Ear, Nose, and Throat

Allergic Rhinitis

What is allergic rhinitis?

Rhinitis is a reaction that occurs in the nose when airborne irritants (allergens) trigger the release of histamine. Histamine causes inflammation and fluid production in the fragile linings of nasal passages, sinuses, and eyelids.

There is usually a family history of allergic rhinitis.

What are the types of allergic rhinitis?

The two categories of allergic rhinitis include:

• seasonal - occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after 6 years of age.

• perennial - occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.

What are the causes of allergic rhinitis?

The most common causes of allergic rhinitis include the following:

• pollen
• dust mites
• mold
• animal dander

What are the symptoms of allergic rhinitis?

The following are the most common symptoms of allergic rhinitis. However, each child may experience symptoms differently. Symptoms may include:

• sneezing
• congestion
• runny nose
• itchy nose, throat, eyes, and ears
• nosebleeds
• clear drainage from the nose

Children with perennial allergic rhinitis may also have the following:

• recurrent ear infections
  
  
• snoring
  
  
• mouth breathing
  
  
• fatigue
  
  
• poor performance in school
  
  
• "allergic salute" - when a child rubs his/her hand upward across the bridge of the nose while sniffing. This may cause a line or crease to form across the bridge of the nose.

The symptoms of allergic rhinitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is allergic rhinitis diagnosed?

Typically, the diagnosis is made by your child's physician based on a thorough medical history and physical examination. In addition to the above symptoms, your child's physician may find, upon physical examination, dark circles under the eyes, creases under the eyes, and swollen tissue inside the nose.

Treatment for allergic rhinitis:

Specific treatment for allergic rhinitis will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the reaction
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the reaction
• your opinion or preference

Treatment options may include:

• avoidance of the allergens
  Avoidance of the allergens that are causing the problem is the best treatment.
  
  
• over-the-counter antihistamines
  Antihistamines help to decrease the release of histamine, possibly decreasing the symptoms of itching, sneezing, or runny nose. Some examples of antihistamines are diphenhydramine (Benadryl®) or hydroxyzine (Atarax®). These medications may cause drowsiness. Consult your child's physician to determine the proper dosage for your child.
  
  
• nonsedating prescription antihistamines
  Nonsedating antihistamines work like antihistamines but without the side effect of drowsiness. Nonsedating antihistamines may include cetirizine (Zyrtec®), loratadine (Claritin®), or fexofenadine (Allegra®). Consult your child's physician to determine the proper dosage for your child.
  
  
• anti-inflammatory nasal sprays
  Anti-inflammatory nasal sprays help to decrease the swelling in the nose. Consult your child's physician to determine the proper dosage for your child.
  
  
• corticosteroid nasal sprays
  Corticosteroid nasal sprays also help to decrease the swelling in the nose. Corticosteroid nasal sprays work best when used before the symptoms start, but can also be used during a flare-up. Consult your child's physician to determine the proper dosage for your child.
  
  
• decongestants
  Decongestants help by making the blood vessels in the nose smaller, thus, decreasing congestion. Decongestants can be purchased either over-the-counter or by prescription. Consult your child's physician to determine the proper dosage for your child.
  
  
• anti-leukotrienes
  These are a relatively new type of medication used initially for ashtma and more recently for controlling the symptoms of allergic rhinitis. These medications help to block both the early response to allergic triggers (itching and sneezing) as well as the delayed response to allergic triggers (congestion). These are usually given by mouth.

If your child does not respond to avoidance or to the above medications, your child's allergist then may recommend allergy shots or immunotherapy based on the findings. Immunotherapy usually involves a three- to five-year course of repeated injections of specific allergens to decrease the reaction to these allergens when your child comes into contact with them. Consult your child's physician for more information.

How is allergic rhinitis prevented?

Preventive measures for avoiding allergic rhinitis include:

• environmental controls, such as air conditioning, during pollen season
• avoiding areas where there is heavy dust, mites, molds
• avoiding pets

The link between allergic rhinitis and asthma:

Controlling asthma may mean controlling allergic rhinitis in some patients, according to allergy and asthma experts. The majority of asthma patients have rhinitis, and patients with rhinitis have a much higher prevalence of asthma than those who do not have rhinitis.

Guidelines from the World Health Organization (WHO) recognize the link between allergic rhinitis and asthma. Although the link is not fully understood, one theory asserts that rhinitis makes it difficult to breathe through the nose, which hampers the normal function of the nose. Breathing through the mouth does not warm the air, or filter or humidify it before it enters the lungs, which can make asthma worse.