D2.176 - Comparison of different treatment strategies for allergic rhinitis in children and their impact on bronchial asthma

Allergic rhinitis (AR) and bronchial asthma (BA) are regarded as manifestations of a unified type‑2 (T2) ‑ mediated airway inflammation within the ARIA‑endorsed “one airway – one disease” concept. AR is a significant predictor of the development and poor control of BA in children, whilst up‑titration of inhaled corticosteroids (ICS) is limited by the risk of systemic adverse events. Intranasal corticosteroids (INCS) remain first‑line therapy for persistent AR; fixed‑dose combinations of INCS with intranasal antihistamines have demonstrated advantages in moderate‑to‑severe AR, but their impact on the control of concomitant BA in children has not been investigated. Objective. To evaluate and compare the effect of a fixed‑dose olopatadine hydrochloride/mometasone furoate intranasal spray versus intranasal mometasone furoate monotherapy on AR and BA control in children.

In an open‑label, comparative real‑life study, 81 children aged 7–17 years with persistent moderate‑to‑severe seasonal and/or perennial AR and partly controlled/uncontrolled mild‑to‑moderate allergic BA were enrolled. Patients were randomized into two groups: fixed‑dose olopatadine hydrochloride/mometasone furoate (OLO/MF, n=60) or intranasal mometasone furoate (MF, n=21) in age‑appropriate doses for 57 days, while baseline BA controller therapy remained unchanged. Outcomes included AR symptoms (VAS), asthma control (ACQ‑5, cACT/ACT), health‑related quality of life (PAQLQ(s)), lung function (FEV1, bronchodilator reversibility), FeNO and markers of eosinophilic inflammation.

Baseline VAS scores did not differ between groups (60 (55–70) mm). After 57 days, AR symptom severity decreased significantly in both groups, with a 43% greater reduction under OLO/MF (20 vs 35 mm; p=0.022). Both groups showed a reduction in the proportion of patients with uncontrolled BA and significant improvement in asthma control (ACQ‑5, cACT/ACT). PAQLQ(s) total and domain scores improved significantly, with more pronounced changes in the OLO/MF group. Spirometry indicated a preferential improvement in lung function with OLO/MF. FeNO remained largely unchanged, whereas changes in eosinophilic inflammation markers were more prominent in the OLO/MF group. Both regimens showed a favourable safety profile.

Intranasal MF and the fixed‑dose OLO/MF combination improve AR and concomitant BA control without escalation of baseline asthma therapy, with OLO/MF providing a more pronounced clinical, functional and anti‑inflammatory benefit and representing a promising option for children with moderate‑to‑severe AR and comorbid BA.