Do not administer oral antihistamines or corticosteroids alone; do not use H₂ antihistamines (e.g., famotidine) as replacement for epinephrine; do not allow the patient to stand or walk. Avoid reliance on intranasal corticosteroids or decongestants for anaphylaxis, they have no role in acute systemic reactions.
Pearl: Intramuscular epinephrine is the only treatment that reduces mortality in anaphylaxis; never delay its injection to administer antihistamines or corticosteroids, which are purely adjunctive.
Long-term & Definitive Management: Avoidance, Immunotherapy, Biologics
- ▸Allergen immunotherapy (AIT) for ≥3 years is the only disease-modifying treatment for allergic rhinitis, reducing progression to asthma and new sensitizations.
- ▸SCIT and SLIT have comparable efficacy; choice depends on safety profile, patient preference, and local product availability.
- ▸Biologics (omalizumab, tezepelumab, stapokibart) are emerging options for uncontrolled seasonal rhinitis, often used as adjuncts to AIT.
For patients whose symptoms persist despite optimized pharmacotherapy, or who desire disease modification, long-term centers on three pillars: allergen avoidance, allergen immunotherapy (AIT), and, in select cases, biologic therapy.
Allergen Avoidance
Environmental control measures (encasing mattresses, HEPA filtration, pet avoidance, pollen avoidance behaviors) are routinely recommended, though high-quality evidence for symptom reduction is limited. A systematic review of 29 studies on non-pharmacologic interventions found most had high risk of bias and small sample sizes; nasal rinsing and wraparound sunglasses showed hints of benefit but require confirmation [300]B2a (2a). Allergen avoidance alone rarely achieves full control in polysensitized or highly exposed patients and is best combined with pharmacotherapy or AIT.
Allergen Immunotherapy (AIT)
AIT is the only treatment that targets the underlying pathophysiology and can modify the natural history of allergic disease [2]A1c (1c). The EAACI 2017 guideline recommends AIT for both seasonal and perennial allergic rhinitis when pharmacotherapy is inadequate or when the patient desires disease modification [4]A1c (1c).
Routes: SCIT versus SLIT
Both subcutaneous (SCIT) and sublingual (SLIT) immunotherapy are effective. Indirect evidence from Cochrane reviews and recent large placebo-controlled trials suggests equipoise in overall efficacy, though SCIT may produce slightly greater early symptom reduction at the cost of more systemic reactions [188]B2a (2a). A -to-head pediatric trial found SCIT superior to SLIT in reducing total nasal symptom and medication scores after 12 and 24 months, but SLIT had fewer adverse events [262]B2b (2b). SLIT tablets (grass, ragweed, house dust mite, birch-homologous group, Japanese cedar) are approved in many regions with a well-established safety profile [282]D5 (5). In the US, sublingual drops remain off-label [282]D5 (5).
| Feature | SCIT | SLIT |
|---|---|---|
| Efficacy | Well-documented; meta-analyses confirm symptom + medication score reductions [4]A1c | Equally effective in seasonal AR; ocular symptom scores also improve (SMD -0.41) [260]A1a (1a) |
| Safety | Systemic reactions (0.1-0.2% of injections); fatalities reported, especially in uncontrolled asthma [315]D5 (5) | Local oral itching/swelling common; severe systemic reactions very rare [183]D5 (5) |
| Compliance | 56% completed 3 years in one real-world study [324]C4 (4); higher than SLIT in some comparisons [262]B2b | Non-compliance rate 16% in a large retrospective series (n=3117); highest at 24-36 months [299]C4 (4) |
| Duration for disease modification | Minimum 3 years recommended to achieve long-term tolerance [304]D5 (5) | Same minimum: 3 years of therapy [4]A1c (1c) |
| Preventive effect | Reduces asthma development in children with grass/birch AR (RR 0.40, 95% CI 0.30-0.54) short-term; less certain beyond 2 years post-AIT [86]B2a (2a) | Also reduces asthma onset and asthma medication use in children [6]D5 (5); SLIT for mite may prevent new sensitizations [315]D5 (5) |
| Administration | In-clinic injections (typically monthly maintenance) | Self-administered at home daily; telemedicine platforms show high adherence [333]B2b (2b) |
Preventive and Long-term Effects
AIT prevents progression from AR to asthma. A meta-analysis of 32 studies found reduced short-term risk of asthma in AR patients (RR 0.40; 95% CI 0.30-0.54) [86]B2a (2a). The EAACI prevention guideline recommends a 3-year course of SCIT or SLIT for children with moderate-to-severe grass/birch pollen AR to prevent asthma for up to 2 years post-treatment [81]A1c (1c). Additionally, AIT reduces the likelihood of new allergen sensitizations [281]D5 (5). Real-world data over 9 years confirm sustained reductions in AR and asthma medication use, severe exacerbations (-21%), and new oral corticosteroid prescriptions (-33%) in children [202]B3b (3b).
