Lately, to our great regret, fewer and fewer babies are born completely healthy. Many of them suffer from hereditary diseases from birth, have a weakened immune system, or acquire a whole bunch of colds and other diseases in early infancy. And what could be the surprise of parents when, against the background of the complete apparent health of their child, their offspring begins to more often catch a cold or suffer an exudative diathesis. He becomes restless, disturbed sleep or appetite. Young mothers are at a loss, because they follow all the rules of feeding, walking, personal hygiene and baby care, constantly go for consultations to the district pediatrician, and the child still grows painful.
What is the reason? The answers to this question can be enormous and unequivocally impossible to answer. Here are just the most common cause of allergic reactions that begin to manifest themselves in the first months of a child's life. Parents notice that abundant rashes appear on the tender skin of the child, eczema develops, the itch begins to disturb the child. These phenomena are explained by the development of allergic exudative diathesis. Already at a later age, at about 2-3 years old, allergic rhinitis in children may develop. At this point, parents have already forgotten to recall the manifestations of diathesis, and suddenly a new problem. Parents are beginning to realize that they either “got cured” in the infancy of their child, or missed something in caring for him.
Only parents are most often not to blame for the fact that their child suffers from heightened sensitivity to external agents. When inhaled, grass pollen, flowers, flowering trees react to this by developing allergic hyperreactions, one of the manifestations of which can be allergic rhinitis. Its danger lies in the fact that if you leave everything as it is and do not take adequate treatment on time, then after years the child can make a very terrible disease - bronchial asthma.
The prevalence of allergic rhinitis among adults and children
Statistics show that in developed countries, the prevalence of allergic rhinitis in the population reaches 10-60%, while 40% of those suffering from this disease begin to develop bronchial asthma. And there is no doubt that allergic rhinitis is a very common disease, which, for example, in the United States affects 18-38% of the total population. Among children in the United States of America, rhinitis of this form is registered in 40%, and boys are most often sick. The figure is colossal! For the CIS countries, these statistics do not differ much. Among all allergic diseases, the share of rhinitis accounts for 60-70%, and the proportion of childhood morbidity reaches 10-15%.
At the age of 3 years, allergic rhinitis is rarely diagnosed, but with the start of kindergarten attendance and schooling, the incidence rate begins to grow steadily. And by the age of 6 rhinitis of an allergic nature occupies a leading position among all allergic diseases, it accounts for 70%. Unfortunately, parents do not immediately begin to sound the alarm and seek the help of an allergist without realizing the problematic nature and severity of this disease.
. Only 5-6 years after the manifestation of the first symptoms of allergic rhinitis, children (usually it happens 10-12 years old) come to see a specialist for the first time when a lot of time has been missed and the disease has become chronic and faces serious complications. And the most common is the transformation of such chronic rhinitis in bronchial asthma and allergic conjunctivitis. Such disorders and complications can occur, such as spasm of the glottis, dysmenorrhea in adolescent girls, and even epileptic seizures.
The concept and types of allergic rhinitis
Doctors treat allergic rhinitis as a disease of the mucous membranes of the nose, which develops on the background of inflammation caused by allergens and manifested by symptoms of rhinorrhea, itching and nasal congestion, unmotivated sneezing. Allergic rhinitis often has a clear dependence on the season, acquiring a seasonal form, although there is such a form of the disease as perennial allergic rhinitis. In the modern classification of the disease, three forms (types) of "allergic rhinitis" are usually distinguished: acute episodic, seasonal allergic rhinitis and year-round (or persistent). Each form of rhinitis has its own characteristics.
Acute allergic rhinitis is manifested by individual episodes of the disease immediately after contact with airborne allergens. These can be cat's saliva proteins, urine of rats or waste products of ticks living in house dust.
Seasonal allergic rhinitis usually occurs acutely during the flowering of plants in spring or summer. During this period, sick children develop copious, watery nature of rhinorrhea, nasal congestion. Symptoms of conjunctivitis may occur, resulting in redness, itching of the eyes and lacrimation. The rest of the time throughout the year, the children do not make any complaints, they look absolutely healthy. The causes of seasonal rhinitis is the effect of plant allergens, pollen and fungal, on the children's body.
Year-round form of allergo-rhinitis has mild symptoms of the disease, which are then amplified, then subside, but almost never cease. According to medical concepts, the form of rhinitis is recognized year-round, if the symptoms of allergic rhinitis occur in patients at least twice a day or at least nine months a year. The cause is usually home-grown allergens — house dust, mites, cockroaches, pet dander, down pillows and feather allergens, etc.
Factors contributing to the development of allergic rhinitis
There is nothing surprising in the fact that any child reacts to a foreign substance that has allergic properties, a normal physiological reaction — sneezing to form some amount of watery secretion in the nasal cavity. But if some children react calmly to the external stimulus or do not notice it at all, then some of them start to develop a violent reaction to a cause invisible to others.
It is often possible to observe how in a group of children someone begins to sneeze vigorously and continuously, without being able to stop. And when such a baby again finds itself in a similar situation, he develops a similar reflex reaction to an imperceptible stimulus, manifested by a runny nose, sneezing, redness of the eyes. When such a reaction occurs repeatedly, the physiological response of the child’s body to external stimuli can develop into a pathological condition. And in this case, the usual cold can already be interpreted as allergic. This group of rhinitis includes hay and vasomotor rhinitis (vasomotor allergic rhinitis).
