Allergic Rhinitis

Allergic rhinitis (hay fever) is a common chronic nasal problem in adolescents and young adults.  In early childhood, allergies to inhalants like pollen, dust, and animal dander can begin to cause sinus and nasal symptoms.  Infants and young children are especially susceptible to allergic sensitivity to foods and indoor allergens.

What causes allergic rhinitis?

Allergic rhinitis typically results from two conditions:

  1. Family history/genetic predisposition to allergic disease.
  2. Exposure to allergens.  Allergens are substances that produce an allergic response.

Children are not born with allergies but develop symptoms upon repeated exposure to environmental allergens, most commonly through food.  During early exposure, infants may develop eczema, nasal congestion, nasal discharge, and wheezing caused by one or more allergens.  Quick ENT fact: Allergies can contribute to repeated ear infections in children.

In early childhood, indoor exposure to dust mites, animal dander, and mold spores may cause an allergic reaction, often lasting throughout the year.  Outdoor allergens including pollen from trees, grasses, and weeds primarily cause seasonal symptoms.

What are allergic rhinitis symptoms?

Symptoms for allergic rhinitis can vary with the season and type of allergen. Symptoms may include sneezing, runny nose, nasal congestion, and itchy eyes and/or nose.  A year-long exposure usually produces nasal congestion (chronic stuffy nose).

In children, allergen exposure and subsequent inflammation in the upper respiratory system can cause nasal obstruction.  This obstruction becomes worse with the gradual enlargement of the adenoid tissue and the tonsils inherent with age.  Consequently, the young patient may have mouth-breathing, snoring, and sleep-disordered breathing such as obstructive sleep apnea.  Sleep problems such as insomnia, bed-wetting, and sleepwalking may accompany these symptoms, along with behavioral changes like short attention span, irritability, poor school performance, and excessive daytime sleepiness.

In these patients, upper respiratory infections such as colds and ear infections are more frequent and last longer.  A child’s symptoms after exposure to pollutants such as tobacco smoke, are usually amplified in the presence of ongoing allergic inflammation.

When should my child see a doctor?

You should seek medical attention if your child’s cold-like symptoms (sneezing and runny nose) persist for more than two weeks.

Emergency treatment is rarely necessary except for upper airway obstruction causing severe sleep apnea or an anaphylactic reaction caused by exposure to a food allergen.  Treatment of anaphylactic shock should be immediate and requires continued observation and care.

How is allergic rhinitis treated?

The most common treatment for allergic rhinitis is to have the patient avoid allergens causing the allergic sensitivity.  The physician will work with the patient or caregivers to develop an avoidance strategy based on the nature of the allergen, exposure, and availability of avoidance measures.

Additional treatment measures may be necessary depending on severity of symptoms, number of allergens, length of exposure, and resources available.  Some of these treatments may include nasal saline irrigations, nasal steroid sprays, and non-sedating antihistamines.  Nasal steroids are the most effective in reducing nasal symptoms of allergic rhinitis.  A short burst of oral steroids may be appropriate for some patients with severe symptoms or to gain control during acute attacks.