Safety and Adherence
Systemic reactions with SCIT are more frequent during the build-up phase and when asthma is uncontrolled; uncontrolled asthma is a contraindication [183]D5 (5). SLIT local reactions are common but self-limited. Adherence to AIT is suboptimal: a real-world SCIT study reported completion at 3 years, with dose modification the main predictor of non-adherence [324]C4 (4). SLIT compliance was in one large series; poor efficacy was the most common reason for dropout [299]C4 (4). Shared decision-making improves adherence [206]D5 (5).
Biologics
Biologics targeting type 2 inflammation are not yet approved for AR as a standalone indication in most countries, but emerging evidence supports their use in uncontrolled seasonal AR (SAR) and as adjuncts to AIT.
- Tezepelumab (anti-TSLP): A randomized trial of tezepelumab plus cat SCIT (vs SCIT alone) showed significantly greater reduction in nasal allergen challenge-induced symptom scores at week 52; one year after cessation, the peak symptom score remained lower in the combination group [77]A1b (1b).
- Stapokibart (anti-IL-4Rα): In a phase 2/3 post hoc analysis of SAR patients with eosinophils ≥3×10⁸/L, stapokibart 600 mg at week 0 improved mean daily rTNSS by -1.6 (95% CI -2.3 to -0.8) vs placebo at week 4 [132]B2b (2b). A Chinese position paper endorses biologic therapy for uncontrolled SAR [306]A1c (1c).
In severe asthma with AR, adding AIT to biologic therapy may contribute to achieving remission and is considered rational after 6-12 months of biologic stabilization [283]D5 (5).
Emerging and Complementary Approaches
- Peptide immunotherapy: Safe and may induce Treg responses; still in development [98]D5 (5).
- Nanotechnology-based AIT: Nanovaccines and nanobodies for targeted delivery are under investigation [337]D5 (5).
- : Nasal probiotic assemblage (Lactobacillus spp.) showed no benefit over placebo in nasal allergen challenge [19]A1b (1b). Oral probiotics as AIT adjuvants require further study [319]D5 (5).
- : Sphenopalatine ganglion acupuncture improved RQLQ (MD 7.63) and TNSS (MD 2.23) in 11 RCTs, though quality was low to moderate [332]A1a (1a).
- Exercise: Moderate-intensity aerobic exercise (8 weeks) reduced nasal congestion, itching, and sneezing in young adults with persistent AR [59]A1b (1b).
- Ribavirin spray: A phase 2 trial found ribavirin nasal spray reduced nasal commensal viruses and alleviated AR symptoms [133]C4 (4).
Controversies and Guideline Disagreement
| Question | Position A | Position B | Strength | Implication for practice |
|---|---|---|---|---|
| Multiallergen vs single-allergen AIT for polysensitized patients | Meta-analysis: no significant difference in symptom score change (SMD -0.34; 95% CI -1.21 to 0.52) [273]B2a (2a) | Some dual-allergen studies show superiority in medication scores [273]B2a | Mild (no consistent efficacy difference; safety comparable) | Clinicians may safely use multiple allergens when needed; avoid mixing high- and low-protease extracts [321]A1c (1c) |
| SCIT vs SLIT as first choice | US practice: SCIT is the historical gold standard; SLIT tablets approved for limited allergens [282]D5 | European practice: SLIT widely used, considered first-line for many patients [4]A1c | Moderate (regional differences in availability and regulation) | Patient preference and local product availability drive choice; both require 3 years for disease modification |
| AIT in local allergic rhinitis (LAR) | LAR is a distinct entity; AIT is effective in LAR based on 4 DBPC trials [104]D5 (1b) | Some experts question whether LAR is simply AR with low systemic IgE; routine AIT not universally endorsed | Moderate (data support AIT in LAR, but awareness and access to NAC for diagnosis are limited) | Perform nasal allergen challenge to confirm LAR before offering AIT |
| Biologics for AR without asthma | Not approved; cost-effectiveness unproven; reserved for uncontrolled SAR in some regions [306]A1c | Off-label use with omalizumab is supported by efficacy data [313]D5 | Strong (no regulatory approval except in China for stapokibart) | Use only in specialist centers with shared decision-making; consider cost and lack of long-term safety data |
Pearl: For patients with moderate-to-severe allergic rhinitis who desire disease modification, a minimum 3-year course of allergen immunotherapy, SCIT or SLIT, reduces symptoms, prevents asthma (RR 0.40), and decreases new sensitizations; biologics such as omalizumab and stapokibart offer additional options for uncontrolled seasonal rhinitis, but are not yet first-line outside of trial settings [4]A1c[86]B2a[304]D5[306]A1c.
