Table 1.

Pros and cons on treatment modalities for pediatric allergic rhinitis (AR)

Medication	Pros	Cons
Oral H1 antihistamines	Non-sedating antihistamine as the first-line treatment and well tolerable	Mild fatigue, headache, nausea, dry mouth, poor drug adherence
Intranasal antihistamines	First or second-line treatment, effective for ocular symptoms	Concerns for patient tolerance, especially with regard to taste
Intranasal corticosteroids	First or second-line treatment All nasal symptoms relief as well as ocular symptoms	Nasal irritation, epistaxis, slow onset, some negative effects on short-term growth in children, but it is unclear for long term
Oral decongestant	For short-term relief of nasal obstruction	Insomnia, loss of appetite, irritability, palpitations, and increased blood pressure. Risk of toxicity in young children
Topical decongestant	For short-term nasal decongestion	Chronic use may carry the risk of rhinitis medicamentosa. Rebound congestion
Leukotriene receptor antagonist	For AR combined asthma symptoms relief	Little effect as monotherapy for AR Cost
Cromones	As alternative for patient cannot tolerate intranasal corticosteroid	Nasal irritation, slow onset, frequent dosing needed
Ipratropium nasal spray	Adjunct to intranasal corticosteroid for the uncontrolled rhinorrhea	Nasal irritation, headache, pharyngitis, epistaxis, nasal dryness, over-dosing
Nasal saline douching	Adjunct to pharmacotherapy Effective in discharge removal	Practice and education needed, intranasal irritation, headaches, and ear pain
Combination: intranasal antihistamine and corticosteroid	Rapid onset, effective when monotherapy fail to control symptoms. Used as second-line therapy	Patient intolerance, especially due to taste Cost