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Allergic diseases, including rhinitis, develop in a child not from scratch. This is facilitated by such indirect factors as:
- metabolic disorders, in particular, rickets,
- nervous and endocrine systems that have not reached physiological maturity, which explains the more frequent occurrence of allergic rhinitis in boys before puberty, and in girls after the first menstruation,
- diseases of the gastrointestinal tract, especially the liver,
- developmental anomalies, diseases, deformations of the nasal cavity: spikes of the septum, chronic irritation of the mucous membrane, polyps,
- increased blood clotting, low blood pressure, leukopenia, eosinophilia.
Allergic rhinitis will predispose the child who has identified:
- heredity, aggravated allergic history (54% of parents of children who suffer from allergic rhinitis, are allergic diseases), the presence of allergic rhinitis during pregnancy,
- prolonged contact with allergens,
- an increase in the permeability of the mucous membrane, the volume of cavernous tissue of the concha,
- frequent ARD (in 12% allergic rhinitis starts after suffering a cold),
- unreasonable antibiotic therapy for colds.
But, of course, the most important factor contributing to the development of allergic rhinitis in a child will be the burdened heredity. If there are allergic diseases in the family, especially among parents, then the probability of diagnosing "allergic rhinitis" in children will be very high.
Causes of development in children
The direct cause of allergic rhinitis in infants and infants is food allergens, which can be found in the usual types of food - cow's milk, semolina, chicken eggs, milk formulas, as well as in drugs and vaccines. At a later age, pre-school and school, come to the fore - inhaled allergens, i.e. those transmitted by airborne droplets.
Manifestations of allergic rhinitis may have their variations depending on the type of the disease. As noted above, there are two types of allergo-rhinitis: seasonal and year-round.
Seasonal allergic rhinitis is usually first diagnosed at the age of 4-6 years. It is characterized by the development of symptoms of the disease in a clear dependence on the season. Children begin to complain of nasal congestion, itching in the ears, eyes and nose, the appearance of profuse watery nasal discharge. You may experience tickling and foreign body sensations in the throat. An external examination of the child reveals redness of the eyes, eyelid inflammation, puffiness of the face, chapped lips and a swollen nose.
By the way, in younger children, the clinical picture of the disease can be hidden, children only constantly try to scratch their eyes and nose. At the end of the flowering season, the symptoms of rhinitis quickly subside until the next new season. At the same time, the intensity of clinical symptoms is directly dependent on the saturation of the air and the environment with allergens.
The year-round form of the disease is characterized by constant manifestations of rhinitis symptoms throughout the year. Children complain of nasal congestion, which is aggravated at night. They are tormented by the desire to sneeze, especially in the morning. These symptoms are worse in winter. Due to the endless flow of rhinitis, over time, children develop complications such as rhinosinusitis, otitis media, and eustachitis. Children may often be bothered by nosebleeds and bouts of dry cough. The child's sleep is disturbed, he quickly gets tired, complains of headaches, increased heartbeat and increased sweating.
Doctors secrete three stages during allergic rhinitis - mild, moderate and severe. If there are impaired health and sleep of the child, fatigue, then this indicates a moderate severity of the disease. If all clinical symptoms become pronounced, then we can talk about a severe degree of the disease.
How to suspect the development of allergic rhinitis in a child?
In fact, inexperienced young mothers can often take the manifestations of allergic rhinitis in their child for symptoms of colds - ARI and ARVI. In fact, the symptoms are very similar, but if parents are more attentive to their child, they should be alerted immediately:
- frequent and painful paroxysmal sneezing,
- copious, clear, watery discharge from the nose,
- itching in the nose and sometimes around the eyes and ears,
- appearance of nasal congestion at night,
- puffiness and puffiness of the face,
- eyelid redness, tearing.
It is especially important for parents to establish the dependence of the clinical manifestations of rhinitis on seasonality. If a clear correlation is observed between the appearance of rhinorrhea and the period of flowering of plants or, for example, contact with animals, and similar symptoms recur for more than one year, then the development of allergic rhinitis can be suspected. The complex of these symptoms can be the basis for diagnosis. But first of all, the child in such cases should be urgently shown to the attending pediatrician, who must conduct a thorough examination - an objective and laboratory test.
Methods of diagnosing "allergic rhinitis" in children
For the diagnosis of allergic rhinitis, you must have objective symptoms of the disease, described above, and features of the disease. When examining a child suffering from allergic rhinitis, it is possible to reveal an extended back of the nose, to pay attention to the constantly open mouth due to difficulty breathing, the appearance of a transverse fold above the tip of the nose, which is often hyperpigmented. A child may have "dark circles" under the eyes, which are called "allergic lanterns".
During rhinoscopy, the doctor detects a plentiful secretion of watery discharge, narrowing of the nasal passages due to pronounced swelling of the nasal mucosa, which becomes pale bluish color. The doctor assesses the allergic history of the family, and then prescribe a laboratory blood test. If positive test results are detected using standard allergens, high levels of common antibodies and, in particular, specific IgEs are recorded, and eosinophilia is noted in the serum and secretions of the nasal cavity, among other things, then it is very likely to diagnose allergic rhinitis.
