Rhinosinusitis and allergic rhinitis in children: treatment tactics for pediatric nasal care
DOI: 10.32364/2618-8430-2026-9-3-20
Rhinosinusitis and allergic rhinitis in children: treatment tactics for pediatric nasal care
V.V. Shilenkova
Yaroslavl State Medical University, Yaroslavl, Russian Federation
Rhinosinusitis and allergic rhinitis (AR) are among the most prevalent upper respiratory tract diseases in pediatric practice and exhibit a strong comorbid relationship. The high prevalence of AR in children with recurrent rhinosinusitis identifies allergy as a primary driver of paranasal sinus inflammation. Specifically, Th2-mediated inflammation leads to edema of the ostiomeatal complex, impaired mucociliary clearance, and disruption of the mucosal epithelial barrier. Consequently, the management of this comorbid condition must be based on the principle of simultaneously targeting inflammation in both the nasal cavity and the paranasal sinuses. Current clinical guidelines recommend intranasal corticosteroids combined with nasal saline irrigation as the cornerstone of baseline therapy for post-viral and bacterial acute rhinosinusitis, as well as for chronic rhinosinusitis, including cases comorbid with AR. Numerous studies confirm the efficacy of nasal irrigation in improving symptoms and quality of life in patients with concomitant conditions. This is achieved through the mechanical clearance of excess mucus, pathological secretions, inflammatory mediators, cytokines, and allergens, thereby creating optimal conditions for the maximal efficacy of topical medications on the nasal mucosa. The excellent safety profile of nasal irrigation supports its recommendation for children of all ages. The choice of saline solution concentration should be tailored to the specific nasal pathology, clinical judgment, and patient preferences. Overall, the comorbidity of AR and rhinosinusitis necessitates not only comprehensive diagnostics but also a personalized therapeutic approach rooted in the "unified airway" concept. As an accessible, safe, and pathogenetically sound intervention, irrigation therapy should be considered an integral component of the optimal therapeutic strategy, enabling both symptom relief and targeted modulation of key inflammatory pathways. This article discusses the benefits of preparations containing Adriatic Sea water with natural microelements, based on the unique composition of seawater and leading to its widespread use in inflammatory diseases of the nasal cavity, paranasal sinuses, and nasopharynx in the pediatric population.
Keywords: acute rhinosinusitis in children, chronic rhinosinusitis, allergic rhinitis, nasal irrigation, nasal saline solutions, Adriatic Sea water preparation with natural trace elements.
For citation: Shilenkova V.V. Rhinosinusitis and allergic rhinitis in children: treatment tactics for pediatric nasal care. Russian Journal of Woman and Child Health. 2026;9(3):360–366 (in Russ.). DOI: 10.32364/2618-8430-2026-9-3-20
About the author:
Victoria V. Shilenkova — Dr. Sc. (Med.), Professor, Professor of Department of Otorhinolaryngology, Yaroslavl State Medical University; 5, Revolyutsionnaya str., Yaroslavl, 150000, Russian Federation; ORCID iD 0000-0001-8553-0489
Contact information: Victoria V. Shilenkova, e-mail: v.shilenkova@mail.ru
Financial Disclosure: the author has no a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 02.06.2026.
Revised 24.06.2026.
Accepted 20.07.2026.
2. Ahmed S., Sami A.S. Rhinosinusitis and its impact on quality of life in children. Br J Hosp Med (Lond). 2022;83(3):1–11. DOI: 10.12968/hmed.2021.0589
3. Izquierdo-Domínguez A., Valero A.L., Mullol J. Comparative analysis of allergic rhinitis in children and adults. Curr Allergy Asthma Rep. 2013;13(2):142–151. DOI: 10.1007/s11882-012-0331-y
4. Church D.S., Church M.K., Scadding G.K. Allergic rhinitis: impact, diagnosis, treatment and management. Clin Pharm. 2016;8(8):8. DOI: 10.1211/PJ.2016.20201509
5. Wannasuphoprasit Y., Bhutta М.F. Management of acute rhinosinusitis in children. Paediatr Respir Rev. 2025;56:3–9. DOI: 10.1016/j.prrv.2025.04.004
6. Jaume F., Valls-Mateus M., Mullol J. Common Cold and Acute Rhinosinusitis: Up-to-Date Management in 2020. Curr Allergy Asthma Rep. 2020;20(7):28. DOI: 10.1007/s11882-020-00917-5
7. Sami A.S., Scadding G.K. Management of allergic rhinitis in schools. Br J School Nurs. 2013;8(3):119–123 DOI: 10.12968/bjsn.2013.8.3.119
