The incidence of allergic rhinitis doubled in children in the past 30 years, reports expert otolaryngologist Dr. Baroody. Researchers are unsure why but theorize that pollutants and other environmental influences play a role. If untreated, allergic rhinitis symptoms in children lead to poor control of comorbidities such as sinusitis and asthma. Current guidelines issued by ARIA, the Allergy and its Impact on Asthma workshop, an international collaborative panel, recommend a management strategy with three parts: avoidance, medication and allergy shots.
Prevalence
Allergic rhinitis is the most common chronic condition in children. It occurs in up to 40 percent of U.S. children and is reported in half of children in a few regions of the world, according to the journal "Pediatric Drugs." The incidence rises with progressing age and peaks during adolescence.
Impact
Allergic rhinitis disrupts sleep in children, leading to fatigue during the day and missed days at school. It may even cause learning impairment, reports Dr. Baroody. On a typical school day, about 10,000 children are absent because of allergy. Allergic rhinitis also causes a financial burden, with children under 12 years old accounting for 40 percent of expenses.
Challenges in Diagnosis
Correctly diagnosing allergic rhinitis in children is difficult, according to Dr. Baroody. Children often under-report their symptoms and may lack the ability to verbalize their problems. In fact, they may have no idea something is wrong with them. Pediatric physicians mistake allergy for the common cold. Another difficulty is that allergy tests, which are rarely performed by family practitioners, require referral to a specialist.
Signs of Allergic Rhinitis in Children
The classic symptoms of allergic rhinitis are nasal congestion and itchy, runny nose and sneezing. Itchy eyes or throat is another typical sign. According to Dr. Baroody, the three facial hallmarks of severe rhinitis in children are a darkening of the lower eyelid, a skin line on the nose caused by constant rubbing and upward rubbing of the nose with the palm of the hand.
Complications
Children with untreated allergy rhinitis are especially prone to complications and comorbidities. Hay fever is associated with middle ear infections, while severe allergic rhinitis is linked to asthma, according to the Mayo Clinic and ARIA. Sinusitis, an inflammation or infection of the membrane lining the sinuses, is a common problem in children that is also linked to allergic rhinitis. Because they believe that children's sinuses are not yet developed, doctors may overlook it or mistake it for respiratory infection, according to Dr. Baroody.
Management
A three-part approach has been recommended for managing allergic rhinitis in children: prevention, immunotherapy and medication. Minimizing exposure to known triggers such as pollen or pet dander is a standard preventive measure. Allergy shots, traditionally reserved for severe allergic disease, are now viewed as capable of altering the course of rhinitis altogether, reports Pediatric Drugs. They block multiple sensitizations, which some investigators believe increases susceptibility to allergy, and prevent onset of asthma. The mainstay of treatment for allergic rhinitis is antihistamines and nasal steroids, both of which have been approved for use in children six years of age and, in some cases, children as young as three years old. New safety studies have not shown growth suppression with the nasal steroids; however, caution should be exercised regarding long-term use.
References
- "Allergic Rhinitis in Children: Diagnosis and Management Strategies"; Pediatric Drugs; Berger WE; 2004
- MayoClinic.com: Hay Fever
- "Allergic Rhinitis: Broader Disease Effects and Implications for Management"; Otolaryngology Head and Neck Surgery; Baroody FM; 2003.
- "Allergic Rhinitis and its Impact on Asthma (ARIa) 2008 Update"; Allergy; Bousquet J; 2008
