Health : what to do to relieve symptoms?
Runny nose, stuffy nose, itching, sneezing … These are the typical symptoms of the common cold, but of allergic rhinitis in children: a chronic medical condition that appears especially in children. But the similarities between the two stop at the symptoms. Unlike the common cold, allergic rhinitis is not caused by a viral infection and does not go away within a few days. Allergic rhinitis is caused by an allergic and remains as long as the allergen that caused it is present. So what is the treatment for allergic rhinitis? Can the symptoms be relieved and the child helped to feel better?
Allergic rhinitis when the child inhales something from the indoor or outdoor environment to which he is allergic. This allergen which can be dust mites, cigarette smoke, plant pollens or fog and these allergens cause inflammation of the lining of the nose. And so this inflammation causes symptoms like sneezing and a runny nose.
Is allergic rhinitis the other name for hay fever?
Allergic rhinitis which is caused by pollens is called hay fever. Hay fever is often encountered in climates where very high levels of seasonal pollen can be found. And even if allergic rhinitis can be present in adults too, it is most often encountered in children between 4 and 17 years old.
Treatment of allergic rhinitis in children often depends on the child’s symptoms
Causes of allergic rhinitis in children
In children, there are a large number of different causes for rhinitis. While adults often suffer from intrinsic rhinitis, the most common cause of rhinitis symptoms in children is allergy. Allergic rhinitis is an inflammatory condition of the lining of the nose that is characterized by symptoms of runny nose, sneezing, and blocked nose.
In geographic regions where there is a definite difference in seasons with an explosion of allergens, these allergens lead to rhinitis which is described as seasonal rhinitis. These rhinitis are often caused by pollen from trees or grasses. These rhinitis can also be continuous and are often caused by mites, mold or dander from animals.
Impact of allergic rhinitis on the quality of life of the child
Even if the symptoms of allergic rhinitis are not life-threatening, these symptoms can be harmful to the child’s physical, psychological and social aspects and can significantly decrease their quality of life: something that is often underestimated by doctors and non-sufferers.
Allergic rhinitis can have a negative impact on childhood. Adolescents who suffer from it often complain of difficulty concentrating which can be worrying for their education. Symptoms of rhinitis and inflammation can cause lethargy, while nighttime symptoms like itching and congestion can affect sleep quality. Together, these effects can have a big impact on school performance.
Allergic rhinitis in children is often caused by pollens from trees and grasses
Even seasonal allergic rhinitis can be associated with reduced academic performance mainly because the partial ones often coincide with the pollen season of grasses and trees. Difficulties in learning can be made worse when it comes to severe rhinitis or rhinitis associated with other complications such as sinusitis or dysfunction and loss of cognitive hearing.
It is not uncommon for the first generation of antihistamines to be used as an allergic rhinitis treatment as these drugs are quite accessible and can be used in young children. Unfortunately, the sedative effect of these drugs can be associated with lethargy.
Diagnosis of allergic rhinitis
Children with allergic rhinitis will have one or more symptoms of the classic symptoms: rhinorrhea, itchy nose, sneezing, and nasal blockage, with or without conjunctivitis. The presence of two or more symptoms normally confirms the diagnosis of allergic rhinitis. A clinical history should establish the duration and seasonality of the symptoms.
There is often but not always a family or personal history of atopy. Allergic rhinitis is a risk factor for the development of asthma and children with moderate or severe rhinitis should be routinely screened for asthma with a history and an appropriate exam.
The correct diagnosis is very important for the treatment of allergic rhinitis in children
Typical facial features of affected children may include an elongated, pale face or folds below the eyes. This child can breathe through the mouth with dry lips and eczema on the lips. There may be halitosis, dental malocclusion and post nasal drip.
Nasal examination may reveal an external nasal fold due to persistent rubbing and a swampy nasal bridge. A metal speculum can be used to demonstrate the reduction in nasal air flow. Typical ways such as ‘allergic salute’ – a usual rubbing of the nose with the hand – reflect the intensity of the itchy nose. An internal examination of the nose will reveal a pale purple or pink, swollen lower swollen with narrowing of the nasal airways. An important differential diagnosis are nasal polyps, which are pale, non-sensitive and mobile – in children, these should be considered due to cystic fibrosis until proven otherwise.
Allergic rhinitis treatment
There is a stepwise approach to the treatment of allergic rhinitis. The goal of allergic rhinitis treatment is to end unattended sleep, stop daytime activity limitation and non-attendance at school, and minimize the side effects of allergic rhinitis treatment.
In addition to treating allergic rhinitis with medication, avoidance of allergens should also be taken into consideration by parents, especially when these allergens have been identified by a successful test. Unlike drugs, the evidence for avoiding allergens is limited, but still highly recommended.
Avoidance of allergens as treatment for allergic rhinitis
Avoiding seasonal allergens like pollens is very difficult. Some simple advice should be offered to patients. Allergens that last throughout the year may be easier to handle, but especially in the case of dust mites, these measures can be very expensive, time consuming and have limited effects. The advice to give up on pets may be poorly received by patients, and it can take a long time even when cleaning to remove all traces of allergens. This is especially true when it comes to cats. A simpler compromise is to keep pets outside and wash them fairly frequently. Hypoallergenic animals already exist, but they are very expensive.
