Allergic Rhinitis in Children

Allergic rhinitis is a prevalent condition among children, causing considerable discomfort and affecting their quality of life. This guide provides insights into understanding, diagnosing, and managing allergic rhinitis to help parents mitigate its impact on their children. In some children, symptoms are present only during certain seasons such as summer and spring, which are pollen seasons. Pollen acts as a trigger, aggravating the symptoms. These children get symptoms when they are outdoors. Others may have year-round symptoms due to the allergic triggers present indoors, such as dust mites, animal furs, and fungi.

What is Allergic Rhinitis?

Allergic rhinitis is an inflammation of the nasal passages triggered by an allergic reaction to triggers/allergens such as pollen, dust mites, pet dander, and mold spores. The immune system mistakenly identifies these harmless substances as threats, causing symptoms. Frequent sneezing, runny nose, and/or blocked nose are common symptoms of this condition.

Indoor Triggers:

• Dust: Common in homes and can accumulate in various places.
• Incense Sticks and Kitchen Smoke: These can irritate the nasal passages.
• Fumes from Mosquito Coils and Strong Deodorants/Perfumes: Often overlooked but can be significant triggers.
• Fungus: Found on damp walls in kitchens or washrooms.
• House Dust Mites: Present on furry toys, upholstery, furniture, carpets, and beddings. Allergic reactions can occur due to their droppings.
• Pet Saliva: Dogs and cats lick themselves, leaving saliva on their fur. Dried saliva can cause allergic reactions.
• Cigarette Smoke: One of the most important indoor triggers. Even passive smoking can harm non-smokers if there is a smoking member in the house.

Outdoor Triggers:

• Dust: Common in homes and can accumulate in various places.
• Incense Sticks and Kitchen Smoke: These can irritate the nasal passages.
• Fumes from Mosquito Coils and Strong Deodorants/Perfumes: Often overlooked but can be significant triggers.
• Fungus: Found on damp walls in kitchens or washrooms.
• House Dust Mites: Present on furry toys, upholstery, furniture, carpets, and beddings. Allergic reactions can occur due to their droppings.
• Pet Saliva: Dogs and cats lick themselves, leaving saliva on their fur. Dried saliva can cause allergic reactions.
• Cigarette Smoke: One of the most important indoor triggers. Even passive smoking can harm non-smokers if there is a smoking member in the house.

Who Gets It More?

Children with a family history of allergies, asthma, or eczema are more prone to allergic rhinitis. Environmental factors, such as living in urban areas with higher pollution levels, can also increase susceptibility.

Symptoms

Nasal Symptoms:

• Sneezing
• Runny or blocked nose
• Itching

Eye Symptoms:

• Itchy, red, or watery eyes

Throat Symptoms:

• Itchy throat
• Postnasal drip

Other Symptoms:

• Fatigue
• Irritability
• Sleep disturbances due to nasal congestion

Symptoms often occur early in the morning when the child may experience bouts of sneezing. Some children may also complain of an itchy nose, leading them to continuously rub it.

Is it Contagious?

No, allergic rhinitis is not contagious. It is an allergic response and cannot be spread from one person to another. Our immune system is designed to fight infections and foreign matter. Sometimes our body’s immune system becomes oversensitive and reacts abnormally to common airborne substances such as grass and weed pollens, fungal spores, animal furs, and dust mites, to name a few. However, this abnormal response only occurs in some susceptible individuals. In these individuals, contact with a trigger causes the body’s defense system to release certain chemicals. One such chemical is histamine which leads to the symptoms of runny nose, itching in the nose, sneezing, and nasal stuffiness.

Diagnosis

Diagnosis typically involves a combination of medical history, physical examination, and allergy testing, such as:

Skin Prick Test:

Identifies specific allergens by introducing small amounts of suspected allergens into the skin over the forearm, and then reading for the responses after a few minutes. This test is more economical and usually performed under your doctor’s supervision in a clinic or hospital.

Blood Test:

Measures IgE antibodies to particular allergens. Specific immunoglobulin E (IgE) levels, the second type of test, can be measured in the blood for which a blood sampling is needed. Results are usually available in 48 hours and many types of allergens can be detected. This test is costly and available at various commercial laboratories. However, we must remember that although these tests are available at commercial laboratories, we must not directly get these done without proper consultation with the child’s pediatrician and an allergy specialist.

Treatment

Avoidance of Allergens:

• Households must be free from all smokes: Cigarette, kitchen, mosquito coils, incense sticks, etc.
• Bathe pets regularly and get them treated for fleas and other ectoparasites. If pets can be avoided, that can be the ideal option.
• Clean the bedcovers regularly in hot water.
• Avoid putting rugs or carpets.
• Do not allow children to indulge too much in furry soft toys and wash them regularly.
• Clean all hard surfaces with a damp cloth. Clean your refrigerator, air-conditioners, bathrooms, showers, doors, and windows regularly.
• Keep windows closed during high pollen seasons.
• Use air purifiers and maintain clean indoor air.
• Regularly wash bedding and use allergen-proof covers.

Medications:

• Antihistamines: Relieve sneezing, itching, and runny nose.
• Nasal Corticosteroids: Reduce inflammation in the nasal passages.
• Decongestants: Help reduce nasal congestion.
• Leukotriene Receptor Antagonists: Address both nasal and eye symptoms.

Immunotherapy:

Allergy shots or sublingual tablets (Immunotherapy): After identifying the offending allergens, desensitization of these allergens is done gradually over a few weeks to months. This alters the natural course of the disease and may suppress the disease permanently. Immunotherapy should be considered only after consulting your pediatrician and, if needed, an allergy specialist and understanding all the pros and cons of the therapy. It is done for selected cases and in trained hands at a dedicated center.

Lifestyle Changes:

• Maintain a clean and allergen-free home environment.
• Monitor pollen counts and limit outdoor activities during high pollen periods.
• Regularly bathe pets and keep them out of bedrooms.

Mitigating the Impact

Educate Family Members and Caregivers:

Ensure everyone involved in your child’s care understands their condition and how to manage it.

Develop an Allergy Management Plan:

Work with your pediatrician to create a comprehensive plan that includes medication schedules and steps to avoid allergens.

Promote a Healthy Lifestyle:

Encourage a balanced diet, regular exercise, and sufficient sleep to strengthen your child’s immune system.

Complications:

It is important to treat allergic rhinitis to prevent complications such as snoring, poor sleep, daytime fatigue, and reduced attention span. Poorly controlled allergic rhinitis may lead to asthma or make asthma control difficult as the nose and lungs are connected. About 4 in 10 children with allergic rhinitis are known to develop asthma if not treated. Similarly, about 7 out of 10 asthmatics already have allergic rhinitis. Allergic rhinitis may also be associated with skin allergy, nasal polyps (localized swelling in the nose), and allergic conjunctivitis (redness and watering of eyes).

Conclusion

Effective management of allergic rhinitis involves a combination of avoiding allergens, using appropriate medications, and making lifestyle changes. By understanding and addressing this condition, parents can significantly improve their children’s comfort and quality of life.