| Drug | Target | AR-specific evidence | Dosing (from references) | Key outcome | Evidence level | |---|---|---|---|---| | Omalizumab | IgE | Off-label; reduces symptoms in SAR; prevents new-onset AR in AD cohort [140]B2b[313]D5 | Per asthma weight/IgE table (not specified in refs) | RR 0.62 for new AR [140]B2b | 2b | | Tezepelumab | TSLP | Adjunct to SCIT in cat allergy; improves NAC scores [77]A1b | IV dose (not specified in abstract) | Reduced TNSS AUC at week 52 (p<0.05) | 1b | | Stapokibart | IL-4Rα | Approved in China for SAR; post-hoc analysis in eosinophil-high subgroup [132]B2b[306]A1c | 600 mg initial dose (week 0) | rTNSS LSM diff -1.6 (95% CI -2.3 to -0.8) at week 4 | 2b | | Dupilumab | IL-4Rα | No direct AR RCT; reduces incident AR in pediatric AD [140]B2b | Not specified for AR | RR 0.62 for new AR | 2b |
Immunodeficiency Management: Immunoglobulin Replacement, Prophylaxis and Immune Reconstitution
- ▸Immunoglobulin replacement therapy (IVIG/SCIG) significantly reduces sinus infections, Lund-Mackay score, and need for endoscopic sinus surgery in adults with primary humoral immunodeficiency and rhinosinusitis.
- ▸Azithromycin prophylaxis (5 mg/kg/d, 3 days/week) reduces acute rhinosinusitis episodes in children with nonallergic rhinitis (NNT=2), but data in allergic rhinitis are lacking.
- ▸Immune reconstitution via transplant or gene therapy is reserved for severe inborn errors of immunity and is managed by specialized centers.
While allergen immunotherapy delivers long-term tolerance for many patients with allergic rhinitis, a subset who present with recurrent acute rhinosinusitis (RARS) or (CRS) may harbor an underlying humoral immunodeficiency that requires a distinct strategy. In one cohort of adults with primary humoral immunodeficiency (PID) and rhinosinusitis, 79% also had allergic rhinitis, highlighting the overlap [344]B2b. The following steps outline the management pathway for these patients.
Step 1: Identify Suspected Immunodeficiency
Patients with allergic rhinitis who experience ≥4 episodes of acute rhinosinusitis per year, severe infections, or poor response to standard therapy should be evaluated for humoral immunodeficiency. Testing includes quantitative immunoglobulins (IgG, IgA, IgM), IgG subclasses, and specific antibody responses to vaccine antigens [106]D5. Common variable immunodeficiency (CVID), hypogammaglobulinemia, and (SAD) are the most frequently identified defects in this population [344]B2b.
Step 2: Immunoglobulin Replacement Therapy
First-line management for patients with PID and recurrent rhinosinusitis is immunoglobulin (IG) replacement therapy, administered intravenously (IVIG) or subcutaneously (SCIG). In a retrospective cohort study of 58 adults with PID and RARS or CRS, IG therapy reduced the mean pretreatment Lund-Mackay sinus CT score from 7.6 to 3.5 and decreased the proportion of patients requiring functional endoscopic sinus surgery from 19% to 3.4%. Prior to IG, 8.6% of patients had >10 sinus infections per year; after starting IG, 58.6% had no infections reported [344]B2b. IG therapy is typically dosed to maintain IgG trough levels >500-700 mg/dL, though precise dosing should follow standard protocols and individual response.
Step 3: Antimicrobial Prophylaxis (Alternative or Adjunctive)
For patients who cannot receive or decline IG therapy, or for those with nonallergic rhinitis, antimicrobial prophylaxis is an option. In a randomized, double-blind, placebo-controlled trial of children aged 5- with nonallergic rhinitis and RARS, 5 mg/kg/d three days per week for 12 months reduced rhinosinusitis episodes from a median of 5 to 0.5 per year, with a number needed to treat (NNT) of 2 to prevent one patient from having RARS. The average visual analog scale score for nasal symptoms also improved significantly (from 5.4 to 2.2) [338]A1b. This approach may be considered in selected pediatric patients, although data in adults with allergic rhinitis are lacking.
Step 4: Monitoring and Titration
For patients on IG therapy, monitor IgG trough levels, infection frequency, and sinus imaging every 6-12 months. For azithromycin prophylaxis, assess for adverse effects, QTc prolongation, and development of bacterial resistance. Discontinue prophylaxis after 12 months if infection rate remains low; extended duration has not been studied.
Step 5: Immune Reconstitution for Severe IEI
In rare cases of severe inborn errors of immunity (e.g., severe combined immunodeficiency, CVID with life-threatening complications), hematopoietic stem cell transplantation or gene therapy may be considered for definitive cure. Such interventions are reserved for patients with profound immune dysfunction and are typically managed by specialized immunology centers [342]B2a[343]D5.
