Allergic Rhinitis (Children)

Allergy refers to an abnormal sensitivity to a substance that normally does not cause problems to most of us. This hypersensitivity usually manifests itself in various illnesses like allergic asthma, allergic rhinitis (hay fever) and atopic eczema.

In Singapore, about one in two children suffer from Allergic Rhinitis. It is more common all year round as compared to seasonal rhinitis.

What are allergens?
Allergens are the substances that cause allergic reactions. There are many known allergens and different people can be sensitive to different sets of allergens. These allergens can enter the body by inhaling, eating or through direct contact to the skin. Common examples of allergens include house dust mites, cockroaches, mold and animal dander.

What is Allergic Rhinitis?


Allergic Rhinitis occurs when an allergen is inhaled.

Symptoms include

• Blocked nose
• Running nose
• Bouts of sneezing
• Itching in the nose/throat
• Mouth breathing
• Throat clearing cough
• Disturbed sleep

Skin prick test
This test is the most common and cost-effective method of determining a person’s sensitivity to the various allergens. It can also help to determine a person’s degree of sensitivity to the allergens.

Why does my child have Allergic Rhinitis?
Most allergic diseases are due to a combination of genetic and environmental factors. This means that there is usually a family member with asthma, allergic rhinitis or eczema. However, this alone does not account for the increase in allergic diseases that is happening all over the world. Factors in the environment play a part.

What are House Dust Mites?
House dust mites are microscopic creatures that are found commonly in mattresses, pillows, bed sheets, clothing, soft toys, fabric sofas and carpets. They live in all our homes and feed mainly on the scales of skin that we shed. Allergic individuals who may suffer from asthma, allergic rhinitis or eczema are commonly sensitised (allergic) to these house dust mites.

The common house dust mites in Singapore are Dermatophagoides species and Blomia Tropicalis. The droppings of these dust mites are the most common trigger of allergy and asthma.

However, there is no relationship between the triggers of allergy and asthma to how clean the house is. As people spend most of their time in the bedroom, it is important to reduce the levels of dust mites there.

How do I avoid the triggers?


Some simple but very effective measures

1. Wash bed sheets and pillowcases in hot water (>60°C) once a week.
2. Avoid having soft furry toys on the bed.
3. No thick heavy curtains in the bedroom and wash them regularly in hot water (>60°C).
4. Clothes and books should be stored in a closed cupboard.
5. Damp dusting should be used to clean surfaces – avoid feather dusters!
6. Vacuum (HEPA filter) or mop floors regularly.
7. Air-conditioners, if used, should be cleaned regularly.
8. No carpets / pets in the room.
9. No smoking to avoid dangers of tobacco smoke that lingers in the home.

Consider: Cover your mattresses and pillows with special non-allergic covers.

What medicines are used in Allergic Rhinitis?

• Topical (nasal spray) steroids are often prescribed. These are generally safe and should be used as prescribed over a period of time and not as needed.
• Antihistamines are safe and effective, even in very young children. They occasionally need to be taken over a sustained period of time to be effective. Some antihistamines may cause your child to be sleepy. Please consult your doctor for the suitable antihistamine.
• For some children, if antihistamine is unable to control the symptoms, leukotriene inhibitors like Montelukast might be effective.
• If medical therapy fails, Specific Sublingual Immunotherapy (SLIT) may be recommended for your child. This therapy involves placing an allergen extract under the tongue. The minimum duration of treatment is three to five years. However, the benefit is that the effect may be long lasting after the end of treatment.

Will Allergic Rhinitis develop into asthma?
Both conditions can also co-exist and both conditions need to be treated for the child to remain well controlled.

Instructions for use of a nasal spray

1. Keep spray next to your toothbrush and use before brushing teeth.
2. Shake bottle well.
3. Look down as if reading a book.
4. Use your right hand for LEFT nostril. Place spray nozzle just inside the nose aiming in a slightly outward direction, away from the mid line to avoid contact with the septum.
5. Squirt once. Do not sniff hard.
   
6. Change hands and repeat for the other side.
7. You may start cleaning your teeth to allow removal of any spray from the throat.