{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T07:46:53Z","timestamp":1782200813843,"version":"3.54.5"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Allergy Immunology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Allergic rhinitis (AR) is one of the most prevalent chronic conditions in children and adolescents, significantly impacting quality of life and scholastic performance. Effective management requires therapeutic approaches that address the complex pathophysiology while ensuring safety and tolerability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This paper reviews the evidence supporting azelastine\u2010fluticasone combination intranasal therapy in pediatric allergic rhinitis, with a focus on efficacy, safety, and clinical implementation. This paper encompassed clinical trials, guidelines (ARIA), consensus statements (SIAIP Delphi Consensus), and real\u2010world evidence gathered from Italian primary care pediatricians managing children and adolescents with AR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Azelastine\u2010fluticasone combination therapy demonstrates superior efficacy compared to monotherapy, exhibiting a rapid onset of action (15\u201330\u2009min) and sustained symptom control. Its dual mechanism effectively addresses both early\u2010phase (H1\u2010receptor antagonism) and late\u2010phase (glucocorticoid anti\u2010inflammatory effects) allergic responses. Clinical trials conducted in adolescents aged 12\u201318\u2009years confirm an excellent safety profile, with no significant effects observed on growth or the Hypothalamic\u2013Pituitary\u2013Adrenal (HPA) axis. Emerging evidence further may support its potential utility in younger children aged 6\u201312\u2009years. The SIAIP Delphi Consensus on AR management, involving 42 pediatricians, achieved over 80% agreement on key management principles, particularly emphasizing the control of type 2 inflammation. Survey data collected from 864 Italian primary care pediatricians, collectively managing 81,231 children, indicates high adherence to ARIA guidelines (exceeding 70%) and a notable increase in the adoption of combination therapy, reaching up to 20% of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Azelastine\u2010fluticasone combination intranasal therapy represents a significant paradigm shift in pediatric allergic rhinitis management. It offers superior efficacy, an excellent safety profile, and practical advantages that foster better treatment adherence. This therapeutic approach is well\u2010aligned with contemporary guidelines and is increasingly being adopted in clinical practice for the management of moderate to severe AR in children and adolescents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pai.70320","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T18:54:41Z","timestamp":1772996081000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Azelastine\u2010fluticasone intranasal therapy: A paradigm shift in pediatric allergic rhinitis management. A point of view of the Italian Society of Pediatric Allergy and Immunology"],"prefix":"10.1111","volume":"37","author":[{"given":"Gianluigi","family":"Marseglia","sequence":"first","affiliation":[{"name":"Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences University of Pavia  Pavia Italy"},{"name":"Pediatrics Fondazione IRCCS Policlinico San Matteo  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Miraglia del Giudice","sequence":"additional","affiliation":[{"name":"Department of Woman and Child and General and Specialized Surgery University of Campania Luigi Vanvitelli  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-6482","authenticated-orcid":false,"given":"Amelia","family":"Licari","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences University of Pavia  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