Table 1: Comparison of Immunoglobulin Therapy vs. Azithromycin Prophylaxis
| Option | Indication | Dose | Key Trial | Outcome | Evidence Level |
|---|---|---|---|---|---|
| Immunoglobulin replacement | PID with RARS/CRS (adults) | Per standard protocols (IVIG/SCIG) | Makary et al. 2021 [344]B2b | Reduced infections, improved LM score, reduced need for FESS | 2b (cohort) |
| Azithromycin prophylaxis | NAR with RARS (children) | 5 mg/kg/d, 3 d/wk × 12 mo | Veskitkul et al. 2017 [338]A1b | Reduced episodes from 5 to 0.5/yr, NNT=2 | 1b (RCT) |
Controversies and Guideline Disagreement
The evidence for IG therapy in CRS is derived from a moderate-sized retrospective cohort without a control group, limiting causal inference. Azithromycin prophylaxis has only been studied in children with nonallergic rhinitis, not in allergic rhinitis. No major guideline disagreements exist for this specific context, but the overall strength of recommendations is based on expert opinion and indirect evidence [106]D5.
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
- ▸The evolution from first-generation sedating antihistamines to second-generation non-sedating agents and intranasal corticosteroids dramatically improved the safety and efficacy of pharmacotherapy.
- ▸Allergen immunotherapy remains the only disease-modifying treatment, with landmark trials demonstrating prolonged clinical remission after 3-4 years of therapy and a preventive effect on asthma development in children.
- ▸Recent advances include intranasal antihistamine-corticosteroid fixed combinations, biologics targeting type 2 cytokines, and digital health tools that personalize symptom monitoring and treatment decisions.
The treatment of allergic rhinitis has evolved from empiric symptom relief to targeted, disease-modifying therapy grounded in an understanding of type 2 inflammation [97]D5. The first major advance came in 1942 with the introduction of oral H₁-antihistamines, which provided rapid relief of sneezing, itching, and rhinorrhea by acting as inverse agonists at the histamine H₁ receptor [360]D5. First-generation agents such as chlorpheniramine and diphenhydramine were effective but caused sedation, psychomotor impairment, and anticholinergic effects, limitations that drove the development of second-generation, non-sedating antihistamines beginning in the 1980s [360]D5. Fexofenadine, loratadine, and cetirizine offered comparable efficacy with negligible central nervous system penetration; fexofenadine was shown even at supra-therapeutic doses up to 800 mg/day to have no effect on the corrected QT interval, establishing a safety benchmark for the class [364]D5.
Intranasal Corticosteroids and the ARIA Era
Topical nasal corticosteroids emerged as the most potent pharmacologic option after a landmark 1987 crossover study demonstrated that one week of pretreatment with intranasal glucocorticosteroids inhibited both early- and late-phase nasal responses to allergen challenge, including suppression of histamine, kinin, and TAME-esterase release [357]A1b. By the 1990s, intranasal corticosteroids had become first-line therapy for moderate‑to‑severe disease, a position reaffirmed by successive editions of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. The 2010 ARIA revision introduced the intermittent/persistent and mild/moderate‑severe classification [2]A1c; the 2016 update used GRADE methodology to recommend intranasal corticosteroids over oral antihistamines as monotherapy and endorsed combination intranasal corticosteroid + intranasal antihistamine for poorly controlled symptoms [1]A1c. The most recent ARIA‑EAACI 2024‑2025 revision further strengthened the recommendation for fixed‑dose intranasal antihistamine + corticosteroid combinations and reversed or changed the directionality of several earlier recommendations based on updated evidence from mHealth data and systematic reviews [3]A1c[5]A1c. A pooled analysis of three randomized trials confirmed that the fixed‑dose combination of olopatadine HCl plus mometasone furoate is superior to either constituent alone, with an onset of action as early as 15 minutes [400]A1a.
Allergen Immunotherapy: From Empiricism to Disease Modification
The modern era of allergen immunotherapy began with controlled trials in the 1990s. In 1999, Durham et al. published the landmark double‑blind discontinuation trial showing that three to four years of grass‑pollen subcutaneous immunotherapy induced prolonged clinical remission that persisted for at least three years after treatment cessation, accompanied by sustained suppression of the late‑skin response and reduced CD3⁺ T‑cell infiltration with interleukin‑4 mRNA [354]A1b. Subsequent trials extended this disease‑modifying concept: the 2021 Japanese cedar (SLIT) tablet study demonstrated a sustained treatment effect during a three‑year treatment period and for two additional years of follow‑up, with a 34 % relative reduction in total nasal symptom‑medication score in the fourth year [351]A1b. In children, the SQ tree SLIT‑tablet achieved a 21.9 % relative reduction in total combined score during the birch pollen season with good tolerability [348]A1b. The EAACI 2017 guideline recommended a minimum of three years of AIT for both seasonal and perennial allergic rhinitis and endorsed its use to prevent asthma in children with grass or birch pollen allergy [4]A1c[81]A1c. Experimental approaches include intralymphatic immunotherapy (ILIT), which in a small randomized trial reduced symptoms and improved quality of life two years after only three doses [277]A1b, and the addition of biologics such as to SCIT, which enhanced efficacy during therapy and showed potential for inducing tolerance at 104 weeks [77]A1b.
