Diseases & Conditions
An inﬂammation of the mucous membrane lining the nose caused by an allergic reaction as inhaled allergens are trapped by the nasal filtration system. In allergic rhinitis, sneezing is a prominent feature and nasal symptoms may be accompanied by itchy watery eyes and intense itching of the nose and soft palate. The disease is triggered in susceptible children by allergic reactions to pollen, mold, dust mites, and other allergens.
Seasonal allergic rhinitis is called HAY FEVER or seasonal allergic rhinitis. In this condition, both the nose and the eyes are affected. Allergic rhinitis that occurs year-round is known as perennial allergic rhinitis. Seasonal pollen allergy may exacerbate symptoms of perennial rhinitis.
Allergic rhinitis is the most common chronic disease in children, affecting about one in ﬁve children by the age of two or three years; up to 30 percent are affected during adolescence. Boys are twice as likely to get allergic rhinitis than girls, but the prevalence of allergic rhinitis may vary greatly by region. A study in Tucson, Arizona, for example, found that 42 percent of children were diagnosed with allergic rhinitis by the age of six.
A family history of allergic rhinitis is the greatest known risk factor for the condition. Other risk factors include higher social class, male gender, breast-feeding for more than one month, being the ﬁrst born, having a mother with asthma, and having a dog in the home.
Hay fever is triggered by windborne pollens such as grass and weeds as well as mold (fungal spores) in the summer and fall. Perennial allergic rhinitis is caused by house dust, feather pillows, cigarette smoke, animal dander, and upholstery.
Hay fever causes sneezing, profuse runny nose, and nasal obstruction or congestion. Nose and eyes may itch. Eyelids and the whites of the eyes may look red and swollen, and there may be headache or sinus pain, dark circles under the eyes, itchy throat, malaise, and fever. Perennial allergic rhinitis may cause dark circles under the eyes and chronic blocked nasal passages often extending to eustachian tube obstruction, particularly in children.
Children suffering from the disease may not sleep well or look well. An estimated one and a half million school days are lost each year due to allergic rhinitis, but even when children are at school, poorly treated allergic rhinitis can diminish their ability to learn, concentrate, and interact socially.
Parents often are able to diagnose hay fever. While a common cold or upper respiratory infection can be confused with allergic rhinitis, parents should suspect rhinitis if the child has irritated eyes and no fever. Food allergies can also cause rhinitis symptoms in 70 percent of infants and young children, but with food allergies there are often other symptoms of skin or stomach irritation as well. A careful history usually reveals the seasonal nature of the complaint and the suspected role of seasonal allergens. Physical examination usually reveals puffy, reddened watery eyes, a red throat, and nostrils ﬁlled with clear watery mucus.
To determine what allergens an individual is allergic to, children may take a skin test in which they are exposed to various substances, such as pet dander, dust mites, or mold.
Seasonal allergic rhinitis responds well to treatment. Ideally, avoiding the offending allergic substance is the ﬁrst approach to managing any allergic disorder. However, it is usually impossible to avoid the offending pollen allergens that cause allergic rhinitis.
Steroid nasal sprays are the most effective type of drug treatment, but some doctors are still reluctant to use these medications because of potential side effects. The safety of steroid nasal sprays is a concern when treating children, since there is potential for some of these medications to enter the bloodstream, where they may affect bone metabolism and slow childhood growth. This potential adverse effect is of particular concern in children with both asthma and allergic rhinitis, who require long-term glucocorticoid therapy by both inhalation and nasal spray. Fluticasone (Flonase) is approved for children over age four. Mometasone (Nasonex) was recently shown to be safe and effective for children ages three and up.
Antihistamines are another treatment choice. The “second-generation” antihistamines can provide relief from symptoms while minimizing side effects, such as drowsiness or irritability. Children with chronic allergic rhinitis may need to take antihistamines every day. Otherwise, they should be taken before exposure to allergens. Cetirizine (Zyrtec) and loratadine (Claritin), both for ages two and up, are effective second-generation antihistamines for children, and fexofenadine (Allegra) is appropriate for children over age six. Claritin is now available without prescription. Clarinex is the same medication as Claritin but at half-strength; it is available by prescription only.
Decongestants, which unblock stuffy noses, may be prescribed as pills or sprays. They should be used with caution in young infants because of potential adverse reactions. Azelastine (Astelin) is a second-generation antihistamine available in a nasal spray for children over age six.
Allergen immunotherapy is a safe and effective treatment for long-term control of multi-seasonal, moderate-to-severe allergic rhinitis. Immunotherapy involves injections of allergens over a number of months until the body becomes accustomed to them. Because severe reactions are possible, immunotherapy is not recommended in very young children.
Left untreated, allergic rhinitis also can lead to other serious conditions, including ASTHMA, recurrent middle EAR INFECTIONS, sinusitis, sleep disorders, and chronic cough. Appropriate management of rhinitis is an important part of effectively managing these coexisting or complicating respiratory conditions.