ALLERGIC RHINITIS IN CHILDREN by Adam Fox

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Published on Thursday, 01 December 2011 21:41

Last Updated on 01 December 2011

Monica Costa

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A very popular article by Dr Fox from our London Mums archive.

Typical features of allergic rhinitis are blocked, itchy and runny nose, sneezing and itchy eyes. However, in more severe cases they cause disturbed sleep, lethargy, sinusitis and glue ear. Whilst often being thought of as a problem of adulthood, allergic rhinitis is becoming increasingly common in children, affecting around 10% of 6-7 year olds. As allergic rhinitis has become more common over time it is also affecting increasingly young children. It is particularly common in children with asthma with around 50-80% of asthmatics also suffering from allergic rhinitis.

Although symptoms of allergic rhinitis are not life threatening they can have detrimental effects on the physical, psychological and social aspects of patient’s lives. That allergic rhinitis can significantly decrease quality of life is often under-recognised by physicians and non sufferers alike. Symptoms of rhinitis and the associated effect on the quality of sleep have significant effects on a child’s ability to perform well at school. Even uncomplicated hayfever may be associated with reduced ability to learn. This is a particular concern given that the timing of public examinations may coincide with the grass pollen season. A study comparing adolescents’ examination performance during ‘mock’ examinations (conducted in winter) with formal examinations in spring/summer revealed that having current symptomatic hayfever was associated with a remarkable 50% increase in the risk of dropping an exam grade between winter and summer.

Frustratingly, whilst even severe rhinitis can be effectively treated, most patients often receive bad advice resulting in unnecessary suffering.

The lost effective way to reduce symptoms is by avoiding the problem allergen. When it is unclear what this is, allergy testing can be very helpful. The most common cause of year round symptoms (or those that are worse in the winter) is dust mite. Dust mites are tiny, spider like creatures, invisible to the naked eye. They like warm moist environments such as bedding and soft furnishing. They eat human skin particles and it is their droppings that cause allergic problems. If allergy to dust mite is causing rhinitis (or asthma or eczema) then reducing exposure to them will help. The most useful measure is getting special covers for the mattress and bedding.

These prevent the faecal particles getting up the nose while sleeping. It is essential to get the right covers, which are properly tested as being effective. A good example would be Allerguard (www.allerguard.co.uk). Other measures include reducing soft toys and furnishings and regular damp dusting. Replacing carpet with hard floors is some help but the effect is quite limited. Unfortunately, with hay fever, there is much less that can be done to avoid pollen. Pollen filters in cars, wrap-around sunglasses and nightly hair washes (to prevent transfer of pollen from the hair to the pillow) all may help. Some people find it helpful to apply Vaseline around the nose to act as a ‘pollen trap’ or to rinse their noses with salty water. However, in many cases, this is not enough and medication may be required.

The mainstay of treatment for most cases of hay fever is antihistamines. It is essential that the correct time of antihistamines are used. Commonly, when buying over the counter, short acting, sedating antihistamines (such as Piriton) are used which have limited beneficial effect and can worsen the tiredness already cause by the hay fever. Ideally, long-acting, non-sedating antihistamines (such as loratidine or cetirizine) should be used. If symptoms persist then there are many over the counter nasal sprays which are also helpful. Whilst these do contain steroids, it is only a tiny quantity and they have been shown to be very safe. Unfortunately, whilst anti-histamines and steroid nasal sprays are enough for most cases, they are not for everyone. However, for more specialist treatment a referral to an allergist would be required. An allergist can confirm exactly what the allergic cause of the problem is and also offer the option of ‘immunotherapy’.

Immunotherapy is the practice of administering gradually increasing doses of an allergen extract (eg pollen) in order to reduce the symptoms of hayfever or asthma that it causes. It was first carried out almost 100 years ago and is now in widespread use around the world. It is sometimes referred to as ‘allergy vaccination’ or ‘desensitisation’. Until recently, immunotherapy involved having a series of injections (subcutaneous immunotherapy) over a period of three to five years. Injections needed to be given in hospital and close observation was required for an hour after each ‘shot’, because of a small risk of a severe allergic reaction. Recent advances have meant that immunotherapy can now be given without injections. Instead, the allergen extract is given under the tongue either by tablets or drops (Sublingual Immunotherapy). This method is very safe and means that injections are not needed. However, it needs to be taken on a daily basis.

Sublingual immunotherapy can be used to reduce allergy to the grass or tree pollens that cause hayfever. Most children receiving treatment report an improvement in symptoms and less medication use. Sublingual immunotherapy against year round allergens such as house dust mites, cat or dog can also help in reducing the symptoms of allergic rhinitis and asthma but is only available from a limited number of very specialist centres. Using sublingual immunotherapy from an early age may actually prevent new allergies developing and reduce the likelihood of getting asthma at all, which is particularly exciting, especially as children with hayfever are at very high risk of developing asthma in later life.

In summary, allergic rhinitis is often considered to be a trivial problem but it is becoming much more common in children and may significantly impact their daily life. Whilst over the counter treatments may be enough for many people, there are more specialist treatment that can really help even the most severe cases.

THE AUTHOR: Dr Adam Fox, MA(Hons), MSc, MB, BS, DCH, FRCPCH, Dip Allergy, FHEA

Adam Fox is one of the UK’s few specialist Paediatric Allergists and is a consultant at Guy’s & St Thomas’ Hospitals, London – the Europe’s largest specialist children’s allergy centre. Adam sees thousands of children with severe allergies every year in his NHS and private practise. He is also actively involved in research, particularly in the area of food allergy, and has published numerous scientific papers. He was named ‘Paediatric Allergist of the Year’ by the charity Allergy UK in 2007 and acts as an advisor to Babycentre, Advertising Standards Agency, the Anaphylaxis Campaign, Annabel Karmel and Dorling Kindersley as well as lecturing around the world. He can be contacted through his website www.adamfox.co.uk

Dr Fox recommends AllerGuard, a new, revolutionary range of anti allergy bedding in the UK which has been statistically proven to drastically reduce symptoms of asthma, ezcema and rhinitis caused by allergy to the house dust mite. Exposure to dust mites is a major cause of asthma and allergy – especially in children – and it is important to protect your childs immune system right from the start by protecting against harmful allergens. Contact AllerGuard UK for more information: Website: www.allerguard.co.uk – Email: info@allerguard.co.uk – Tel: 020 8886 2821 – AllerGuard UK exhibited at the Allergy & Gluten Free Show 2009 and was recommended as the Number 1 brand in allergen proof bedding!