Management of Allergic Rhinitis
There are several important steps in the treatment of allergic rhinitis. Nasal douching and sprays also apply to the treatment of other types of rhinitis.
Allergen avoidance
-Avoidance of any known triggers, if possible
-Air filters, for example in cars
-Avoidance of irritation caused by passive smoking
-Application of vaseline to the front of the nose may help to block the ingress of allergens
Nasal saline washes
This is also known as nasal douching. It involves flushing the nose through with a salty water solution. You sniff the solution into the nose, then blow it out or spit it out. This flush removes any secretions, and removes allergies from the nose.
It's important to flush the nose, and not swallow the solution! Therefore your child needs to be old enough to tolerate this rather odd sensation, and know that they need to blow out the solution or spit it out. The best thing to do is to make a game of it, perhaps during bath time in toddlers. In older children, it can be done over a sink.
A variety of over the counter preparation for nasal douching are available, for example Medicleanse and NeilMed Sinus Rinse. In younger children that cannot douche, a saline spray or saline drops can be used instead.
Nasal douching is one of the best ways of managing allergic rhinitis, and it avoids the need for medication. It may be odd at first, but it's worth persevering.
Medication for allergic rhinitis
A variety of medications can help allergic rhinitis. The mainstay of treatment is steroid nose sprays and antihistamines.
In general, steroid sprays and antihistamines are best used regularly for maximum effect. So when you start treatment, use it regularly for 2-3 months. If you wish, you can stop at a time of the year when you know that symptoms will be better. Or you can use the spray for a few months, then stop to see what the symptoms are like. The worst thing to do is to use it irregularly, some days not enough, and other days too much.
It is also worth switching to a different spray or antihistamine if symptoms are not well controlled, as sometimes one will be better than another for your specific problems. Both antihistamines and steroid nose sprays can be used at the same time, as they are different types of medication.
Steroid nose sprays
Steroid nose sprays (for example beclomethasone) are particularly effective against blocked nose.
It's important that the spray us used correctly. The direction of the spray should be slightly away from the midline, towards the eye. If your child is using the spray themselves, show them to use the right hand to spray in the left of the nose, and the left hand to spray in the right nose: this naturally directs the spray away from the midline. Also, no big sniffing in. If the child takes a deep breath / sniff, the spray moves straight though the nose into the lungs and it won't do anything for the nose! Therefore, a gentle breath in is OK, but no big sniffing.
Parents often worry about the fact that the spray contains steroid. In general, the steroid works just in the nose, rather than affecting the rest of the body, and is therefore safe for long term use.
The different steroid sprays have a minimum age of use, although occasionally your doctors might discuss using the spray at a younger age that is usually suggested. This would only be if you and your doctor make the decision that the symptoms are severe enough to justify spray use. If you are using steroid sprays long term, particularly if your child is also on other steroid medication, we suggest that you ask your GP whether any monitoring is required.
Antihistamines
These work best for itchy eyes and nose, and lots of different ones are available. Chose a non-sedating one: your GP or pharmacist will advise you. Examples include cetirizine and loratadine.
In addition to oral antihistamines, antihistamine nose sprays are also available (azelastine). There is also a spray that combines steroid and antihistamine medication.
Other medication for allergic rhinitis
Sodium chromoglycate nose spray or eye drops are another option. To work well, they need regular application, for example up to four times per day. Unlike steroid nose sprays, they can be used in very young children. Having said that, diagnosing allergy in very young children is often difficult (difficult to differentiate allergy from adenoids or respiratory infections), so chromoglycate isn't used that often.
You may also hear about decongestants such as Otrivine or Vicks Sinex. These should only be used for a few days, because longer use can cause damage to the nose.
Medications to control asthma often have a beneficial effect on allergic rhinitis. In fact, making the nose better makes the chest better, and vice versa!
Immunotherapy
The usual answer to the question "Can you cure allergies?" is no, but actually that isn't quite true. Immunotherapy is a way of teaching your immune system to tolerate the allergens rather than mount a response to them. Giving small doses of the allergen, time and time again over a long time period, teaches the body to become accustomed to the allergen and stop mounting a reaction against it.
However, immunotherapy requires strict commitment to a regular schedule of treatment over a couple of years or more, and may involve injections, and potentially serious side effects. In the UK, we don't use immunotherapy as much as elsewhere in the developed world. We should probably be using it more often. If your child's symptoms are not controlled using the strategies described above, you may wish to ask your GP about the possibility of immunotherapy.
There is also a "home remedy" that probably works on the principles of immunotherapy. It is the use of honey! It needs to be honey produced in your local area (so it contains your local allergens), and not be pasteurised (this would destroy the allergens). So it needs to be honey bought from your local bee keeper and not supermarket honey from South America! Eating that honey on a regular basis is though to expose your body's immune system to low levels of allergens over a period of years, so that the body stops mounting an allergic reaction. It is an old "home remedy", but there is some medical evidence that it might work.
Prognosis
Treatment of allergic rhinitis requires a long-term commitment. Don't expect any quick fixes, or easy cures. There are a variety of options though, so discuss them with your GP.
Buying allergy medication
Some of the medication discussed above is available to buy over the counter and on the internet.
Please remember that the internet cannot replace advice given by health professionals such as your GP or pharmacist. They will know the available treatments, and be able to tailor them to your child specifically. The information contained on this website offers general advice to help you know what the options are, and thus help you get the most out of your discussion with your treating team. We do not recommend one brand over another, instead we provide information about broad groups of medication, and examples of drugs in that group.
Buying over the counter or on the internet is fine if you know what you need, and have been appropriately advised by your health professional. If you are not sure, please discuss with your doctor or pharmacist.
Section contributor:
Mitra Mummadi MRCS
ENT registrar