Allergic rhinitis in children

Allergic rhinitis is the most common allergic disorder in both Australia and New Zealand and affects 10 to 20% of the world’s population. While not life-threatening, it can have a very negative impact on the quality of life, particularly in children. It can affect a child’s  sleep, concentration and learning function and ultimately even result in development or behavioural problems. The disorder often co-exists with asthma, or if a child doesn’t already suffer from asthma, allergic rhinitis can be a risk factor for developing asthma at a later stage. There is often a family history of allergic rhinitis.

Allergens in the air trigger histamine to be released by the body. Histamine causes swelling, itching and fluid to build up in the sensitive and delicate tissues lining the nose, sinuses and eyelids. Common symptoms are sneezing, a stuffy or runny nose, itchy eyes, nose, throat or ears, and nosebleeds. Other symptoms that parents may not always realise could be connected to allergic rhinitis are snoring, persistent ear infections, breathing only through the mouth, poor school performance, a line or crease across the bridge of the nose from constant nose-wiping, and dark circles (“allergic shiners”) or creases under the eyes. Allergic shiners are a result of pressure from the blocked nasal passages on the small blood vessels. When a child’s nose is so congested that they only breathe through their mouth, the child doesn’t get a restful nights sleep and will be tired the next day. It is important for parents and caregivers to be aware of these common signs and symptoms of allergic rhinitis so that this condition can be managed from an early stage.

Commonly known as ‘hay fever’, many people think that it is just a seasonal affliction that will disappear once the offending pollen or grass has died down, but the condition can persist all year round. It also has many causes other than the usual villains of pollen from trees, grass and weeds. Dust mites, animal dander, cigarette smoke, cockroach waste and mould spores are also common allergens that can trigger allergic rhinitis.

Treatments that help relieve the symptoms include non-sedating antihistamines such as cetirizine and loratadine, steroid nasal sprays, short term use of decongestants, nasal saline irrigation, and managing allergic conjunctivitis with eyedrops containing antihistamines or cromoglycate. If your child is asthmatic, it is important that medicines for treating asthma symptoms are taken regularly.

Lifestyle measures to minimise exposure to allergens can help. Avoiding pets, or at least keeping them out of the bedroom, avoiding areas with heavy dust, mites or moulds, using air conditioning instead of opening windows during the pollen season can all help sufferers. When pollen counts are high, avoid going outside. Pollen counts can be high in the morning, on windy days and also after a thunderstorm. To reduce dust mites make sure sheets are washed in a hot wash (over 55 degrees Celsius) or put in the drier. Favourite soft toys need a regular spin in the drier or they can be placed in a bag in the freezer overnight and aired in the sun. It can be worth investing in mite proof covers for bedding such as the mattress, duvet and pillows as well as a good quality vacuum with a HEPA filter. If symptomatic treatment and prevention measures don’t seem to help, your child might need to be referred to an allergy specialist who can do allergy skin testing. The results of the skin testing will tell you exactly what things are causing the symptoms in your child. A last resort in the  treatment of allergic rhinitis is immunotherapy which is the only treatment that can change the disease progression. This is where the allergy sufferer is given allergen extracts repeatedly in order to bring long-term symptom relief and improved quality of life. To be effective this can require several years of treatment so isn’t a decision to be made lightly, and should be fully discussed with your health professional.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.