Abandoned and Emerging Strategies
Several once‑common interventions have been abandoned or downgraded. Systemic corticosteroids for chronic allergic rhinitis were discarded because of unacceptable adverse effects. Impermeable bedding covers for house‑dust‑mite avoidance, despite proven allergen reduction, failed to improve symptoms in a multicenter randomized trial [356]A1b. Nasal administration of a probiotic assemblage of lactobacilli was safe but did not affect quality‑of‑life or symptom scores [19]A1b. Oral leukotriene receptor antagonists, while effective, are now recommended only as second‑line therapy after intranasal corticosteroids, partly because of a mild but statistically significant risk of neuropsychiatric events in allergic rhinitis patients (OR 1.099, 95 % CI 1.004‑1.202) [347]B2a.
On the horizon, low‑dose interleukin‑2 expanded regulatory T cells in a phase 2 trial and improved nasal symptom scores and lung function without severe adverse events in birch‑pollen‑allergic patients [252]A1b. Mobile‑health applications that combine pollen forecasts, symptom diaries, and medication reminders have demonstrated clinical benefit in controlled trials [349]A1b. The future points toward personalized immunotherapy augmented by biologics and digital tools, guided by biomarkers such as specific IgE and component‑resolved diagnostics [230]D5[97]D5.
Pearl: Three years of allergen immunotherapy is the only treatment that alters the natural history of allergic rhinitis, with sustained clinical benefit persisting for years after discontinuation and evidence that it reduces the development of asthma in children [354]A1b[351]A1b[81]A1c.
Complications, Comorbidities & Iatrogenic Risks
- ▸Allergic rhinitis is not an isolated airway disease but a hub for systemic comorbidities including asthma, sinusitis, otitis media, and sleep-disordered breathing.
- ▸First-generation antihistamines are no longer recommended due to sedation and cognitive impairment; second-generation options provide equivalent efficacy without these risks.
- ▸Olfactory dysfunction affects 20-40% of AR patients and increases with disease duration; treatment with intranasal corticosteroids or immunotherapy offers limited improvement.
Treatment advances have reduced, but not eliminated, the multisystem burden of allergic rhinitis (AR). Disease-driven complications and the atopic comorbidity cluster extend beyond the nasal mucosa, and therapeutic choices carry distinct iatrogenic risks.
Atopic Comorbidity Cluster
AR is a core component of the "atopic march," a spatial-temporal sequence from in infancy to , then and AR in childhood [153]D5. Approximately 50% of patients with AR have comorbid asthma [13]A1c, and AR is an independent risk factor for asthma development and poor asthma control [54]D5. Allergic rhinitis is also strongly associated with (affecting up to 40% of AR patients) [37]D5, with or without [199]D5, and [91]D5. The International Severe Asthma Registry reports that AR, nasal polyposis, and chronic rhinosinusitis each increase annual exacerbation frequency by 1.12- to 1.29-fold in patients with severe asthma [39]B2c.
Disease-Driven Complications
Olfactory dysfunction occurs in 20-40% of AR patients, frequency rising with disease duration; improvement with topical steroids or immunotherapy is limited [402]B2a. Nasal obstruction contributes to , snoring, apnea, and daytime somnolence, which intranasal corticosteroids can partially reverse [409]D5[411]D5. In children, persistent moderate-to-severe AR predisposes to ; allergy evaluation is warranted when OME is recurrent [407]B2a. AR-related inflammation can extend to the lower airway ("one airway, one disease"), impairing and pulmonary function [59]A1b. Mental health comorbidity is increasingly recognized: depressive and anxiety symptoms are more prevalent in AR populations, likely driven by neuroinflammation and disease burden [34]D5.
Iatrogenic and Treatment-Related Risks
First-generation cause sedation, psychomotor retardation, and impaired academic performance; they are no longer recommended [38]D5[54]D5. Second-generation oral antihistamines (e.g., , ) have minimal sedation and are generally safe [189]B2a[412]D5. are well-tolerated, but local irritation and epistaxis occur in 5-10% of users; long-term use in children has not shown significant growth suppression at standard doses [130]D5[417]D5. (AIT), both subcutaneous (SCIT) and sublingual (SLIT), carries risk of local reactions (oral pruritus, swelling) and, rarely, systemic . A fatal systemic reaction to SCIT occurs at a rate of approximately 1 in 2.5 million injections [403]A1a. AIT has been associated with induction of in susceptible individuals, though this is uncommon and usually reversible upon discontinuation [328]D5. Novel biological therapies such as (anti-IL-4Rα) show a favorable safety profile; in a phase 2b study, the 300 mg every 2-week dose improved AR symptoms in comorbid perennial AR without unexpected adverse events [401]A1b.
