Study Finds Underuse of Allergy Treatments in Teens with Pollen Allergic Rhinitis

A study showed that children with pollen-induced allergic rhinitis will most likely continue having this disease into young adulthood.1 They are also likely to have an increased risk of asthma development compared with children without allergies.

“Data from this population-based birth cohort study indicate an unmet need for pollen [allergic rhinitis] management,” wrote investigators, led by Magnus Lindqvist, from the department of medicine solna in the division of immunology and respiratory medicine at Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. “More than 50% of subjects with pollen [allergic rhinitis] at 16 years of age had uncontrolled disease, and there seems to be underuse of both symptomatic allergy treatment and [allergen immunotherapy]. Increased knowledge about pollen [allergic rhinitis] treatment in healthcare, as well as among patients, would increase quality of life for patients and reduce costs for society.”

With pollen seasons lengthening due to climate change, more people are experiencing pollen allergies than in the past, emphasizing the importance of proper management.2 Many with allergic rhinitis are facing longer, more severe symptoms.

Investigators used longitudinal data from the Barn/Children Allergi-Allergy Milieu Stockholm Epidemiologic study cohort (BAMSE).1 The cohort included 4089 children born between 1994 and 1996 in Stockholm, Sweden, recruited at a median age of 2 months. Participants underwent repeated follow-ups for blood sampling to screen specific IgE and complete allergy questionnaires; either themselves or their parents provided informed consent for each follow-up.

The sample included participants aged 16 years who reported uncontrolled pollen-induced allergic rhinitis disease with a VAS score ≥ 5. Pollen-induced allergic rhinitis was defined as reactions to birch or grass pollen with sIgE ≥ 0.35 kUA/l.Participants also reported affected activities or sleep, the presence of asthma, medication use, and lower airway symptoms.

Additionally, investigators assessed the proportion of participants with pollen-induced allergic rhinitis who qualified for allergen immunotherapy. Qualifiers include VAS ≥ 5, affected activities or sleep, and lower airway symptoms despite being on antihistamine and intranasal corticosteroids.

The analysis revealed that the pollen prevalence of allergic rhinitis was 16.5%, with more than half of these participants (51.8%) having uncontrolled pollen allergic rhinitis with a VAS ≥ 5. More than that, 39.5% reported that their disease affected sleep or daily activities. Moreover, about 32.9% reported lower airway symptoms upon pollen exposure.

Most participants used symptomatic medication (89.8%), although only 14.4% reported having optimized treatment with both intranasal corticosteroids and antihistamines. Among participants with pollen-induced allergic rhinitis and either VAS ≥ 5, affected activities or sleep, or lower airway symptoms, 7% had not used any symptomatic medication. The study also showed among 13.8% of participants who met the criteria for allergen immunotherapy, only 4.2% received treatment.

Investigators wrote that the findings were limited by the self-reported data on symptoms and medication use, along with the questionnaires not being strictly completed during or after the pollen season. Even if all questionnaires were completed during pollen seasons, these periods vary in intensity; pollen counts in this study stayed at average levels during follow-up years.

“This indicates a lack of proper pollen [allergic rhinitis] management and a possible underuse of symptomatic medication and [allergen immunotherapy],” investigators wrote. “Studies show that higher socioeconomic status and education increase the likelihood of receiving treatment for allergic rhinitis. Education on asthma and allergy among healthcare personnel, as well as increased awareness among patients, is essential since the consequences of uncontrolled disease could negatively affect social life, school, or work performance, and increase health care costs for society.”

References

1. Lindqvist M, Westman M, Linneberg A, Kull I, Bergström A, van Hage M, Melén E, Leth-Møller KB. The Severity of Pollen-Induced Allergic Rhinitis at 16 Years of Age: Data From the Population-Based BAMSE Birth Cohort. Allergy. 2025 Apr 29. doi: 10.1111/all.16571. Epub ahead of print. PMID: 40298191.

2. Derman, C. Adapting Allergy Care Due to Increased Pollen Seasons, with Sharmilee Nyenhuis, MD. HCPLive. March 1, 2025. https://www.hcplive.com/view/adapting-allergy-care-due-increased-pollen-seasons-sharmilee-nyenhuis-md. Accessed May 12, 2025.