Allergic rhinitis (hay fever) in children

What is allergic rhinitis?

Having a runny nose is very common in children, and in adults too. Parents that have toddlers always carry a packet of tissues or wipes in their bags. Most of the time, a runny nose is the result of an upper respiratory tract infection, and these will typically be caused by viruses. Nonetheless, many children suffer from allergic rhinitis, which is a chronic condition associated with exposure to inhaled allergens.
According to some of the statistics, about 15-20% of the general population suffer from some degree of allergic rhinitis. Some studies estimate that the prevalence of this condition is higher, or even double in children and adolescents.

What are the causes of allergic rhinitis?

The cause of allergic rhinitis is a sensitivity of the immune system against particles carried in the air. When these particles, which are referred to as allergens and can include pollen from olive tree or proteins found on the skin of a cat, come in contact with the mucosa of the nose, the immune system is activated and antibodies against these particles are formed. The important antibody when it comes to allergic rhinitis is the IgE type of antibody, which leads to a series of reactions that cause the secretion of mucous and additional symptoms.
There are additional causes to chronic rhinitis that is not caused by allergies, and therefore it is important not to miss these and to get examined by a specialist that will help determine the correct diagnosis and management. A thorough physician will also make sure to screen for the presence of accompanying conditions, such as asthma, sinusitis or atopic dermatitis.

How is allergic rhinitis diagnosed?

The most important factor to help make the diagnosis is a careful history of the illness, and a history of the symptoms the patient is suffering from. The classic symptoms are recurrent episodes of nasal congestion, runny nose, sneezing and itching of the face. Often there are comorbidities including allergic conjunctivitis that manifests in itching, redness, tearing and irritation of the eyes.
What else can help guide us to the diagnosis? Seasonality of the symptoms, which often present mainly during season changes, worsen on exposure to dust or other inhaled allergens, additional allergic conditions such as family and patient history of asthma and eye symptoms. On the other hand, having rhinitis in one nostril or other infectious symptoms such as fever, will lead us to think against the diagnosis of allergic rhinitis.

Is it possible to find out who the “criminal” (allergen) that is causing the allergic rhinitis, is?

Once allergic rhinitis is suspected, and a physical assessment has been carried out to rule out other causes of rhinitis, we can try and identify the specific allergen causing the rhinitis.
There are two types of allergens: allergens that are commonly found outside, especially in plants: tree pollen, grass, shrubs and these typically cause seasonal symptoms during the pollen season. The other type are allergens found indoors: the main indoor allergens are dust mites (more about this below), proteins found on the bodies of animals and mold. Often, the patient will be allergic to more than one thing.
The preferred diagnostic test is performing skin tests by exposing the skin to a panel of common inhaled allergens. The exposure is typically done with the using a piece of plastic with ends that have been dipped into allergen extract. This plastic is pressed onto the skin of the forearm or back. The size of the skin reaction is measured about 15 minutes later.
An alternative form of testing is a blood test to detect for specific IgE antibodies against these allergens.

OK, what can be done once the diagnosis of allergic rhinitis is made and the suspected cause is determined?

The treatment of allergic rhinitis can be divided into three main aspects: prevention, medical treatment and immune therapy.

Prevention

In order to reduce the symptoms to a minimum, one must try and minimize exposure to the allergen. When allergic to dust, for example, this is actually an allergy to a tiny organism called dust mite that is found in all the houses, even those that are sparkling clean, and it likes living in moist areas such as in mattresses and sheets.
One of the ways in which you can reduce exposure to dust mites is by using a mattress cover that protects the patient from continuous exposure to the dust mite overnight.
When there’s an allergy to animals we recommend reducing the number of hours of exposure to the pet or preventing the animal from entering the patient’s bedroom. However, when a person is allergic to seasonal pollens, it is very hard to prevent exposure to them during the pollen months.

Medical treatment for allergic rhinitis

If a patient has mild allergic rhinitis, that presents for short periods of times, they can benefit from the use of anti-histamines which reduce the symptoms of allergic rhinitis for several hours. Patients that suffer from constant symptoms are prescribed nasal steroidal sprays. It is important to keep in mind that when using topical steroids, it may take time until we see improvement of symptoms, and that the use of these steroids is safe and does not carry any side effects, as opposed to steroids given by mouth for long periods of time. Anti-histamines can also be given through nasal sprays or eye drops to help alleviate the symptoms.

Immunotherapy for allergic rhinitis

Generally speaking, when prevention and medical therapy are insufficient, we recommend immunotherapy. This therapy is based on the gradual exposure of the relevant allergens to the patient through injections that are given at increasing intervals of time. This gradually “teaches” the immune system to stop responding to the inhaled allergens. This therapy has been found to be very effective but requires persistence and there may be side effects during administration. The main advantage to this therapy, which is administered over the course of a few years, is the “healing” of the allergy and possibly prevention of development of asthma later on in life. Immune therapies given in the form of tablets, that can be administered daily sublingually, have also been developed in recent years.

Is allergic rhinitis a condition for life?

Allergic rhinitis tends to be a chronic condition. Only about 10% of children recover spontaneously, most children will continue to have some degree of symptoms, with a tendency for improvement in adulthood. Nonetheless, with the right guidance and treatment, the symptoms can be controlled in such a way that they do not affect the person’s quality of life.

In conclusion, allergic rhinitis is not dangerous in itself, but may cause significant damage to the quality of life, including difficulty sleeping, fatigue, restlessness, and sometimes even depression, decreased social functioning and attention deficit, concentration and memory problems, especially in children. For this reason, the treatment should be based on correct diagnosis, listening and participation of the patient and his family in the decision making in order to achieve an optimal quality of life.