Allergic rhinitis has a similar clinical picture with many diseases and malformations. Therefore, doctors have to differentiate it from:
- Wegener's granulomatosis,
- immunodeficiency states and diseases
- drug rhinitis,
- the presence of foreign bodies in the upper respiratory tract,
- nasopharyngeal tumors,
- primary dyskinesia of cilia,
- nasal polyps,
- malformations and abnormalities of the nasal cavity,
- chronic course of infectious rhinitis.
For the diagnosis of allergic rhinitis will need to:
- a clinical study of blood levels of eosinophils, plasma and mast cells, leukocytes, general and specific IgE antibodies,
- instrumental techniques - rhinoscopy, endoscopy, computed tomography, rhinomanometry, acoustic rhinometry,
- skin testing to identify cause-significant allergens, which helps to establish the exact nature of allergic rhinitis,
- cytological and histological studies of nasal secretions.
Treatment of allergic rhinitis in children
The treatment of allergic rhinitis in children has its own difficulties associated with the age group of young patients. Not every drug for the treatment of allergic rhinitis can be used in the general scheme of therapy. In addition, it is necessary to carefully select each medicinal product in order not to harm the growing body of the child. The therapeutic scheme can not be the same for each patient, it is selected only individually, and exclusively by the doctor. Self-medication can lead to serious tragic consequences, as parents should be aware of. How to treat allergic rhinitis can only know the doctor!
The whole complex of therapeutic measures should begin with monitoring the environment in which the child lives, in order to exclude or minimize the contact of the child with allergens. If this stage is not organized, then no drug therapy will provide adequate and effective treatment, which, in turn, is divided into pharmacotherapy and specific immunotherapy.
If during the diagnosis of the disease was established the source of allergies, then parents will be easier to engage in the prevention of allergic rhinitis. To do this, you will need to carry out regular wet cleaning of the room, save children from contact with animals, birds, an aquarium, flowering plants, which are the perpetrators of all exacerbations of the disease. It will be necessary to limit the contact of children with chemicals and drugs with pronounced sensitizing activity, for example, antibiotics, acetylsalicylic acid and other nonspecific anti-inflammatory drugs. Sometimes careful implementation of all the rules of this stage helps to reduce the recurrence of rhinitis by 80%.
Но чаще всего обойтись без медикаментозной терапии невозможно. Поэтому детям назначаются препараты, которые купируют проявления аллергических реакций и предупреждают развитие обострений. Medications may include medications for the treatment of allergic rhinitis:
- drugs with pronounced anticholinergic local action,
- vasoconstrictor drugs (vasoconstrictor drops for allergic rhinitis),
- mast cell stabilizers.
Antihistamine medicines are the drugs of choice in the treatment of allergic rhinitis. They well eliminate puffiness and itching in the nasal cavity, eliminate bouts of sneezing and rhinorrhea. Recently, the use of tavegil, suprastin, fenkarol, diazolin, peritol, antihistamines of the first generation, has been limited due to their pronounced sedative and anticholinergic effects on children. Therefore, now the main focus is on such drugs as claritin, zyrtec, which have a minimum of side effects for children, their high safety has been clinically confirmed. In addition, these drugs are highly effective in the treatment of allergic rhinitis and do not have a depressant effect on the central nervous system.
In some cases, topical antihistamines of local action can be prescribed - vibrocil, histimet, allergodil, which can also be produced in the form of nasal drops. It eliminates the symptoms of rhinorrhea, but can not stop nasal congestion. Therefore, they most often go in combination therapy with vasoconstrictor medications that regulate the tone of blood vessels and relieve swelling of the nasal mucosa.
However, vasoconstrictor drugs with prolonged use can cause the development of medical rhinitis. Particular caution in prescribing this group of drugs should be in the treatment of infants because of the possibility of side effects. For children over 12 years old, a rhinopront or a conjact can be a good drug of choice. This nose drops in the treatment of allergic rhinitis have both a vasoconstrictor effect and an antihistamine effect.
As a prophylaxis of rhinitis, cromones can be prescribed, which are represented by a number of drugs - cromolin, cromohexal, cromosol, lomuzol and nedocromil sodium. These drugs have anti-inflammatory effects, but have a very short period of action.
To combat abundant rhinorrhea, it is sometimes necessary to resort to the anticholinergic drug Ipratropium bromide, the dose of which is adjusted depending on the severity of the stage of the disease. The effect of it lasts from 30 minutes to 12 hours.
In the treatment of allergic rhinitis in children, potent glucocorticosteroid drugs can be used, but they have many side effects, and are therefore prescribed only in exceptional cases. When on the background of treatment of increased excitability, anxiety, sleep disturbances, tachycardia and tremor, hormonal preparations should be abandoned or the daily dosage should be significantly reduced.
But the effect of hormone therapy is superior to antihistamines and cromones combined. Moreover, modern topical preparations, while observing the exact dosage and not exceeding the duration of treatment for 14 days, usually do not cause side effects. The most common drug of choice for the treatment of allergic rhinitis in this group is nasonex, which can be used from 2 years of age of the child. This drug has a pronounced anti-inflammatory and anti-allergic effect, has virtually no side effects, because applied as a local nasal spray. Signs of overdose can hardly be expected when using nasonex. It should be noted that glucocorticosteroid drugs of systemic action in the treatment of allergic rhinitis in children are not used.
