Allergic rhinitis

Pediatrics for Parents, March, 2008 by Martin Belson

One of the most common presentations of allergies in children involves the nose and eyes. The clinical condition involving nasal symptoms is called "rhinitis" and allergic involvement of the eyes is called "conjunctivitis." According to the American Academy of Allergy, Asthma and Immunology (AAAAI), allergic rhinitis (hay fever) affects about 40 million people in the U.S., including up to 40% of children.

With the onset of spring and fall, many children begin to exhibit symptoms of seasonal allergic rhinitis, or hay fever due to exposure to outdoor allergens, such as tree pollens, grasses and weeds.

What Causes Hay Fever?

Seasonal allergic rhinitis, or hay fever, is caused when a person's immune system mistakenly identifies an allergen (e.g., pollen) as an intruder, much like bacteria or viruses. Once the body has identified a particular allergen as an intruder, it produces antibodies specific to that allergen. In the future, when that allergen enters the allergic person's body, it attaches to the antibodies and triggers the release of histamine and other chemical mediators of inflammation. This release of histamine and other chemical mediators is what causes allergy symptoms.

How Often Can Hay Fever Occur?

Constant exposure for the allergic individual can cause daily symptoms, resulting in what your physician would diagnose as "persistent, chronic, or perennial allergic rhinitis." Allergens responsible for these chronic symptoms may include house dust mites, mold spores, cockroach allergen, feathers, or indoor pets.

Symptoms of allergic rhinitis can also be acute or intermittent, presenting only when one is exposed to a relevant allergen. It is not uncommon for a cat-allergic individual to have an acute episode of allergic rhinitis when he enters into the home where a cat resides.

Seasonal allergic rhinitis, as its name implies, will manifest itself usually during the pollen seasons, most typically in the spring and fall. Exposure to tree pollens is generally responsible for late winter and springtime symptoms, and grass pollens are generally the cause of springtime and early summer symptoms. Flare ups in the fall are typically due to weed pollens and high mold spore exposure.

Different people are allergic to the pollen of different plants, but people whose bodies develop allergies to one plant are very likely to develop allergies to others as well.

Can Hay Fever Run in Families?

Allergic rhinitis does run in certain families and is more common in children that have asthma or eczema. It is also more common in children that are exposed to second-hand smoke, air pollution and pets.

What are the Signs and Symptoms of Hay Fever?

* Sneezing

* Runny nose

* Nasal congestion

* Watery eyes

* Itchy nose, eyes, ears and throat

* Headache

* Ear and facial pain

* "Allergic salute"--a common habit of children that consists of rubbing their nose upward. This is usually because the nose is itchy and this practice can lead to a small crease in the skin of the lower part of the nose.

* "Allergic shiners"--dark circles under the eyes caused by nasal congestion

How Does Allergic Rhinitis Adversely Affects Children?

According to the Pediatric Allergies in America survey, which is the largest and most comprehensive national survey of parents of children under the age of 18 who suffer from allergic rhinitis, and presented at the AAAAI 2008 Annual Meeting in Philadelphia, allergies do interrupt a child's productivity, sleep cycle and daily functioning.

More than 500 parents who had a child with allergies were interviewed about severity and effects of allergies on their child's life, and their responses were compared to more than 500 parents of children without allergies.

Some of the major findings include:

* Allergy symptoms interfere with children's sleep. Forty percent of parents indicated that their child's allergies interfere a lot or somewhat with their sleep.

* Allergy symptoms limit children's activities. Twice as many parents (21%) said allergies limit their children's activities, compared with only 11% of parents whose child did not suffer from allergies.

* Allergy symptoms interfere with children's education. Forty percent of parents of children with allergic rhinitis report their condition interferes with their performance at school compared to only 10% of parents of children without allergic rhinitis.

How is Hay Fever Diagnosed?

Based on the history and physical examination, your pediatrician can make a clinical diagnosis of hay fever. She may then elect to give your child a trial of the basic medications used for treatment. An allergist can also help your child with the immediate symptoms of seasonal allergic rhinitis. And, more importantly, an allergist can identify the pollens to which your child are allergic and then design an effective treatment program to eliminate or minimize allergies in the future.

If the medical history suggests allergic rhinitis, an allergist is likely to perform allergy testing in order to confirm the diagnosis, identify the offending allergen(s), and ascertain the severity of the allergy. The preferable testing method by most allergists is skin testing. This method allows the testing of multiple allergens with the results being available immediately. Alternatively, similar results can be obtained through a blood test called RAST or ImmunoCap.