Effect of SQ SLIT-Tablets on Asthma Symptoms and Safety in Children with Allergic Rhinitis and With or Without Concomitant Asthma Across Multiple Trials

Presenter: O. Pfaar

This analysis evaluated the effect and safety of sublingual immunotherapy (SLIT) tablets in children with allergic rhinitis/rhinoconjunctivitis (AR/C), with or without coexisting asthma. The study included data from five randomized, double-blind trials assessing grass, ragweed, tree pollen, and house dust mite (HDM) SLIT tablets. A total of 4,035 children received either daily SLIT tablets or placebo. At baseline, 26%–43% of children across the trials had asthma. Asthma outcomes were assessed using asthma daily symptom score (DSS), short-acting beta agonist (SABA) use, and asthma-related night-time awakenings. Compared with placebo, SLIT tablet treatment reduced asthma symptom scores across all five trials. The relative reduction in asthma DSS ranged from 21% to 64% during the assessment periods. SABA use was also reduced, with relative reductions ranging from 30% to 68%. A numerical reduction in night-time awakenings due to asthma was also observed with SLIT tablets. Treatment-related adverse events were similar in children with and without asthma, indicating that SLIT tablets were well tolerated regardless of asthma status.

Overall, pollen and HDM SLIT tablets not only improved allergic rhinitis/rhinoconjunctivitis outcomes but were also associated with reduced asthma symptoms and rescue medication use in children.

Comparison of Long-Term (52 week therapy) Maintenance vs. As-Needed Intranasal Corticosteroid Therapy in Pediatric Allergic Rhinitis: Assessment Using Exhaled Breath Condensate Leukotriene E4

Presenter: YM. Park

This study evaluated whether daily maintenance treatment with intranasal corticosteroids provides better long-term control than as-needed use in children with allergic rhinitis (AR), using exhaled breath condensate (EBC) leukotriene E4 (LTE4) as an inflammation marker. Eighteen children with AR (median age: 4 years 7 months) received fluticasone furoate treatment for 52 weeks and were divided into a daily-use group (Group A, n=8) and an as-needed-use group (Group B, n=10). Symptom scores and EBC LTE4 levels were assessed at multiple time points from baseline to week 52. At baseline, there were no significant differences between the groups in symptom scores or EBC LTE4 levels. Both groups showed significant improvement in symptoms from week 8 onwards (P<0.01). However, after 52 weeks, Group A had better symptom control compared with Group B, with lower symptom scores (1.3 vs 2.3; P<0.01). EBC LTE4 levels decreased significantly in both groups after treatment, from 74.7 to 9.8 pg/mL in Group A and from 72.8 to 24.3 pg/mL in Group B (P<0.01). At week 52, LTE4 levels were significantly lower in the daily-treatment group compared with the as-needed group (9.8 vs 24.3 pg/mL; P<0.01).

Overall, the study found that daily intranasal corticosteroid maintenance therapy provided better long-term symptom control and greater reduction in airway inflammation compared with as-needed treatment in children with AR. EBC LTE4 measurement may help monitor inflammatory changes during treatment.

Evidence of Lower Airway Inflammation in Children with Allergic Rhinitis Without Asthma

Presenter: AV. Soares

This study assessed whether children with allergic rhinitis (AR) but without asthma show signs of inflammation in the lower airways, based on the concept of “one airway, one disease.” A community-based cross-sectional study was conducted among children from 20 public schools in Porto, Portugal. Children underwent clinical evaluation, fractional exhaled nitric oxide (FeNO) measurement, and spirometry[au1] . Current allergic rhinitis was identified by self-reported medical diagnosis.  with physician-diagnosed asthma were excluded. Among 559 children without asthma, 84 (15%) had current AR and 475 (85%) did not have rhinitis. Children with AR had significantly higher FeNO levels compared with children without rhinitis,median 15 ppb [IQR 7–37.50] vs 10 ppb [IQR 6–16], p = 0.0001, suggesting increased lower airway eosinophilic inflammation. However, lung function measurements were similar between the two groups. Median pre[au2] -bronchodilator forced expiratory volume in 1 second (FEV₁) was 1.80 L in children with AR compared with 1.74 L in those without AR (P=0.131). Post-bronchodilator FEV₁ was 1.88 L versus 1.82 L, respectively (P=0.120). Other lung function measures, including forced vital capacity (FVC) and peak expiratory flow, also showed no significant differences and remained within normal ranges.

