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Allergic rhinitis / hay fever

 

Allergic rhinitis means inflammation of the nose due to allergy. It is a common condition which can affect up to three out of ten children. It is getting even commoner, particularly in urban areas. Many children with allergic rhinitis also have asthma or eczema, or a  family history of allergies.

Children can be allergic to many things. A common allergen is hay and pollen; the specific type of allergic rhinitis caused by allergy to hay and pollen is called hay fever.

 

Please also have a look at the section on blocked and snotty noses. It is often difficult to know exactly what is responsible for a child's blocked and snotty nose. Allergic rhinitis is usually diagnosed in the early school years, although symptoms may start sooner or later. The key thing that suggests allergies is sneezing and itchy eyes. In many children, two or more causes are responsible for the blocked and snotty nose: it is not unusual for a cild to suffer both with allergic rhinitis and large adenoids.

What are the symptoms of allergic rhinitis?

Symptoms of allergic rhinitis are:

-episodes of sneezing

-runny nose

-blocked nose

-itching of the eyes, ear, nose and mouth

 

As a result of these symptoms, children can be irritable and tired, with disturbed breathing during sleep, fatigue, and poor attention.

 

Symptoms can occur at one specific time of the year (for example "hay fever" allergy to trees and grass), or be present all year round (for example house dust mites, pet allergy). The allergies that affect children all year round are often worse in the winter, because children spend more time indoors and therefore get more exposure to allergens such as house dust mites.

What tests are available?

 

Allergic rhinitis is usually diagnosed from your child’s history and examination findings. The GP is usually the person that is the expert in diagnosing and managing it.

If your GP's management isn't working, your GP may wish to ask the ENT doctors for a review. The ENT team will look for any other causes of blocked snotty nose, such as polyps. If your child will allow it, they may examine inside the nose with a small camera.

 

Your child can also be tested to see what is responsible for the allergies. This either involves a blood test, or a series of small superficial skin pricks with a tiny needle. People like to know what the cause of the allergy is, although in practice knowing what the trigger is doesn't usually help us manage the symptoms very much (you can't avoid grass, and most people would not remove the family pet). 

In older children / teenagers, scans of the sinuses are sometimes also used if there is concern about chronic sinusitis.

 

In toddlers / younger children with long-standing blocked snotty noses, frequent respiratory infections and large adenoids, the sinuses are almost always affected. Therefore, we generally assume the sinuses are affected by these recurrent infections also, and don't specifically go looking for sinus disease. Sinuses in these younger children are usually small and not yet fully developed. The management of long-standing sinus infections in younger children is similar to the management of other conditions that cause a blocked snotty nose, ie management of adenoids and management of allergic rhinitis.

 

(Note that acute sinus infections with complications such as periorbital cellulitis are separate from the long-standing chronic problems described here)

Management of Allergic Rhinitis

There are several important steps in the treatment of allergic rhinitis. For details click here.

Section contributor:

Mitra Mummadi MRCS

ENT registrar