Hay fever (allergic rhinitis) is often treated as the poor relation of eczema and asthma – just a bit of a seasonal inconvenience. It is an allergy to house dust, house dust mites, moulds, trees, grass pollens and cat/dog dander.
It is estimated that up to 40% of children are affected by allergic rhinitis and when untreated, it can interfere usual daily activities and cause impaired sleep quality. Studies have shown that children with rhinitis have reduced school attendance and academic performance and also increased risk of developing asthma.
What are the symptoms?
- Nasal discharge - watery and clear, sometimes yellowish/greenish
- Nasal blockage
- Sneezing, stuffy nose, post nasal drip, itchy eyes. Post nasal drip is the sensation of mucus trickling down the back of throat and can cause children to cough at night.
Historically, allergic rhinitis has been divided into seasonal (with symptoms tending to occur in the spring or summer), and perennial (with symptoms all year round). The timing of symptoms gives an indication of the likely seasonal allergen, for example, tree pollens are most prevalent in spring, whilst grass pollens are predominant in summer.
Children with seasonal symptoms occurring specifically in the autumn, are often reacting to mould spores in the air. Unfortunately, children (and adults) often lack the ability to recognise the specific triggers of their symptoms, hence the need for diagnostic testing to clarify the specific allergens.
In a paediatric allergy consultation, we undertake skin prick testing as the principle means of identifying the causative allergen. Skin prick testing is extremely safe, rapid and reliable. However, the skin prick test does mean a child must stop taking any antihistamines for several days before the testing is done. An alternative to this is blood testing.
Allergic rhinitis should be treated holistically, with the main lines of treatment being: education, allergy avoidance and pharmacological treatments. In clinics, parents are routinely taught about the nature of the condition, causes and mechanisms of rhinitis, the symptoms and available treatments.
Allergen avoidance works! Avoiding all common allergens by implementing the below measures is effective:
House dust mite reduction:
- You can reduce exposure to dust mites by removing soft toys from the child’s bed (If your child is attached to a particular toy, you can leave it providing its machine washable or after freezing it in a plastic bag overnight)
- Regularly vacuuming carpets (HEPA filter vacuum cleaner, exhaust filtered vacuum cleaner) and wet mopping wooden floors
- Washing bed linen at 60 degrees
- Use anti house dust mite covers for pillows, blankets and mattress
- This is tricky as pollen spores are windborne and travel for miles on air currents. However you can monitor pollen forecasts daily and stay indoors whenever possible.
- Allergen barriers are available as balms or gel nasal sprays, you can apply these around edge of each nostril to trap or block pollens.
- Keep windows closed when indoors especially in the early mornings and in the evenings (refer to allergy uk website).
Cat and dog dander:
- Don’t allow your pets into your child’s bedroom
- If a blood test identifies your child is allergic, then it is best to avoid contact with dogs and cats.
You may be allergic to spores of fungi. Some spores spread in dry weather and others during humid conditions. Indoors, fungi are often found in bathroom, kitchen, basement and laundry areas.
- Invest in a de-humidifier
- Use exhaust fans in bathrooms
Regular use of antihistamines (cetrizine, Loratidine etc) or nasal steroid sprays (or drops) can treat allergic rhinitis. However these tend to treat the symptoms rather than modifying the disease. Their effect is observed after 12 hours, but reaches maximal effect after a few days.
Treatment failure may be related to poor technique in the use of nasal sprays and drops. See our diagram to the right to ensure you are using your nasal spray and drops correctly!
This is desensitisation and it involves administration of gradually increasing doses of allergen extracts over a period of years, given by injection or drops/tablets under the tongue. This is the only treatment able to modify the natural history of allergic rhinitis – it’s not just treating the symptoms but altering the underlying immunological process that causes the condition.
For information regarding our allergies services at Parkside Hospital and our allergies consultants click here.
This information is intended solely for the general information of the reader and is not a substitute for medical care provided by a licensed and qualified health professional. Please consult your GP/health care provider for a formal diagnosis.