Up to ten percent of children occasionally suffer the sneezing and runny nose caused by allergic reactions of the upper-respiratory tract—or, allergic rhinitis. The most well known of these reactions, hay fever, also causes a scratchy throat and itchy, watery eyes. Hay fever is triggered by ragweed and various pollens in the spring and fall. Other substances, however, can also lead to respiratory allergies in children. These include molds (which may cause symptoms in the early spring and late fall), animal dander (tiny flakes of skin from beneath the fur of household pets), and dust mites (microscopic bugs that grow in house dust).
Although respiratory allergies are generally considered seasonal illnesses, those that are triggered by dust and animal dander can occur year-round. In small children, these allergies are more common than hay fever, which rarely shows up before the age of six.
Children who are prone to allergic rhinitis also tend to develop symptoms when exposed to cigarette smoke, strong fumes, and in some cases, cold air. The incidence of asthma, chronic sinusitis and chronic middle-ear infections is particularly high in children with allergic rhinitis.
WHAT CAUSES ALLERGIC RHINITIS?
The underlying mechanism is a hypersensitivity to an inhaled foreign substance. Hypersensitivity develops when a child is exposed to an antigen, which is a protein that triggers immune-system production of a specific disease-fighting agent called an antibody. The immune-system response to the antigen triggers allergy symptoms.
The first exposure to an allergy-causing substance produces no reaction. Subsequently, however, the substance will lead to swelling of the tissues that line the nasal passages, watery eyes and a profuse nasal discharge. The head may be stuffy, and the nose may be completely blocked.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS ALLERGIC RHINITIS?
Symptoms of allergic rhinitis are similar to those of a cold. As a result, it can sometimes be hard to tell the difference. Colds are more common in winter than in spring and fall, while the reverse is true of allergies. A cold usually lasts less than seven days and typically starts with a scratchy throat and watery nasal discharge, which rapidly becomes thicker and more opaque. Allergic rhinitis, by contrast, causes a watery discharge and almost constant sneezing. Not all allergic rhinitis patients, however, have sneezing symptoms. Children with allergic rhinitis usually exhibit persistent nose rubbing, because of the irritation or itch in the nose. Allergic rhinitis may be seasonal depending upon the allergen involved.
IS MEDICAL ATTENTION NECESSARY?
Yes. Severe allergic rhinitis can be very uncomfortable and interfere with a child's normal functioning. Since prevention is often a simple matter of avoiding the substance that causes the reation, it is worthwhile to find out what is causing the symptoms.
HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS ALLERGIC RHINITIS?
The pediatrician looks for physical signs that distinguish allergies from colds. Some children with severe allergies develop so-called allergic shiners—dark rings below the eyes. The nasal lining may appear puffy and bluish, and the tonsils and adenoids are often swollen. The pediatrician will also ask questions to determine whether symptoms follow an allergy pattern or a cold pattern. Finally, a sample of nasal secretions may be examined under a microscope to check for cells associated with allergic reactions.
WHAT TREATMENTS ARE AVAILABLE?
Occasional bouts of allergic rhinitis can be treated with anithistamines. More severe allergies may require daily medication, at least during certain months. Corticosteroid nasal sprays can help children with debilitating seasonal allergy symptoms.
Children who have continuing problems despite these treatments may benefit from allergy shots (immunotherapy). Unfortunately, however, immunotherapy is expensive and time-consuming, and it does not produce immediate results.
CARING FOR A CHILD WITH ALLERGIC RHINITIS
• Learn to recognize the signs of an allergy attack and, if possible, remove the trigger from the child's environment or remove the child from the environment.
• Do not allow smoking in your home, and sit in a non-smoking area when you go out.
• Avoid giving the child over-the-counter nasal sprays, which can worsen symptoms.
• Use an air conditioner in the child's bedroom (or the entire house, if possible) when the pollen count is high if the child has hay fever.
• Keep the bedroom as dust-free as possible by eliminating heavy drapes, rugs and knick-knacks and cleaning often.
• Ask about giving antihistamines at night only so that side effects such as drowsiness will not be disruptive.
GETTING HELP
Call your doctor if your child:
• Has a "cold" that lasts for more than a week
• Has cold symptoms that wax and wane depending on where she is or what the weather is like