Complication Table
| Complication | Frequency | Prevention | |
|---|---|---|---|
| Olfactory dysfunction | 20-40% [402]B2a | Control inflammation with INCS/IT | INCS, AIT (limited efficacy) |
| Sleep-disordered breathing | 30-60% of AR patients [409]D5 | Relieve nasal obstruction | INCS, decongestants short-term |
| Otitis media with effusion (children) | Up to 40% in AR [407]B2a | Effective AR treatment | Medical management, consider myringotomy |
| Asthma exacerbations | 1.12-1.29× increase [39]B2c | Optimize AR control (INCS, IT) | Standard asthma therapy plus AR management |
| First-gen antihistamine sedation | 20-30% [38]D5 | Avoid first-generation agents | Switch to second-generation |
| AIT systemic reaction | 0.1-0.2% of injections [403]A1a | Dose adjustment, observation period | Epinephrine, antihistamines, steroids |
Pearl: In children with persistent moderate-to-severe AR, screen for otitis media with effusion, and consider the atopic march when evaluating comorbidities, early immunotherapy may modify progression to asthma [13]A1c[54]D5.
Prognosis & Natural History
- ▸Allergic rhinitis prevalence rises through childhood, peaking in adolescence; most children have persistent symptoms with significant impairment.
- ▸Allergen immunotherapy is the only treatment that alters natural history, reducing the short-term risk of asthma by 40%.
- ▸Prognostic factors include parental atopy, polysensitization, food allergy history, and environmental exposures (siblings, farm, pollution).
Having catalogued the complications and comorbidities that can arise, clinicians must also appreciate that allergic rhinitis follows a heterogeneous trajectory, from spontaneous resolution in some to relentless persistence with progression to asthma in others. In childhood, the 12-month prevalence of AR quadruples from 6% at age 3 to 24% at age 13 in children of non-allergic parents, and more than triples from 13% to 44% in those with an allergic parent [380]B2b. The majority of affected children experience persistent symptoms lasting two months or more annually, and most are impaired in daily activities [380]B2b. By adolescence, the clinical course tends to stabilize, but only a minority remit completely.
Prognostic Factors
Multiple exposures and host factors shape the likelihood of persistence. Parental atopy, early and polysensitization, severe disease, and filaggrin (FLG) mutations all predict a more difficult course with multimorbidity [87]D5. The protective influence of older siblings (RR 0.79, 95% CI 0.73-0.86 for current AR) and farm exposure before age 1 (OR 0.60, 0.52-0.70 against sensitization) highlights the role of microbial diversity [24]B2a[427]B2a. Conversely, caesarean delivery (OR 1.23, 1.12-1.35 for AR), neonatal jaundice (OR 3.01, very low certainty), and air pollution (OR 1.43, 1.026-1.98 for AR in exposed subjects) each increase risk [425]B2a[263]B2a[424]B2a. Children with a history of food protein-induced allergic proctocolitis carry a fourfold higher odds of subsequent asthma and threefold higher odds of AR [163]B3b. Delayed resolution of food sensitizations, particularly to milk and egg, distinguishes children whose AR progresses to asthma from those who remain with rhinitis alone [72]C4.
Disease Modification and Remission
Allergen immunotherapy (AIT) is the only treatment that alters the natural history of AR. Three years of AIT induces long-term clinical tolerance, with downregulation of type 2 inflammation and persistent IgG/IgA-associated blocking activity [6]D5[280]D5[42]D5. In children with seasonal pollinosis, both subcutaneous and sublingual AIT reduce the short-term risk of developing asthma (RR 0.40, 95% CI 0.30-0.54) [86]B2a. Preliminary data suggest that house dust mite SLIT initiated in infancy may reduce multiple sensitizations and prevent asthma at age 6 years [6]D5. However, remission as a formal construct remains poorly operationalized in AR; current outcome measures capture symptom control rather than stable disease inactivity [312]D5. Real-world initiation of AIT is low (36.2% of those recommended), and only about one-third complete the recommended three-year course; median time on subcutaneous AIT is 3 years in adults and 4.7 years in children [423]B2b. For those who persist, patient-perceived benefit is high: 84% of children and adolescents achieve a meaningful Patient Benefit Index score at 12-15 months, with sustained improvements in symptom burden and rhinitis severity [190]B2b.
Pearl: In a child with moderate-to-severe seasonal allergic rhinitis and polysensitization, the strongest argument for initiating allergen immunotherapy is not symptom control alone, it is the demonstrated 40% relative risk reduction for developing asthma over the short term (RR 0.40), a disease-modifying effect no pharmacotherapy can match [86]B2a.
Special Populations and Pregnancy
- ▸Pediatric AR is common (10-20%) and impacts quality of life; intranasal corticosteroids are first-line, with combination therapy and SLIT for refractory cases.
- ▸In pregnancy, management balances maternal symptom control with fetal safety; second-generation antihistamines and intranasal corticosteroids are preferred, while oral decongestants are avoided in the first trimester.
- ▸Elderly patients often have mixed rhinitis and polypharmacy; immunotherapy is safe and effective in selected patients.
The natural history of allergic rhinitis varies across the lifespan, with age-specific presentation, comorbidities, and treatment considerations that require tailored .