Overall, the findings indicate that children with AR may have lower airway inflammation even in the absence of asthma, while lung function remains preserved. The results support the link between upper and lower airway inflammation in paediatric allergic respiratory disease.

Prevalence of Attention Deficit Hyperactivity Disorder and Related Factors in Children Aged 6–14 Years Diagnosed with Allergic Rhinitis

Presenter: S. Çevik

This study evaluated the presence of attention deficit hyperactivity disorder (ADHD) symptoms in children with allergic rhinitis (AR) compared with healthy children and assessed whether AR-related factors such as disease severity and duration were associated with attention problems. The study included 110 children aged 6–14 years with AR and 112 healthy controls. Allergic rhinitis was diagnosed according to Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, and ADHD symptoms were assessed using the SNAP-IV scale completed by parents and teachers. The proportion of children with scores suggestive of ADHD symptoms was higher in the AR group compared with healthy controls (9.1% vs 6.2%), although the difference was not statistically significant. However, children with AR had significantly higher hyperactivity/impulsivity scores compared with healthy controls (5.85±4.88 vs 4.85±4.80; P=0.045). Parent and teacher assessments showed moderate agreement (r=0.445; P<0.001), although parents reported significantly higher symptom scores than teachers (P=0.001). In subgroup analysis, children with moderate-to-severe AR had higher SNAP-IV ADHD scores compared with those with mild AR (13.24±10.06 vs 9.25±6.33; P=0.046). Higher total nasal symptom scores (TNSS) and longer symptom duration were also associated with higher attention deficit scores (r=0.246; P=0.010 and r=0.227; P=0.017, respectively). ADHD scores were also significantly higher in boys compared with girls (P=0.006).

Overall, AR alone was not associated with a significant increase in ADHD symptoms, but greater disease severity and longer symptom duration were linked with more attention-related difficulties. The findings suggest that children with persistent or moderate-to-severe AR may benefit from evaluation for cognitive and behavioural symptoms.

Bronchial Inflammation and Lung Function in Children with Asthma and Allergic Rhinitis: The Contribution of FeNO and Spirometry

Presenter: Z. Lafi

This pilot study evaluated the relationship between airway inflammation and lung function in children with asthma and allergic rhinitis (AR). Since asthma and AR involve inflammation of both the upper and lower airways, the study assessed fractional exhaled nitric oxide (FeNO) as a marker of eosinophilic airway inflammation along with spirometry for lung function evaluation. The prospective study included 26 children older than 6 years with asthma and AR diagnosed based on clinical features and positive skin prick testing. Participants underwent FeNO measurement and spirometry, including assessment of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), and the FEV₁/FVC ratio. Among the 26 children, 38.5% had FeNO levels above 35 parts per billion (ppb), indicating persistent eosinophilic inflammation in the airways. Spirometry showed moderate impairment in lung function, with a median FEV₁ of approximately 60% of predicted value. Higher FeNO levels showed a trend toward lower spirometric measurements, suggesting that increased airway inflammation may be associated with reduced lung function.

Overall, the findings highlight that FeNO measurement and spirometry provide complementary information when assessing children with asthma and AR. FeNO may serve as a useful non-invasive marker for evaluating airway inflammation alongside lung function testing.