A very important area of treatment of allergic rhinitis is a specific immunotherapy, which is used in case of revealed hypersensitivity to pollen allergens or house dust.
Treatment of allergic rhinitis folk remedies
Sometimes parents begin to think about how to cure allergic rhinitis with the help of folk remedies, abandoning medication. This is fundamentally the wrong way, because the use of various herbal infusions, which may be effective in treating adults, may do more harm than good to the child. If parents are set to treat rhinitis with folk remedies, they must first consult with an allergist before beginning experiments on a child. In fact, the only method of popular treatment of allergic rhinitis in children can be called nasal washing with a weak saline solution, but this harmless procedure will be ineffective without the use of a modern medical treatment regimen.
Under the article you can read reviews about the treatment of allergic rhinitis in children, also leave your comment and opinion. It is possible to share your experience.
Even with a hereditary history of anamnesis, the child does not have to suffer from allergic diseases, including allergic rhinitis. To do this, even during pregnancy, the expectant mother needs to follow a diet in which high-allergenic foods will be excluded. It is necessary to abandon all contact with harmful factors of production, life, not to use drugs without the appointment of doctors. It is very important to prevent active and passive smoking. After childbirth, in the absence of contraindications, it is desirable to breastfeed the baby for up to 4-6 months, and the feeding up should be started no earlier than 4 months by age.
Proper child care, a balanced healthy diet and a lack of contact with allergens will help fight the development of any allergic reactions. If, nevertheless, the child is diagnosed with allergic rhinitis, then in order to prevent relapse, preventive treatment with intranasal glucocorticoids should be carried out about a month before the expected seasonal exacerbation of the disease. But this type of prophylaxis is possible only from the 12-year-old child.
If the time to identify and do the correct and optimal treatment of allergic rhinitis in a child, the disease will eventually recede forever. Then it will be possible to avoid the terrible complications, which can be a huge problem for the rest of your life. To avoid this, be more attentive to your children. It is better to be reinsured once again to visit the doctor, than to miss the beginning of a serious illness.
The article above and comments written by readers are for informational purposes only and do not call for self-treatment. Talk to a specialist about your own symptoms and illnesses. When treating with any medicinal product, you should always use the instructions in the package along with it, as well as the advice of your doctor, as the main guideline.
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Children's allergic rhinitis
Allergic rhinitis is a disease of the nasal mucosa that develops due to inflammation, which occurs under the influence of an allergen.
This is the way in which some people react to allergens.
Allergic rhinitis in children has a hereditary tendency. When one or two parents experience allergic rhinitis, there is a significant chance that their children will have this ailment.
Allergic rhinitis in a child, like other allergic reactions, is not contagious. However, the symptoms of allergic rhinitis can be confused with the symptoms of an infectious respiratory disease that spreads from person to person.
Allergens involved in the development of allergic rhinitis come from external or internal sources. Outdoor "street" allergens - pollen or mold spores, as a rule, are the culprits of seasonal allergic rhinitis. Domestic allergens, such as animal dander or dust mites, are common causes of perennial (year-round) allergic rhinitis.
An allergic reaction occurs when the body overreacts to an element that it regards as a foreign "interventionist." The immune system functions without interruption to protect the body from supposedly dangerous enemies, such as toxins, viruses, bacteria.
For reasons not always clear, some children are hypersensitive to elements that are generally harmless. When the immune system falsely recognizes these elements (allergens) as a danger, an allergic and inflammatory response occurs.
Antibodies - immunoglobulin E (IgE) is a major participant in allergic reactions. When the allergen enters the body, the protective system produces IgE antibodies. These antibodies then attach themselves to mast cells that "live" in the eyes, nose, lungs, and mucous membrane of the gastrointestinal tract.
Fat cells release histamine, which causes atopic symptoms (sneezing, wheezing, coughing). These cells continue to work and produce more histamine, which activates the production of more IgE.
All types of allergies, including allergic rhinitis, are caused by three types of allergens - inhalation and microbial allergens, food products.
Often, children develop allergic rhinitis due to the effects of inhaled allergens, which are divided into home, plant, animal and fungal. Allergic rhinitis is rarely due to dietary and microbial allergens.
- Home allergens are house dust, which includes many small particles of synthetic and cotton fabrics, dyes, plastics, laundry detergent, feathers and down pillows, as well as dust mites.
- Animal allergens are fragments of hair, lint, dandruff, and poultry and animal feces.
- Fungal spores are microscopic fungi that are found in large quantities in the house dust of unventilated, damp and dark rooms. Textile, pharmaceutical, leather and food industries are popular sources of fungal allergens. Also, certain types of fungi can affect the plants consumed in food and their fruits. Accordingly, in contact with the infected fungus vegetables and fruits, the child is in contact with allergens of fungal origin.
- Allergens of plant origin are found in grass, flowers, trees and algae, fruits and vegetables. Allergic rhinitis is a reaction of the child to both the pollen of the plant and the plants themselves. Certain plants, such as clover, ivy, provoke an allergic reaction when it comes into contact with skin or mucous membranes. Many plants that can provoke an allergic reaction are used in cosmetics, perfumery and pharmaceutical products. Therefore, the smell of cosmetics and drugs can cause allergic rhinitis in a child, even without direct contact.