Pediatrics
Allergic rhinitis affects 10.5% of children by physician diagnosis and up to 19.9% by self-report, with a rising trend [10]B2a. Presentation often includes nasal congestion, sneezing, and rhinorrhea, but children may also exhibit snoring, mouth breathing, and sleep-disordered breathing (OR 2.24 for habitual snoring) [184]A1a. Diagnosis relies on history, skin prick testing, and specific IgE; basophil activation testing can help identify local allergic rhinitis when standard tests are negative [116]D5.
First-line pharmacotherapy is intranasal corticosteroids (INCS). Beclomethasone dipropionate nasal aerosol 80 or 160 μg once daily is effective and well tolerated in children aged 6-11 years [440]A1b. The fixed combination olopatadine-mometasone (GSP301, 1 spray each nostril twice daily) also significantly improves nasal symptoms (reflective Total Nasal Symptom Score difference -0.6 vs placebo) [439]A1b. In adolescents aged 12-18 years, INCS produce greater quality-of-life gains and fewer school absences than oral antihistamines alone [177]B2b. (SLIT) is effective for pediatric allergic rhinitis, with a meta-analysis showing significant reductions in symptoms (standardized mean difference 0.56) and medication use (0.76) [444]A1a; 3 years of treatment are needed for sustained immunologic changes [238]C4. as adjunctive therapy improve nasal symptoms (standardized mean difference -1.40) and quality of life, but results are heterogeneous [62]A1a. Dupilumab reduces the risk of incident allergic rhinitis in children with atopic dermatitis (RR 0.62) [140]B2b.
Pregnancy and Lactation
Managing allergic rhinitis during pregnancy requires balancing maternal symptom control with fetal safety. Disease control is particularly important because uncontrolled rhinitis can aggravate asthma and affect quality of life. First-generation oral antihistamines and oral decongestants are avoided, especially in the first trimester [198]D5. Second-generation antihistamines, including cetirizine, loratadine, and fexofenadine, are preferred; fexofenadine maintains a favorable safety profile in pregnancy [193]B2a. Intranasal corticosteroids (budesonide, fluticasone, mometasone) are first-line therapy with extensive safety data. Allergen immunotherapy initiated before pregnancy can be continued, but initiation during pregnancy is not recommended [457]D5. Prenatal supplementation with fish oil (2.7 g/day in the third trimester) reduced asthma medication prescriptions in offspring (HR 0.54) but did not significantly affect allergic rhinitis medication (HR 0.70) [437]A1b. Vitamin D and probiotic supplementation during pregnancy have not been shown to reduce allergic rhinitis in offspring [78]A1a, [441]A1a. Prenatal antibiotic exposure is associated with increased risk of childhood allergic rhinitis (RR 1.13) [442]B2a.
Elderly
Rhinitis in elderly patients is underdiagnosed; up to 21% have local allergic rhinitis (LAR) with positive nasal provocation but negative skin tests [469]C4. Allergic rhinitis often coexists with non-allergic rhinitis, and age-related nasal structural changes (dryness, reduced mucociliary clearance) complicate presentation [466]D5. First-generation antihistamines should be avoided due to anticholinergic effects, sedation, and fall risk [466]D5. Second-generation antihistamines and INCS (including fixed combinations with intranasal antihistamines) are first-line [466]D5. Sublingual immunotherapy is safe and effective in patients aged 60-75 years, with a 44% reduction in nasal symptom score and a 51% reduction in medication use after 3 years [445]B2b. Notably, pollinosis in older adults is associated with lower all-cause mortality (HR 0.57), possibly reflecting preserved immune function [450]B2b. Polypharmacy and frailty require monitoring for drug-drug interactions and adherence.
Immunocompromised
Limited evidence exists for allergic rhinitis management specifically in immunocompromised patients. Standard pharmacotherapy with intranasal corticosteroids and second-generation antihistamines is generally considered safe. Allergen immunotherapy is relatively contraindicated in patients with severe immunosuppression (e.g., transplant recipients, active malignancy on chemotherapy) due to theoretical risk of infection and lack of efficacy data [13]A1c. Local allergic rhinitis and non-allergic rhinitis should be considered in the differential diagnosis, as triggers such as medications or infections are common.
Controversies and Guideline Disagreement
| 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 |
| Prenatal vitamin D for offspring allergic rhinitis | Not effective: meta-analysis of RCTs (RR 0.89, CI 0.69-1.15) [441]A1a | Observational studies suggest inverse association with wheeze [84]B2a | Low | Vitamin D supplementation during pregnancy is not indicated for AR prevention |
| 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 |
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.
Prevention, Screening & Surveillance
- ▸No primary prevention strategies reliably reduce allergic rhinitis incidence; early-life emollients, probiotics, vitamin D, omega-3, and dust mite covers have insufficient or negative evidence.
- ▸Allergen immunotherapy (AIT) offers the only disease-modifying intervention: a 3-year course in children with moderate-to-severe AR reduces progression to asthma (RR 0.60, 95% CI 0.42-0.84) and is recommended by EAACI.
