20-year trajectory of risk and progression of pollen allergy in children

About 75% of children with pollen-induced allergic rhinitis at ages 4 or 8 still had it at 24, with remission peaking between ages 16 and 24 as IgE levels decreased and prevalence plateaued.

Allergic rhinitis (AR) is a widespread chronic condition, but long-term data on its persistence and remission are scarce. This study explored the course of AR due to pollen, starting from childhood till the adult stage (age 4 to 24 years).

The study analyzed data from 1137 participants. This included questionnaires on AR symptoms, asthma, allergen immunotherapy, and allergen-specific IgE levels at ages 4, 8, 16, and 24. Pollen-AR was characterized by symptoms such as sneezing, a runny or blocked nose, and itchy or watery eyes in response to birch and/or grass pollen, combined with allergen-specific IgE levels of ≥0.35 kUA/L for these allergens.

Around 75% of children with pollen-AR at ages 4 or 8 continued to have symptoms by age 24, with 30% also developing asthma. Even at low levels of pollen-specific IgE, the risk of persistence was high.

The most significant remission (21.5%) occurred between ages 16 and 24, though most remained sensitized. During this stage, the annual frequency of new cases dropped from 1.5% to 0.8%.

Pollen-AR often persists for decades, with childhood to teenage years being the most dynamic period for the condition. The study highlighted the strong link between allergen sensitization, AR, and asthma, emphasizing the need for ongoing management and monitoring.