- Microbial allergens are included in the structure of microbial cells and their metabolic products. Allergic rhinitis in response to microbial allergens can occur in a child with an ear and respiratory bacterial infection.
Additional causes of allergic rhinitis in children include: environmental pollution, vitamin deficiency, dry and hot air, and adverse living conditions.
Allergic rhinitis often depends on the season of the year, perennial allergic rhinitis is a bit less common.
This is usually 3 types of disorders: episodic acute, seasonal and year-round rhinitis. Each form has its own characteristic features.
Acute allergic rhinitis in children develops immediately after contact with the allergen, which hovers in the air in the form of the smallest structures. This may be cat's saliva or waste products of house dust mites.
Seasonal allergic rhinitis develops only during strong aerial pollination of plants.
Allergens of seasonal rhinitis.
- Ragweed. It is a frequent culprit in allergic rhinitis, affecting about 75% of those suffering from allergies. One plant releases 1 million pollen grains per day. The effects of ambrosia are felt in the middle - end of August and last until the first frost. Ambrosia allergy is usually the most severe in the morning.
- Herbs. Influencing children from mid-May to the end of June. Herbal allergies in the air are more prevalent at the end of the day.
- Wood pollen. Small pollen grains from certain trees usually cause symptoms in the middle of spring.
- Mold spores. Mold that grows on dead leaves and spores into the atmosphere is a common allergen throughout all seasons except winter. Mold spores have a quantitative peak on windy, dry or wet and rainy days - early in the morning.
Manifestations of year-round allergic rhinitis are less pronounced, they grow and weaken, but do not disappear. Rhinitis is year-round if symptoms are present for at least 9 months per year. The main causes are allergens of local origin - mites, cockroaches, dust, animal hair, down pillows.
The direct causes of allergic rhinitis in infants and young children are food allergens that are contained in food: cow's milk, chicken eggs, semolina, milk formula, as well as vaccines and medications. In preschoolers and schoolchildren, allergens transmitted by air have a predominant effect on the body.
Symptoms of allergic rhinitis in children
Manifestations of nasal allergies can develop within a few minutes or hours after inhalation of the allergen. Symptoms may last for several days.
- Continuous sneezing, especially after the morning awakening.
- Runny nose
- Cough or tickling in the throat caused by post-nasal runoff of mucus.
- Tearing, itchy eyes.
- Itching nose, throat, ears.
Other manifestations that may occur after some time.
- Nasal congestion, possibly snoring.
- Breath by mouth, as the nose is blocked.
- Rubbing the nose. Children are especially prone to do this.
- Eyes become sensitive to light.
- A feeling of tiredness or gloominess develops.
- Worried about a bad dream.
- Long (chronic) cough.
- Feeling of pressure in the ears or hearing loss.
- Dark spots or circles appear under the eyes.
Symptoms may worsen or weaken at different times of the year.
- when a child is allergic to dust mites, mold or dander of animals, the manifestations are stronger in the winter, since the child is in the room longer,
- When a child is allergic to pollen, the symptoms vary according to the plants in your area and when they bloom.
As they mature, allergens may have less effect on the child.
Decreased quality of life
Allergic rhinitis is considered a mild illness, but it affects many key aspects of life. With nasal allergies, the child often feels tired and irritable. Allergic rhinitis sometimes causes a decline in school performance.
Children with nasal allergies, especially year-round ones, may suffer from sleep disturbances and daytime fatigue. Often, these manifestations are attributed to allergy medications, but the common cause of these manifestations is a banal nasal congestion. Children with severe allergic rhinitis have more sleep problems, including snoring, than those with mild allergic rhinitis.
Greater risk of asthma and other allergies
Asthma and allergies often coexist. Children with nasal allergies often suffer from asthma, or they have an increased risk of it. Allergic rhinitis is also associated with eczema, an allergic skin reaction characterized by itching, thickening of the skin and its dryness. Chronic uncontrolled allergic rhinitis can worsen asthma attacks and eczema.
Chronic swelling in the nasal passages (turbinate hypertrophy)
Any chronic rhinitis, whether allergic or non-allergic, can cause nasal congestion to swell, which can become persistent. The conchs are tiny protruding bone structures that protrude into the nasal passages. They help to warm, clean and moisten the air that passes over them.
If shells hypertrophy develops, it causes permanent congestion, and sometimes leads to pressure and pain in the center of the face and forehead. This condition may require the intervention of surgeons.
Non-allergic rhinitis describes a group of nasal diseases that have no signs of allergic etiology. By the genesis of its occurrence can be divided into non-anatomical and anatomical.
The most common form of non-allergic rhinitis in children is infectious rhinitis, which is acute or chronic.
- Острый инфекционный ринит (простуда) вызван вирусами и обычно проходит в течение 7-10 дней. В среднем ребенок имеет от трех до шести простудных заболеваний в год, причем наиболее уязвимыми являются дети младшего возраста и дети, посещающие какое-либо образовательное учреждение. Infection is manifested by sore throat, fever and poor appetite.
