D2.103 - Severe Persistent Allergic Rhinitis in an Adolescent: A SNOT-22–Based Case Report

Introduction : Allergic rhinitis is a common chronic inflammatory disease in children and adolescents, often underestimated in its impact on quality of life and school performance. We report the case of a 15-year-old adolescent with persistent severe allergic rhinitis, highlighting the importance of accurate diagnosis, appropriate management, and validated follow-up tools.

Case presentation: A 15-year-old male student weighing 55 kg presented with fluctuating nasal obstruction, rhinorrhea, daily sneezing, and allergic conjunctivitis. The clinical impact was significant, causing impaired sleep and concentration, confirmed by a SNOT-22 score of 56/110 at baseline (day 1). Immunological assessment showed polysensitization to house dust mites (Dermatophagoides pteronyssinus class 5, Dermatophagoides farinae class 6, Acarus siro class 4, Blomia tropicalis class 5). According to the ARIA classification, this case was categorized as persistent moderate-to-severe allergic rhinitis. The patient was treated with bilastine (20 mg/day), antiallergic eye drops (Levopta®), daily saline nasal irrigation, and dust mite avoidance measures. By day 14, symptoms had markedly improved, with the SNOT-22 score decreasing to 22, indicating significant clinical and functional recovery.

Discussion and conclusion : This case highlights the importance of integrated clinical assessment, immunological confirmation, and tailored therapeutic strategies, including patient education and environmental control measures. The use of the SNOT-22 questionnaire enabled objective quantification of treatment response. A combined approach of pharmacotherapy, allergen avoidance, and standardized follow-up remains essential in the management of pediatric allergic rhinitis.