On optimizing pharmacotherapy of chronic adenoiditis combined with allergic rhinitis in children

   Introduction. According to current clinical guidelines, glucocorticosteroids are recommended for children with chronic adenoiditis combined with allergic rhinitis. However, their prolonged use increases the risk of adverse effects and may negatively impact the child’s immune status. Therefore, it is clinically relevant to evaluate the dynamics of disease symptoms when replacing glucocorticosteroids with antihistamines.

   Aim. To assess the feasibility of optimizing pharmacotherapy for chronic adenoiditis associated with allergic rhinitis in pediatric practice.

    Materials and methods. Two groups of children aged 6–15 years with diagnosed adenoid hypertrophy and allergic rhinitis were formed at the Amur Regional Children’s Clinical Hospital (Blagoveshchensk). The control group (n = 15) received standard therapy with intranasal mometasone furoate spray–1 dose (50 µg) per nostril once daily (total 100 µg/day)–for 1 to 3 months. In the main group (n = 12), mometasone was discontinued and oral desloratadine was administered once daily at 2.5 mg (for children 6–11 years) or 5 mg (for children ≥12 years). Symptom monitoring (rhinorrhea, nasal congestion, breathing difficulty) was performed by patients and their parents at follow-up visits on days 7, 14, 21, and 28 using three criteria: "complete symptom resolution", "improvement", or "no change".

   Results. By the end of the second week, the proportion of patients with complete symptom resolution in the desloratadine group was 40% higher than in the control group (χ² = 14.25, p = 0.00016); by the third week, the difference increased to 42 % (χ² = 18.11, p = 0.00002); and by the fourth week, it reached 43 % (χ² = 26.10, p < 0.00001). Endoscopic nasopharyngeal examination on day 28 confirmed therapeutic efficacy, revealing positive dynamics in nearly all patients in the main group.

   Conclusion. The study demonstrates that pharmacotherapy for chronic adenoiditis associated with allergic rhinitis in children can be optimized by incorporating the histamine H1-receptor antagonist desloratadine into the treatment regimen while omitting topical glucocorticosteroids. Larger-scale studies with increased sample sizes are warranted to confirm these findings and establish robust statistical conclusions.

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