- ▸Screening with allergy testing is warranted in children with early atopic dermatitis, food allergy, or strong family history; prediction models using antibiotic use and tobacco exposure can identify high-risk infants.
Building on the considerations for pregnant women and other special populations, attention now turns to strategies that reduce the incidence of allergic rhinitis (AR) and modify its natural history. Prevention efforts span three tiers: primary prevention to avoid disease onset, secondary prevention to halt progression to asthma, and screening to identify at-risk individuals early.
Primary Prevention Strategies
Several early-life interventions have been investigated, but most fail to reduce AR incidence. Daily emollient use from birth in high-risk infants reduced atopic dermatitis (AD) at 12 months in the STOP-AD trial (95% CI 0.52-0.97) [136]A1b, yet the larger BEEP trial found no effect on eczema by age 2 (aRR 0.95, 95% CI 0.78-1.16) and noted an increase in skin infections (incidence rate ratio 1.55, 95%) [18]A1b. A meta-analysis of impermeable dust mite covers showed no reduction in AR risk (RR 1.03) [489]A1a. Probiotic supplementation during pregnancy or infancy did not significantly reduce AR odds at any age (≤1 year: OR 0.73, 95% CI 0.46-1.15; >1 year: OR 0.95, 95% CI 0.83-1.09) [78]A1a. Vitamin D supplementation in pregnancy or infants shows very low certainty evidence for AR prevention [483]B2a[23]B2a. Omega-3 and omega-6 supplementation failed to demonstrate benefit for AR prevention (RR 0.80) [485]A1a. Farm milk consumption early in life is associated with lower AR risk (OR 0.68, 95% CI 0.57-0.82) in meta-analysis, but raw milk carries infection risk and is not recommended [486]B2a. Indoor dampness and mold are modifiable risk factors: visible mold increases AR risk (OR 1.51, 95% CI 1.39-1.64), supporting remediation [482]A1a. Phthalate exposure (DEHP) is associated with childhood AR (95% CI 1.02-1.39) [85]B2a. Overall, only non-modifiable factors, parental AR (aHR 2.49), early sensitization (aHR 4.53), and early eczema (aHR 1.83), are robust predictors up to age 20 [443]B2b.
Screening Recommendations
Screening for AR should target children with early atopic dermatitis, food allergy, or a strong family history of atopy. The ARIA 2016 guidelines recommend allergy testing (skin prick or specific IgE) when symptom-directed history suggests AR and the result would alter management [2]A1c. In infants with food allergy, a prediction model incorporating parental allergy history, antibiotic use frequency, and tobacco smoke exposure achieved AUC 0.915 for later AR development [334]B2b. Routine screening for in AR patients may be considered given the elevated odds (OR 1.71, 95% CI 1.36-2.15) [488]B2a. The EAACI guideline on allergen immunotherapy (AIT) for prevention recommends that children with moderate-to-severe grass/birch pollen AR be offered a 3-year course of subcutaneous or sublingual AIT to prevent asthma for up to 2 years post-treatment (recommendation grade strong, moderate-quality evidence) [81]A1c.
Vaccine Considerations
Allergic rhinitis is not a contraindication to any routine vaccine. Patients should receive standard immunizations including influenza and vaccines. The presence of AR alone does not increase risk to vaccines; risk-stratified deferral is not cost-effective [501]D5. Inhaled or intranasal corticosteroids do not contraindicate live attenuated influenza vaccine (LAIV); the 2020 NAEPP update supports LAIV use in individuals with AR [503]D5.
Patient Education
Key messages include: allergen avoidance (mold remediation, dampness control), realistic expectations about dust mite covers (no proven benefit), the importance of AIT adherence for disease modification, and awareness that early eczema and food allergy warrant monitoring for AR. The evolving role of community pharmacists in AR screening and education is highlighted by the ARIA-Italy initiative [413]D5.
Pearl: For children with moderate-to-severe allergic rhinitis, a 3-year course of allergen immunotherapy is the only proven disease-modifying strategy that reduces the risk of developing asthma by approximately 40% (RR 0.60, 95% CI 0.42-0.84) in real-world settings; early initiation before age 12 may yield greater benefit [487]B2b[202]B3b.
| Intervention | Outcome | Effect Estimate | Recommendation |
|---|---|---|---|
| Daily emollient from birth | AR incidence at 12 mo | No benefit (RR 0.95, CI 0.78-1.16) [18]A1b | Not recommended |
| Probiotics (prenatal/infant) | AR incidence at any age | No effect (OR >1yr 0.95, CI 0.83-1.09) [78]A1a | Not recommended |
| Vitamin D supplementation | AR incidence | Very low certainty [483]B2a[23]B2a | Insufficient evidence |
| Dampness/mold remediation | AR risk reduction | Visible mold OR 1.51 (CI 1.39-1.64) [482]A1a | Recommended |
| Allergen immunotherapy | Prevention of asthma in AR | RR 0.60 (CI 0.42-0.84) [487]B2b | Strong recommend (EAACI 2017) [81]A1c |
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