Severe Persistent Allergic Rhinitis in an Adolescent: A SNOT-22–Based Case Report

Presenter: L. Mouangue-Mbonjo

This case report describes the clinical impact and management of persistent severe allergic rhinitis (AR) in a 15-year-old adolescent. The report highlights the importance of accurate diagnosis, appropriate treatment, and objective assessment of treatment response in children with AR. A 15-year-old boy presented with fluctuating nasal obstruction, runny nose, daily sneezing, and allergic conjunctivitis. His symptoms affected sleep and concentration, with a baseline Sino-Nasal Outcome Test-22 (SNOT-22) score of 56/110 on day 1. Immunological testing showed multiple sensitivities to house dust mites, including Dermatophagoides pteronyssinus (class 5), Dermatophagoides farinae (class 6), Acarus siro (class 4), and Blomia tropicalis (class 5). Based on Allergic Rhinitis and its Impact on Asthma (ARIA) classification, the patient was diagnosed with persistent moderate-to-severe AR. The patient was treated with bilastine 20 mg/day, (antiallergic eye drops[au3] ), daily saline nasal irrigation, and dust mite avoidance measures. After 14 days of treatment, symptoms improved significantly, with the SNOT-22 score decreasing from 56 to 22, indicating improvement in both symptoms and daily functioning.

Overall, the case demonstrates that a combined approach involving medication, allergen avoidance, patient education, and regular assessment can improve outcomes in pediatric AR. The SNOT-22 questionnaire helped objectively measure symptom improvement following treatment.

Levels of House Dust Mite in Dust Settlements are Associated with Risk for Allergic Rhinitis in Children

Presenter: I. Banic

This study investigated whether indoor exposure to house dust mites is associated with the risk of allergic diseases in children. House dust mites are common indoor allergens and may contribute to allergic respiratory conditions such as allergic rhinitis (AR) and allergic asthma. The observational study included 207 children aged 5–18 years, including children with allergies and non-allergic controls, as part of the Horizon Evidence Driven Air Quality Improvement (EDIAQI) project. Participants underwent skin prick testing, blood testing for allergen-specific immunoglobulin E (sIgE), and lung function assessment. Dust samples were collected from mattresses and analysed for major house dust mite allergens, including Dermatophagoides pteronyssinus allergen 1 (Der p1) and Dermatophagoides farinae allergen 2 (Der f2), using enzyme-linked immunosorbent assay (ELISA). Children with AR had higher levels of Der p1 compared with participants without AR (P=0.002). Additionally, every 10 nanograms/mL increase in Der p1 concentration was associated with a 10% increase in the risk of AR (P=0.036; Exp(B)=1.01; 95% confidence interval [CI]: 1.001–1.019). In contrast, storage mite levels did not differ between allergic and non-allergic children or between children with and without specific allergic conditions.

Overall, the study found that higher indoor exposure to house dust mite allergens, particularly Der p1, was associated with an increased risk of AR in children. The findings support the importance of reducing indoor allergen exposure as part of allergy prevention and management strategies.

Association Between Environmental Conditions and Mold Sensitization in Children with Allergic Rhinitis and Asthma

Presenter: D. ALTINTAŞ

This study evaluated the relationship between environmental factors and mold sensitization patterns in children with allergic rhinitis (AR) and/or asthma. Although mold exposure has been linked with allergic airway diseases, the influence of environmental conditions on different mold sensitization patterns in children remains unclear. This retrospective study included 250 children with AR and/or asthma who had confirmed mold sensitization between 2018 and 2023. Children were categorized based on sensitization pattern as indoor, outdoor, or combined indoor and outdoor sensitization. The study assessed demographic details, eosinophil counts, total immunoglobulin E (IgE) levels, residential area, and meteorological factors including humidity, temperature, wind speed, precipitation, and rainy days. Among the 250 children (42% female; median age 6 years), 34.4% lived in rural areas and 65.6% in urban areas. Asthma was present in 49.6% of participants. Indoor mold sensitization was identified in 35.2% of children, outdoor sensitization in 31.2%, and combined sensitization in 33.6%. The most common indoor molds were Alternaria (38.4%) and Cladosporium (39.6%), while Aspergillus (38%) and Penicillium (36.4%) were the most frequent outdoor molds. Asthma was significantly more common in children with indoor mold sensitization compared to those with [au4] only outdoor sensitization (P=0.04). Children with combined sensitization had significantly higher eosinophil counts and total IgE levels (P<0.001). Combined sensitization was also more frequent among urban children compared with rural children. No significant association was found between mold sensitization and meteorological factors. Indoor sensitization was significantly higher during the first 10 months of 2023 (P<0.05).