8. Sami A.S., Scadding G.K. Rhinosinusitis in secondary school children-part 1: pilot study of the MSNOT20 young person questionnaire (MSYPQ). Rhinology. 2014;52(3):215–224. DOI: 10.4193/ Rhin12.011-1
9. Jelding-Dannemand E., Malby Schoos А.-M., Bisgaard H. Breast-feeding does not protect against allergic sensitization in early childhood and allergy-associated disease at age 7 years. J Allergy Clin Immun. 2015;136(5):1302–1308. DOI: 10.1016/j.jaci.2015.02.023
10. Sidell D., Shapiro N.L., Bhattacharyya N. Obesity and the risk of chronic rhinosinusitis, allergic rhinitis, and acute otitis media in school-age children. Laryngoscope. 2013;123:2360–2363. DOI: 10.1002/lary.24038
11. Thomas M., Yawn B.P., Price D. et al. EPOS Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps 2007 — A summary. Prim. Care Respir. J. 2008;17:79–89. DOI: 10.3132/pcrj.2008.00029
12. Silviu-Dan F., Fanny S.-D. Pediatric Chronic Rhinosinusitis. Pediatr Ann. 2014;43:e201–e209. DOI: 10.3928/00904481-20140723-10
13. Jiang X., Ren X., Liu H. et al. Health-related quality of life among children with adenoid hypertrophy in Xi'an, China. Int J Pediatr Otorhinolaryngol. 2015;79:2321–2326. DOI: 10.1016/j.ijporl.2015.10.036
14. Bulfamante A.M., Saibene A.M., Felisati G. et al. Adenoidal Disease and Chronic Rhinosinusitis in Children-Is there a Link? J Clin Med. 2019;8(10):1528. DOI: 10.3390/jcm8101528
15. Lin C.D., Tsai M.H., Lin C.W. et al. Association of adenoid hyperplasia and bacterial biofilm formation in children with adenoiditis in Taiwan. Eur Arch Oto-Rhino-Laryngol. 2012;269:503–511. DOI: 10.1007/s00405-011-1704-x
16. Coticchia J., Zuliani G., Coleman C. et al. Biofilm surface area in the pediatric nasopharynx: Chronic rhinosinusitis vs obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2007;133:110–114. DOI: 10.1001/archotol.133.2.110
17. Waage J., Standl M., Curtin J.A. et al. Genome-wide association and HLA fine-mapping studies identify risk loci and genetic pathways underlying allergic rhinitis. Nat Genet. 2018;50(8):1072–1080. DOI: 10.1038/s41588-018-0157-1
18. Wu A.C., Dahlin A., Wang A.L. The Role of Environmental Risk Factors on the Development of Childhood Allergic Rhinitis. Children (Basel). 2021;8(8):708. DOI: 10.3390/children8080708
19. Kanannejad Z., Taylor W.R., Mohkam M., Ghatee M.A. Urban Lifestyle and Climate-Driven Environmental Exposures: Immunological Consequences for Pediatric Respiratory Allergies. Immun Inflamm Dis. 2025;13(8):e70248. DOI: 10.1002/iid3.70248
20. Ellie A.S., Sun Y., Hou J. et al. Prevalence of Childhood Asthma and Allergies and Their Associations with Perinatal Exposure to Home Environmental Factors: A Cross-Sectional Study in Tianjin, China. Int J Environ Res Public Health. 2021;18(8):4131. DOI: 10.3390/ijerph18084131
21. Rodrigues J., Rocha M.I., Teixeira F. et al. Structural, functional and behavioral impact of allergic rhinitis on olfactory pathway and prefrontal cortex. Physiol Behav. 2023;265:114171. DOI: 10.1016/j.physbeh.2023.114171
22. Острый риносинусит. Практические рекомендации. Под редакцией А.С. Лопатина А.С. и В.В. Шиленковой. Пересмотр 2024 года. Фармакология и фармакотерапия. 2024;Спецвыпуск:34–53. DOI: 10.46393/27132129_2024_1_36. Acute Rhinosinusitis. Practical Recommendations. Edited by A.S. Lopatin, A.S., and V.V. Shilenkova. Revision 2024. Pharmacology and Pharmacotherapy. 2024;Special Issue:34–53 (in Russ.). DOI: 10.46393/27132129_2024_1_36
23. Bastier P.L., Lechot A., Bordenave L. et al. Nasal irrigation: From empiricism to evidence-based medicine. A review. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(5):281–285. DOI: 10.1016/j.anorl.2015.08.001
24. Chitsuthipakorn W., Kanjanawasee D., Hoang M.P. et al. Optimal Device and Regimen of Nasal Saline Treatment for Sinonasal Diseases: Systematic Review. OTO Open. 2022;6(2):2473974X221105277. DOI: 10.1177/2473974X221105277
25. Козлов В.С., Курдюкова А.В., Державина Л.Л., Крамной А.И. Влияние различных концентраций раствора хлорида натрия на динамику изменения функциональных показателей полости носа у больных острым гнойным синуситом. Российская ринология. 2008;2:44. Kozlov V.S., Kurdyukova A.V., Derzhavina L.L., Kramnoy A.I. The influence of different concentrations of sodium chloride solution on the dynamics of changes in functional parameters of the nasal cavity in patients with acute purulent sinusitis. Russian Rhinology. 2008;2:44 (in Russ.).