- Chronic infectious rhinitis should be suspected if there is a mucopurulent nasal discharge with symptoms that persist for more than 10 days. Combination with middle ear disease, such as otitis media or dysfunction of the Eustachian tube, may be an additional manifestation of infection.
Non-allergic, non-infectious rhinitis (vasomotor rhinitis) can manifest as a runny nose and sneezing in children with copious, clear nasal discharge. Exposure to irritants such as cigarette smoke and dust, as well as strong vapors and odors (perfumes and chlorine in pools) can cause these symptoms. Cold air (“skier's nose”), hot / spicy food intake (gustatory rhinitis) and exposure to bright light (reflex rhinitis) are examples of vasomotor rhinitis.
Medical rhinitis, which is primarily due to excessive use of local nasal vasoconstrictor drugs (oxymetazoline, phenylephrine) is not a common disease in young children. Adolescents get used to these drugs.
The most common anatomical problem in young children is a violation of nasal breathing, which develops as a result of adenoiditis.
Adenoiditis may be suspected with symptoms such as mouth breathing, snoring, hyponasal (nasal) speech, and persistent rhinitis with or without chronic otitis media. Infection of the nasopharynx is thus secondary to infection of the inflamed adenoid tissue.
Choanal atresia is the most common congenital anomaly of the nose and implies a bone or membranous septum between the nose and pharynx. The airway obstruction is relieved when the infant opens its mouth to weep, and worsens when the calmed infant again tries to breathe through the nose. Some newborns have difficulty breathing during feeding. Nearly half of the crumbs with Choan atresia have other congenital abnormalities (congenital heart disease, developmental delay, disorders of the genitourinary system, ear abnormalities).
Nasal polyps are rare in children under 10 years of age, but if they are present, they require assessment and search for the main disease process, such as cystic fibrosis or primary ciliary dyskinesia (impaired functioning of the respiratory tract mucosa).
Foreign bodies in the nose are more common in young children who put food, small toys, stones, or other things into their nose. It is determined by the presence of unilateral, purulent nasal discharge or unpleasant smell. Foreign body can often be seen during examination with the help of a nasal mirror.
As a rule, allergies are initially diagnosed using a combination of characteristic symptoms in combination with examination results.
If a child has typical manifestations of allergic rhinitis, consultation with an allergy specialist will help identify allergens.
Many allergens can be identified already in the course of a conversation when receiving information about the history of the disease. For example, if symptoms usually worsen on contact with cats, then cat dander is a likely allergen causing the symptoms. If mowing the grass is associated with the onset of symptoms, then herbal allergy is likely.
A patient response history is important to determine his unique allergy. Allergy testing is carried out only when the allergy creates an excessive load on the child and significantly worsens the condition.
Because the identification of allergens is important and difficult to determine, skin tests are often required to accurately identify the specific substance causing the allergy.
Testing is carried out with minimal discomfort and is performed as follows.
- A small amount of suspicious allergenic substance is placed on the skin.
- Then the skin is gently scratched through a small drop with a special sterile needle. This method is usually used for initial evaluation. The second method, known as the intradermal method, involves injecting a small amount of the test substance into the skin. This intradermal testing is more sensitive, but usually gives more false-positive results.
- If the skin turns red and, more importantly, swells, then the individual is considered “sensitized” to a specific allergen. If typical symptoms occur when a sensitized person is exposed to a suspected substance, then an allergy to this substance is likely.
The described skin testing is not allowed in children under 5 years of age.
A number of blood tests are also available to diagnose allergies. These blood tests will be helpful if children cannot be subjected to skin testing. In studies, various methods of searching for IgE antibodies in the blood are commonly used. If the allergy test is consistent with the list of symptoms, then a diagnosis of allergic rhinitis is likely.
Nasal swab is also informative in the diagnosis. Nasal secretions are examined microscopically to identify factors that indicate the cause of the common cold. For example, an increase in the number of leukocytes, detection of infection, or a high number of eosinophils. A high degree of eosinophils indicates an allergic condition, but low rates do not exclude nasal allergies.
In children with chronic rhinitis, the doctor will check for sinusitis.
Scanning with a CT scanner will be helpful if you are considering a diagnosis of sinusitis or sinus polyps.
In some cases of chronic or irregular seasonal rhinitis, the doctor may use endoscopy to examine any irregularities in the structure of the nose.
How to treat allergic rhinitis in a child?
Treatment of allergic rhinitis in children involves many options:
- preventing allergens,
- local nasal treatment
- systemic therapy - antihistamines, oral steroids,
Avoiding the identified allergens is a determining factor in combating allergy symptoms. Attempts to control the environment and prevention measures often help in alleviating the symptoms. However, the prevention of allergies is often difficult. You need to have a thorough discussion with your doctor. Control measures may be required daily.
Topical Nasal Steroids
Effective, especially with symptoms of nasal congestion. And they have a clear advantage over antihistamines in treating this symptom. Parents should understand that this drug should be given to the child regularly so that it is effective. If the symptoms are intermittent, it is worthwhile to begin treatment more than 2 weeks before the start of the operating season to get the most benefit.
The Drug Safety Committee reported that the growth of children in need of long-term treatment with nasal corticosteroids should be regularly monitored, and if there is evidence of stunting, contact your pediatrician. It should be noted that steroids at moderate doses inhibit growth, but it remains unclear whether this affects the final height of an adult.