Overall, indoor mold sensitization was associated with a higher prevalence of asthma in children with AR. Urban living may be linked with combined mold sensitization, while further studies are needed to better understand environmental influences on mold allergy.

Comparison of Different Treatment Strategies for Allergic Rhinitis in Children and their Impact on Bronchial Asthma

Presenter: N. Nenasheva

This study evaluated whether a fixed-dose combination of olopatadine hydrochloride and mometasone furoate intranasal spray provides better control of allergic rhinitis (AR) and associated bronchial asthma (BA) compared with mometasone furoate alone in children. The study was based on the concept of “one airway, one disease,” where upper and lower airway inflammation are considered closely linked. This open-label comparative real-life study included 81 children aged 7–17 years with persistent moderate-to-severe seasonal and/or perennial AR and partly controlled or uncontrolled mild-to-moderate allergic BA. Children were assigned to receive either fixed-dose olopatadine hydrochloride/mometasone furoate (OLO/MF; n=60) or mometasone furoate (MF; n=21) for 57 days, while their existing asthma controller treatment remained unchanged. Outcomes assessed included AR symptoms, asthma control, quality of life, lung function, fractional exhaled nitric oxide (FeNO), and markers of eosinophilic inflammation. At baseline, symptom severity measured by visual analogue scale (VAS) was similar between groups (60 mm). After 57 days, AR symptoms improved significantly in both groups, with a greater reduction observed in the OLO/MF group (final VAS score: 20 vs 35 mm; P=0.022), representing a 43% greater improvement compared with MF alone. Both groups showed improved asthma control, with fewer children having uncontrolled BA and better scores on asthma control measures, including the 5-item Asthma Control Questionnaire (ACQ-5) and childhood/adolescent Asthma Control Test (cACT/ACT). Health-related quality of life measured using the Paediatric Asthma Quality of Life Questionnaire (PAQLQ[s]) also improved, with greater improvements seen in the OLO/MF group. Lung function showed greater improvement with OLO/MF, while fractional exhaled nitric oxide (FeNO) levels remained mostly unchanged. Changes in eosinophilic inflammation markers were more noticeable with OLO/MF. Both treatments were well tolerated and had favourable safety profiles.

Overall, both intranasal mometasone furoate and the fixed-dose olopatadine hydrochloride/mometasone furoate combination improved AR and associated BA control without increasing asthma therapy. The combination treatment showed greater clinical, functional, and anti-inflammatory benefits in children with moderate-to-severe AR and asthma.

Associations Between Prevalence of Sensitization to Pets and Symptoms of Allergic Rhinitis in Children

Presenter: M. Sung

This study evaluated the association between pet sensitization, pet ownership, and allergic rhinitis (AR) characteristics in children in Korea. With increasing pet ownership and rising rates of cat and dog sensitization among children, the study aimed to assess whether pet sensitization was linked with AR severity and allergic markers. The study included 330 children aged 1–15 years with AR who participated in the Korean Childhood AR Study. Data were collected using questionnaires and paediatric evaluations. The study assessed pet ownership, AR-related symptoms, total immunoglobulin E (IgE) levels, eosinophil counts, and atopic status. Children sensitized to pets (n=182) were compared with those without pet sensitization (n=148). There were no significant differences between children with and without pet sensitization in terms of gender, age, body mass index (BMI), AR severity, or eosinophil counts (P>0.05). However, total IgE levels were significantly higher in children with pet sensitization compared with those without sensitization (P<0.05). Regression analysis showed that pet sensitization was associated with increasing age and higher total IgE levels, while it was also linked with lower parental history of allergic disease among children with AR (P<0.05). Pet sensitization was not associated with AR severity. Symptoms triggered by pet exposure were significantly associated with both pet sensitization and pet ownership, but not with total IgE levels or eosinophil counts. No significant differences were found in allergic symptoms between children who owned dogs and those who owned cats (P>0.05).

Overall, pet sensitization in children with AR was associated with markers of atopic status, particularly higher total IgE levels, but was not linked with greater AR severity.

EAACI 2026, June 12-15, Istanbul, Türkiye