Allergic Rhinitis

Allergic rhinitis is due to allergy to house dust, house dust mites, trees and grass pollens, cat & dog dander and moulds. It is estimated that up to 40% of children are affected by allergic rhinitis

How does it impact on the child’s routine life?

It is associated with reduced quality of life because of its impact on sleep. Such children can have reduced school attendance and academic performance. Some studies show that children who suffer rhinitis are at increased risk of developing asthma.

What are the symptoms of allergic rhinitis?

Nasal discharge - watery and clear, sometimes yellowish/greenish

Nasal blockage

Sneezing, stuffy nose, post nasal drip, itchy eyes. Post nasal drip is the sensation of mucus trickling down the back of throat and can cause children to cough at night.

What are the available tests?

Flexible nasal endoscopy to look for any associated adenoid enlargement.

There are blood tests for allergy (RAST IgE). For children older than 6 years, skin prick testing is available. For skin prick testing, it is important that they do not use any antihistamines up to 5 days before the test.

How is allergic rhinitis managed?

Avoiding all common allergens by implementing the below measures.

House dust mite reduction measures

Removing all soft toys from bed (Don’t be so harsh…may be leave one toy in bed which is machine washable or after freezing them in plastic bags overnight) 

Regularly vacuuming carpets (HEPA filter vacuum cleaner, exhaust filtered vacuum cleaner) and wet mopping wooden floors

Washing bed linen at 60 degrees

Use anti house dust mite covers for pillows, blankets and mattress

Pollen avoidance measures 

This is very difficult as tiny pollen spores are windborne and travel for miles on air currents. Monitor pollen forecasts daily and stay indoors whenever possible. Allergen barriers are available as balms or gel nasal sprays. Apply them around edge of each nostril to trap or block pollens. Keep windows closed when indoors especially in the early mornings and in the evenings (refer to allergy uk website).

Cat and Dog dander

Avoid cats and dogs entering children’s bedroom. If found to be allergic on blood tests, best is to avoid contact with dogs and cats.

Mould (fungus) 

You may be allergic to spores of fungi. Some spores spread in dry weather and others during humid conditions. Indoors, fungi are often found in bathroom, kitchen, basement and laundry areas.

Invest in a de-humidifier

Use exhaust fans in bathrooms

Medical treatment:

Regular antihistamines (cetrizine, Loratidine etc)

Steroid nasal sprays (Avamys, Nasonex)

Paediatric saline nasal spray (Sterimar nasal spray / Neilmed Sinurinse)- This helps to eliminate inflammatory proteins, bacteria and allergens from within nose and sinuses.

Antibiotics if there is active bacterial infection

Over the counter decongestant nasal sprays are not recommended

Latest addition to nasal spray (Steroid plus antihistamine) - Dymista (only for children over 12 years of age)

Immunotherapy - (Oral/Sublingual) This is desensitisation and it involves administration of gradually increasing doses of allergen extracts over a period of years, given by injection or drops/tablets under the tongue