For the treatment of allergic rhinitis, it is also recommended to avoid being outside early in the morning and in the evening since it is during these times that pollens are most present. Here are other tips to follow:
- Let the child sleep with the windows closed
- When you are in the car, you must also close the windows. You should also invest in anti-pollen filters.
- The child should wear goggles and use protective goggles when swimming.
- Pollens can be brought into the house, so you can try using a dryer during the allergen season.
- Limit the child’s travel to rural areas. Sea breezes blow pollens inside the earth, so avoid the sea coasts too.
- Wash the child well, as well as his hair whenever he makes it from the outside. Also change clothes.
- Showering your nose can help remove pollens and irritants from inside the child’s nose.
What you can also do to avoid exposure to allergens is: use hypallergenic mattresses and pillowcases; vacuuming often is especially if you have carpets at home; avoid stuffed toys; wash bed linen in hot water; do wet dusting often on surfaces; reduce indoor humidity.
Medical allergic rhinitis treatment
Unfortunately, in the vast majority of cases avoiding allergens is neither possible nor sufficient to control the symptoms of allergic rhinitis and for this reason medication becomes necessary. Historically, a wide variety of drugs have been used for the treatment of allergic rhinitis, although the mainstay of treatment for allergic rhinitis generally includes oral antihistamines and nasal steroids. Topical antihistamines, anticholinergics, sodium cromoglicate and decongestants may all have their place under defined circumstances, while leukotriene receptor antagonists (LTRA) and immunotherapy are important options for resistant cases.
– Antihistamines : Oral antihistamines are the drugs most often prescribed for the treatment of allergic rhinitis. These drugs are particularly effective against runny nose, itching and sneezing since these symptoms tend to be mediated by histamine. Second or third generation non-sedating antihistamines also improve allergic symptoms at sites other than the nose such as the conjunctiva, palate, skin, and lower respiratory tract. These drugs are less effective against nasal blockage even if they offer certain benefits. The greatest positive aspect is seen in patients who take antihistamines regularly and not just when necessary.
The biggest problem with antihistamines is their sedative effect and especially in young children. For this reason, first generation antihistamines should be avoided as regular therapy. Second and third generation antihistamines do not have such a sedative effect and have minor interactions with other drugs.
Topical antihistamines such as nasal sprays or eye drops are sometimes used for less severe symptoms and are useful for treating allergic rhinitis. This type of medication has no other effect than treating the symptoms locally.
– Topical corticosteroids
Topical corticosteroids are the mainstay of moderate and severe allergic rhinitis treatment and can be used in addition to oral antihistamines. They should be used as first line treatment in patients who have persistent or moderate symptoms. This class of medication is best suited for underlying chronic inflammation and nasal blockage symptoms. The intranasal route of corticosteroid administration is significantly safer than potentially harmful oral or intramuscular corticosteroid preparations.
A small proportion of intranasal corticosteroid spray is always swallowed after administration and despite the metabolism of the livers, presents a potential risk of systematic side effects if used systematically or in large doses.
-Leukotriene receptor antagonists
The inflammatory antagonist mediators released by nasal cells and eosinophils in the early and late phases of the allergic response. These are administered orally and appear to be particularly effective against nasal blockage and mucosal production with improved symptom control achieved when used in conjunction with antihistamines.
For patients with resistant symptoms and those with coexisting asthma, leukotriene receptor antagonists can be used as an additional therapy, even if some patients respond better than others. They are also a useful alternative for those who are unable to use a nasal spray, for children whose parents do not want to use steroids, and for children who cannot stand the smell or taste of nasal sprays. Unfortunately they have side effects including nightmares at night and a change in behavior.
-Allergenic immunotherapy (desensitization)
While most children will be relieved using an avoidance combination of allergens and the above drugs, in a significant minority of children this combination will not be effective. There are also many children whose parents are resistant to long-term or short-term use of steroid medications. In these scenarios, allergen immunotherapy has a large role in the treatment of allergic rhinitis. The practice of administering gradually increasing doses of allergen extract to reduce symptoms associated with subsequent exposure dates back to 1911.
Sublingual immunotherapy in the form of tablets and sprays is generally preferred in children since it eliminates the need to inject for at least three years. There are a limited number of sublingual immunotherapy products for use in children over 5 years of age. The first dose of these drugs should be given under supervision in the hospital, but this allergic rhinitis treatment is then continued at home.
Several scientific studies have shown that sublingual immunotherapy is effective in reducing symptoms in children with allergic rhinitis. One study found a reduced risk of developing asthma in patients with allergic rhinitis who received sublingual immunotherapy compared to those who received placebo.
Access to sublingual immunotherapy remains problematic for these children with persistent symptoms despite maximum therapy with drugs. A 2011 audit estimated that only 2 percent of children who meet the conditions for immunotherapy actually receive it.
Allergic rhinitis is a very common disease in childhood but which can have a considerable impact on the quality of life of the child. In the majority of cases, treatment for allergic rhinitis is fairly safe and effective using drugs such as antihistamines or nasal steroids with combinations of more recent treatments used. Immunotherapy is an addition used in the treatment of allergic rhinitis, especially in children with asthma.