Does my child have allergic rhinitis?
V
ery often, we are unsure how to recognize allergic rhinitis in our child, or we think it is just common colds (recurrent nasopharyngitis) which are frequent and recurrent in childhood mostly due to the normal maturation of the immune system and exposure to various agents in nurseries or kindergartens. Allergic rhinitis can seriously impair the quality of life of both the child and the parents so it is crucial to recognize and treat this disease as early as possible.
Allergic rhinitis is a condition caused by inflammation of the nasal mucosa dependent on immunoglobulin E (IgE) following exposure to an allergen. The word “allergy” comes from the Greek words αλλος (“other”) and εργου (“reaction”) and was introduced into the scientific literature by an Austrian pediatrician professor Clemens von Pirquet in 1906 as the body’s ability to react specifically but “differently” to external stimulation.
This disease most commonly appears in genetically predisposed individuals and is often associated with other allergic conditions such as asthma, conjunctivitis, atopic dermatitis, and increasingly common food allergies. The hereditary nature of allergic rhinitis has been demonstrated in numerous studies and recent genetic research focuses mainly on the study of genes involved in the immune response, whether specific or not to allergens as well as on the study of cytokines.
Allergic rhinitis is a condition caused by inflammation of the nasal mucosa.
According to data from the World Health Organization (WHO), allergic diseases are the third most common chronic diseases in adults and the first in children. Symptoms of rhinitis in preschool-age children, unrelated to a cold, occur in 48% of children.
The prevalence of allergic rhinitis in children in Croatia is about 16-17%. The numbers vary across regions with a slightly higher rate present in coastal Croatia. Genetic predisposition to the development of allergies – called atopy – is based on a large number of genes which explains its complexity. A child of two allergic parents does not necessarily have to be allergic and conversely – a child of parents without allergies can have allergic rhinitis.
The incidence of allergic rhinitis is increasing, with causes of this rise linked to decreased infection rates due to improved hygiene, especially in the Western world, increased antibiotic use, poor diets rich in saturated fats and sugar (fast food), and exposure to passive smoking.
Recognizing Symptoms
Perennial allergic rhinitis, related to house dust and mites, is suspected if symptoms are present year-round with worsening during autumn and spring. Intermittent or seasonal allergic rhinitis is suspected if symptoms occur during spring and summer and are related to pollen exposure.
The main symptoms of allergic rhinitis are nasal congestion, clear nasal discharge, sneezing fits, and itchy nose. In children, watery discharge, sniffing tics, and nose rubbing are key diagnostic signs. Ophthalmic symptoms like itchy eyes, eyelid swelling, tearing, and redness are more common with pollen and/or animal hair allergies. Nasal congestion requires mouth breathing, leading to other issues like sleep disturbances, snoring, chapped lips, and bad breath. It always worsens in a lying position. Nasal discharge is clear and watery, with the amount varying throughout the day.
Sneezing is more pronounced if an allergen is present, such as cat hair or dust. Children often do not mention itchy noses, but parents notice that their child frequently scratches their nose, sometimes leading to a horizontal crease on the skin just behind the nasal tip.
Diagnosis and Treatment
Allergic rhinitis is diagnosed based on symptoms that worsen upon exposure to allergens such as dust, cat hair, or pollen, confirmed by a skin test. Avoidance of allergens is not very effective, especially with house dust due to its widespread presence. Nevertheless, regular washing of walls and floors, avoiding carpets, and frequently washing curtains and pillowcases are recommended, especially for children with both allergic rhinitis and asthma.
The first line of treatment for intermittent and perennial allergic rhinitis in children includes intranasal corticosteroids (from 3 years) and a combination of intranasal corticosteroid and antihistamine (from 12 years).
For younger children (from 1 year), oral antihistamines in syrup form are used, which can also be the first line of treatment if preferred by parents or patients, and can be combined with intranasal corticosteroids.
Specific immunotherapy (sublingual or subcutaneous) is usually indicated for mite and pollen allergies in children, consisting of two phases: the initial phase with progressive dose increases and the maintenance phase lasting 3-5 years.
Immunotherapy is particularly significant for children as it can modify the natural course of the allergy, potentially preventing new sensitizations and the development of asthma. It is recommended for moderate to severe allergic rhinitis, with or without asthma, not controlled by standard therapy, typically from 5 years of age. Surgery is only advised if there is independent rhinosinus pathology, such as mechanical obstruction due to a deviated septum or significantly enlarged lower nasal turbinates without improvement from intranasal sprays.
Allergic rhinitis in children is a very important issue as it affects the quality of life of the child and the whole family, as well as asthma control if the diseases are associated. Diagnosis is straightforward through conversations with parents and the child, clinical examination, and allergy testing. Treatment is very simple and effective, and with the advent of molecular allergology and child-friendly sublingual immunotherapy, we have entered a modern and child-friendly treatment sphere.
Contact our team, book your appointment, and resolve all doubts regarding the diagnosis of allergic rhinitis. Reach out to us!