Reduce sneezing and runny nose in a significant proportion of patients. Some parents do not want to give their children steroids in any form, either because of their potential side effects, or because of problems with absorption and long-term effects that may occur.
Local antihistamines in these cases have the advantage of being taken as needed. However, they do not help with nasal congestion.
Other topical medications
Kromoglikat sodium relieves allergic symptoms - itching, sneezing and runny nose. But there are problems with compliance with the constant use due to the tight schedule of dosing (4 times a day). They are generally well tolerated, although rarely used in practice, since other means are more efficient and convenient.
Vasoconstrictor agents act by narrowing the blood vessels of the nasal mucosa. This temporarily helps with nasal congestion, although they do not reduce sneezing and itching. Local vasoconstrictor agents should be used only for short periods, preferably not more than a week, to prevent rebounding, when swelling and nasal congestion increase with drug withdrawal.
Systemic antihistamine therapy
Antihistamines are particularly useful for controlling some symptoms, such as sneezing, runny nose, and itchy eyes. These drugs do not stop the formation of histamine and do not neutralize the conflict between IgE and antigen. Antihistamines do not stop the allergic reaction, but protect the tissues from the effects of the reaction.
Drugs can be taken when necessary, and they do not need to be taken continuously, but it will take 1-2 hours before they give their maximum effect. Cetirizine, Desloratidine and Loratidine are approved for children from 2 years old, Levocetirizine - from 6 years old, while other second-generation antihistamines are contraindicated in children under 12 years old.
If antihistamines and nasal sprays are ineffective or the child does not tolerate them well, other types of therapy are available. Allergy desensitization, or immunotherapy may be required.
Allergic immunotherapy stimulates the immune system with gradually increasing doses of substances to which the child is allergic. Since the patient is exposed to an allergic substance, an allergic reaction may occur, and this treatment should be monitored by a doctor.
This form of treatment is very effective in allergies to pollen, ticks, cats, and especially insects (for example, bees). Effective allergy immunotherapy usually requires a series of injections and takes from three months to one year. The required duration of treatment may vary, but the typical course is from three to five years. Frequent visits to the doctor’s office are necessary. Immunotherapy is not administered to children under 5 years old.
Seasonal nasal allergy treatment
Since seasonal allergies usually last several weeks, experts do not recommend more serious prescription drugs for children. But in children with asthma and allergies, rhinitis treatment can also improve asthma symptoms.
- Prescription drugs are required only in severe cases. Patients with severe seasonal allergies should start taking medications several weeks before the start of the pollutant season and continue to take them until the end of the season.
- Immunotherapy is an option for patients with severe seasonal allergies who do not respond to treatment.
- Nasal flushing. With moderate allergic rhinitis, washing will help to remove mucus from the nose. You can buy a salt solution in a pharmacy or prepare it yourself (2 tbsp. Warm water, 1 tsp. Salt, a pinch of baking soda).
- Vasoconstrictor remedies for children from 2 years of age relieve nasal congestion and itchy eyes.
- Use of antihistamines. Second-generation non-sedative antihistamines - cetirizine, loratadine, fexofenadine, or desloratadine. These drugs cause less drowsiness than first-generation drugs, such as Diphenhydramine.
Treatment of moderate to severe nasal allergy
Patients with chronic nasal allergies or those who have annoying symptoms that are active for most of the year may need daily medication.
These drugs include:
- anti-inflammatory drugs. Nasal corticosteroids are recommended for children with moderate and high severity of allergies, isolated or with second generation antihistamines,
- non-sedative antihistamines,
Allergic rhinitis is a chronic disease. Accordingly, it persists for a long time. In some children, the symptoms decrease with age. Other symptoms persist for life. Allergic rhinitis is not associated with severe complications and can be effectively controlled with medication and sometimes desensitizing therapy.
Since allergic rhinitis is associated with genetic susceptibility, the prevention of this condition is impossible. However, attacks can be prevented by avoiding contact with the allergy-causing substance.
Types of allergic rhinitis
The course and occurrence of exacerbations distinguish such forms of allergic rhinitis:
- seasonal allergic rhinitis: it is characterized by a certain frequency of exacerbations in the same season or month each year, which is associated with the flowering period of plants,
- year-round allergic rhinitis, for which the seasonality of exacerbations is not characteristic, the symptoms of rhinitis are observed throughout the year almost constantly.
Allergens with pollinosis (seasonal allergic rhinitis) can be:
- tree pollen (maple, birch, oak, elm, alder),
- grass pollen (rye, fescue, foxtail, bluegrass, timothy, ryegrass, etc.),
- weeds (ambrosia, wormwood, quinoa) - the plants themselves or their pollen,
- mold fungi affecting plants.
Allergens that cause year-round allergic rhinitis are:
- household allergens,
- excretions of rodents, cockroaches,
- mold fungi,
- food allergens (fish, cow's milk, eggs, honey, etc.)
The most characteristic manifestation of year-round rhinitis is nasal congestion. Compounded by discomfort atmospheric pressure drops, low air temperature, smoke, inhaled air (passive smoking), infections.