26. Nikakhlagh S., Abshirini H., Lotfi M. et al. A comparison between the effects of nasal lavage with hypertonic, isotonic and hypotonic saline solutions for the treatment of chronic sinusitis. J Glob Pharma Technol. 2016;8(12):68–73.
27. Ramalingam S., Cai B., Wong J. et al. Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels. Sci Rep. 2018;8(1):13630. DOI: 10.1038/s41598-018-31936-y
28. Venekamp R.P., Ainsworth B., Thomas T. et al. Saline nasal irrigation for acute sinusitis (SNIFS II): a randomised controlled pilot trial with nested process evaluation. BJGP Open. 2025;9(3):BJGPO.2024.0307. DOI: 10.3399/BJGPO.2024.0307
29. La Mantia I., Stilo G., Lentini L., Ciprandi G. Efficacy, Safety, and Tolerability of Nasal Wash in Patients with Upper Respiratory Tract Diseases. Int Arch Otorhinolaryngol. 2025;29(3):1–8. DOI: 10.1055/s-0045-1802576
30. Yadegari B., Houshmand H., Ghaemi M.R. Effectiveness of the Nasal Irrigation Effectiveness in Treating Allergic Rhinitis in Children 6 to 12 Years Old. Iran J Allergy Asthma Immunol. 2025;24(1):12–20. DOI: 10.18502/ijaai.v24i1.18016
31. Радциг Е.Ю., Ермилова Н.В., Богомильский М.Р. Заложенность носа у детей: причины и способы лечения. Педиатрия. Журнал им. Г.Н. Сперанского. 2012;91(5):85–90. Radtsig E.Yu., Ermilova N.V., Bogomilsky M.R. Nasal congestion in children: causes and treatment methods. Pediatrics. Journal im. G.N. Speransky. 2012;91(5):85–90 (in Russ.).
32. Popovych V.I., Koshel I.V., Piletska L.I., Orlovska R.M. Multicenter, randomized, open-label, comparative study of the effectiveness of nasal spray Aqua Maris Extra Strong as a symptomatic therapy in the technology of delayed antibiotic prescription in the treatment of acute rhinosinusitis in children aged 6–11 years. Am J Otolaryngol. 2024;45(2):103644. DOI: 10.1016/j.amjoto.2022
33. Мирошниченко Н.А., Кандрашина А.А., Бакотина А.В., Савранская К.В. Элиминационно-ирригационная терапия при дегенеративных заболеваниях слизистой оболочки полости носа. Эффективная фармакотерапия. 2024;20(3):60–64. DOI: 10.33978/2307-3586-2024-20-3-60-64. Miroshnichenko N.A., Kandrashina A.A., Bakotina A.V., Savranskaya K.V. Elimination and Irrigation Therapy for Degenerative Diseases of the Nasal Mucosa. Effective Pharmacotherapy. 2024;20(3):60–64 (in Russ.). DOI: 10.33978/2307-3586-2024-20-3-60-64
34. Васина Л.А., Карабаева Г.С. Влияние препарата Аква Марис на цилиарную активность мерцательных клеток слизистой оболочки носа у больных полипозным риносинуситом. Кремлевская медицина. Клинический вестник. 2014;1:13–15. Vasina L.A., Karabaeva G.S. Effect of Aqua Maris on the ciliary activity of ciliated cells of the nasal mucosa in patients with polypous rhinosinusitis. Kremlin Medicine Journal. 2014;1:13–15 (in Russ.).
35. Лопатин А.С., Тетеркина М.Н., Пелишенко Т.Г., Волов Н.В. Ирригационная терапия в ринологии и ринохирургии. Фармакология & Фармакотерапия. 2022;(спецвыпуск):54–59. DOI: 10.46393/27132129_2022_S_54. Lopatin A.S., Teterkina М.N., Pelishenko T.G., Volov N.V. Irrigation therapy in rhinology and rhinosurgery. Pharmacology & Pharmacotherapy. 2022;(special issue):54–59 (in Russ.). DOI: 10.46393/27132129_2022_S_54
36. Štanfel D., Kalogjera L., Ryazantsev S.V. et al. The Role of Seawater and Saline Solutions in Treatment of Upper Respiratory Conditions. Mar Drugs. 2022;20(5):330. DOI: 10.3390/md20050330
This work is licensed under a Creative Commons «Attribution» 4.0 License.
