Allergic Rhinitis (‘Allergies’)

When we hear people talking about having ‘allergies,’ we know what they are talking about: sneezing, itchy eyes and throat, runny nose, coughing and so on in response to some allergenic trigger. Of course an allergy is a type of reaction and there are many other allergies, like food allergies and contact allergies. If we wanted to be specific, we are really talking about ‘Allergic Rhinitis.’ That’s the official term for hay fever and what we commonly call ‘allergies.’
Allergic Rhinitis (AR) is a miserable thing for those who suffer from it. The secretions, coughing, sneezing and itchy eyes can make daily activities very difficult and a child or adult with AR can feel exhausted all the time.
AR is persistent so long as the allergen is in a child’s environment. This means a child with tree pollen allergy will have symptoms through much of the spring and grass allergy, throughout the fall season.  Sometimes symptoms persist throughout the whole year.  In this case it is important to evaluate the home and even school environment for triggers like second hand smoke, cats, dogs, cockroach, mold, or dust mites. Second hand smoke is a big one here. Recently in the medical press, doctors have been theorizing about the decline in ear infections over the past decade. Some credit the pneumococcal conjugate vaccines but others theorize it is the reduction of smoking around children. Chronic exposure to smoking is really awful for the human body.

What can be done?

Well, quite a bit actually. As a general pediatrician, I often start with a long acting nonsedating antihistamine, something like Claritin. Sometimes this is all that is needed. We always talk about possible allergens in the household as well.
If this alone does not seem to be working, there are several other medical options but it important at this point to try to identify the triggers. What time of year is it? What activities is the child engaging in? Outside? Think tree pollen in the spring and grass pollen in the fall. Then there are the household allergens. Is there a cat in the house? A smoker? Perhaps the child sitting next in class lives in a house with four cats and that is what is irritating the child’s nose. There are blood tests that can be run that test for IgE levels to various allergens. There can be false positives on these serum tests so keep that in mind but sometimes the answer is obvious on one of these panels.

The next step is to add a nasal steroid spray like Nasonex or try a medication called Singulair, which can be used for both Asthma and AR. If symptoms are severe enough or if the search for a cause leads to ambiguous results, the next step is to have your child visit a specialist in Allergy and Immunology. These specialists can perform skin testing and give sensitization shots for allergies once they have been identified.

You can not change the season or keep that old oak tree out back from dropping millions of pollen grains but there is one simple step a parent can take: avoidance. Once you and your doctor have identified the likely culprit(s), remove those things from your child’s environment. If it is a seasonal outdoor allergy, medication is probably important to dampen down symptoms because you can’t keep children inside for the whole season, but pay attention to the pollen report and, perhaps plan an indoor activity on particularly bad days. Use the air conditioner instead of opening the window if possible. If it is an indoor allergen, there is a lot more you can do to remove the allergen. Is your child allergic to the cat or dog? I am an absolutely crazy dog lover and I understand the bond but when a child has dark circles under his eyes, repeated sinus infections and constantly low energy I ask parents what is more important. Dust mites can be combated with good cleaning and bed and pillow covers. Cigarettes should go in the trash for good, never to be seen again! A child does not have to live in a constant haze of Allergic Rhinitis. It affects all aspects of her life and there is so much that can be done to help them.

Matthew Toohey, MD. March 2011.