The main symptoms of seasonal rhinitis are:
- copious rhinorrhea (discharge of liquid mucus),
- severe itching in the nose,
- repeated sneezing
- skin irritation of the nasal passages (due to friction with a handkerchief or fingers),
- burning eyes,
- itching and swelling of the eyelids,
In some cases, there is no heavy discharge from the nose, and there is a marked violation of breathing through the nose due to severe swelling of the mucous. The process can extend to the Eustachian tube (connecting the nasal cavity with the middle ear), which is manifested by a feeling of congestion and tinnitus, a decrease in hearing acuity.
The reference data for the diagnosis of allergic rhinitis are:
- characteristic symptoms of rhinitis,
- the presence of allergies in close relatives,
- no signs of bacterial or viral infection during the inspection,
- the presence of other manifestations of allergies,
- an increased number of eosinophils (cells indicating an allergic reaction) in the analysis of mucous secretions from the nose and in the blood,
- elevated levels of immunoglobulin IgE in the blood and accelerated ESR.
An allergist may prescribe special tests to determine the specific allergen. The doctor has to differentiate allergic rhinitis from other types of rhinitis (vasomotor, viral and bacterial, medication, hormonal).
Important to get rid of allergic rhinitis is the elimination or at least a sharp reduction in contact with the allergen. With seasonal rhinitis, it is recommended to travel with a child during a dangerous period to another area where there is no allergen plant. For walks and games of children, you need to choose places with no grass, bushes and flowers.
Necessary preventive measures are:
- regular cleaning of premises to reduce the concentration of inhaled allergens,
- getting rid of mold, rodents, cockroaches,
- removal of animals, aquariums, birds from the apartment,
- getting rid of carpets, feather bedding,
- the inadmissibility of smoking in the apartment or in the presence of a child on the street,
- withdrawal from the diet of highly allergic products.
Drug treatment is aimed at eliminating the manifestations of inflammation and preventing relapse. Used drugs of general and local action.
Pharmacotherapy includes the following components:
The need for their appointment is associated with the mechanism of development of an allergic reaction. In the presence of hypersensitivity to the allergen and the occurrence of contact with it, the immune cells produce strong biologically active substances.
One of these substances is histamine, which causes the onset of allergy symptoms by acting on certain receptors. Antihistamines block these receptors and do not allow the action of histamine.
There are and are used more than 50 drugs of three generations of this group. Drugs of the first generation are now used less frequently, when the side effect of these remedies is necessary - sedative and hypnotic effect. More often, children are prescribed highly effective second- and third-generation drugs with rarely occurring side effects.
Children of antihistamines are used:
Ketotifen's membrane stabilizing effect helps to protect mucous cells from destruction. Older children are prescribed:
Also used topical preparations in the form of sprays or nasal drops:
Sodium cromoglycate, administered 2 weeks before the onset of seasonal exacerbation, helps prevent the development of rhinitis,
Drugs can be used in the form of nasal drops for therapeutic purposes with moderate and mild allergic rhinitis. The effect will come in a few days, but the course should be continued (sometimes up to 3 months).
Если ринит сочетается с проявлениями конъюнктивита, то используются глазные капли:
- Кортикостероидные (гормональные) препараты.
In the absence of the effect of the treatment, with moderate and severe rhinitis use drugs adrenal cortex (nasal steroids), providing a pronounced anti-inflammatory effect, quickly restoring nasal breathing. These include:
- Fliksonaze (Fluticasone),
- Dexarine Spray
- Aldecine (Beclomethasone).
The drugs are available in the form of a nasal spray. They are used for 1-2 p. a day about a month.
Nose drops or nasal sprays of these drugs:
Restore nasal breathing, that is, they do not affect the cause of the disease and are only symptomatic treatment. Their term of application is limited to 5-7 days due to side effects on the mucous membrane.
The therapeutic method of reducing the body's sensitivity to allergens by administering according to a special scheme under the supervision of an allergist, micro allergies. Such treatment is possible only in the case of accurate determination of the allergen. This method is used for several months.
Persistent remission in some children is achieved after administering an antiallergic immunoglobulin or histaglobulin. But their use can also cause an increase in the manifestations of the disease, a temperature reaction due to individual intolerance.
A good result can be achieved with the help of homeopathic medicines:
- Natrium Muriatikum,
- Arsenium Jodatum,
There are several foreign drugs:
However, an individual selection of the means should be done by a children's homeopath.
In case of allergy exacerbation, it is necessary to prescribe sorbents in the complex of medicinal preparations in order to free the body from allergens. For internal reception are used:
For children with an increased tendency to allergies, the so-called hypoallergenic regimen should be observed:
- limiting contact with animals, birds, fish,
- adhere to the recommendations of the allergist on the nutrition of the child,
- use besprievye bedding for the child,
- use medicines strictly prescribed by a pediatrician or allergist,
- avoid use for the child of cosmetic and hygiene products that have a strong smell,
- engage in hardening of the baby, which stimulates the function of the adrenal glands and reduces the likelihood of developing exacerbations of rhinitis.
Resume for parents
It is not always easy to protect a child from an allergic reaction, one of the options for which is allergic rhinitis. However, if he has developed in a baby, you should immediately consult an allergist, follow all (!) Of his recommendations to avoid relapses, even if the treatment course takes several months.
Pediatrician E. O. Komarovsky tells about allergic rhinitis: