South Africa is emerging from an unprecedented winter where the COVID-19 epidemic has kept children away from school and most of their usual activities. It is safe to say that the majority of children haven’t even had the usual winter cold or flu.
Now that spring is here with blossoms, green grass and pollen, children may experience a spike in sneezes, itchy eyes and coughs. This is most likely due to allergy. Many children experience an increase in these symptoms during spring. Allergic rhinitis is the proper term for this kind of allergic reaction but people often know it as hay fever. An amusing little fact is that hay fever is not caused by hay and doesn’t produce a fever.
Allergic rhinitis (AR) is a reaction to airborne allergens (especially pollen) and results in fluid production in the eyes, sinuses and fragile lining of the nose. It often causes inflammation and itching as well. These symptoms occur because the immune system sees the allergen as a danger.
It releases antibodies to attack the allergen and this leads to a release of histamines. The runny nose, itching eyes, scratchy throat and sneezing are all thanks to the histamines.
Research has shown that while allergic rhinitis (AR) is generally not considered to be life-threatening, it is one of the most common reasons for visits to the paediatrician.
Why are these children taken to the paediatrician?
AR is commonly mistaken for an upper respiratory tract infection. The children have symptoms of:
- Blocked or runny nose
- Itching of the eyes, nose and palate
- Postnasal drip
- Fatigue (tiredness)
Children with year-round AR may also suffer from:
- Nose bleeds
- Mouth breathing
- Sleep disorders and inadequate rest
- Recurrent ear infections
- Poor performance at school
- “Allergic salute” – a child with AR often rubs their hand across the bridge of the nose while sniffing and may end up with a line across the bridge of the nose.
Of course not all children will experience all of these symptoms but one can understand that a combination of such symptoms is very likely to leave your child feeling miserable. This especially because the symptoms may persist for anything from four days in a week to four weeks. The condition affects 40% of children worldwide and is getting worse. Climate change and pollution may also be contributing to the epidemic.
Causes of allergic rhinitis
Pollen is the number one cause of allergy during spring. Trees, flowers, grasses and weeds spray pollen into the air. The pollen can travel for miles, so the allergic reaction can be as a result of plants kilometres away. Other causes of allergic rhinitis are:
- Mould (often found in more damp climates)
- Dust mites (these occur naturally in the home and in particular on mattresses)
- Cockroach droppings
- Cigarette smoke
What can parents do to reduce these symptoms?
Pollen is literally all around us so avoiding it is not always easy especially when a child wants to be outside. Small changes that one can make to reduce the amount of pollen your child is exposed to could include:
- Checking the weather forecast for the pollen counts. These are usually highest in the early morning so keeping the child indoors when counts are high is advisable.
- Vacuuming the carpets at least twice a week would help to collect pollen which may have blown in or travelled on clothing.
- Wipe down surfaces like bookshelves and counters regularly during spring.
- Give your child a bath or shower and wash his or her hair after he or she has played outside. Pollen can stick to the hair and cause a reaction.
If one looks at the other causes of allergic rhinitis we can see that controlling the environment may help children with this condition:
- Adults should never smoke around children or inside the home.
- Pets should remain outside or stay in areas where their hair won’t collect.
- Pest control will ensure your home is cockroach free.
- In areas where the pollen count is very high, an air conditioner may help.
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What can your doctor do to help a child with AR?
If your child does suffer from AR quite severely it is probably a good idea to perform skin prick tests or in certain circumstances, blood tests to determine what allergens are causing the symptoms. From these tests one is able to specifically identify airborne allergens such as pollen or mould.
Treatment of AR
The most likely treatment will include medications to reduce the symptoms associated with AR. These choices may include:
- Antihistamines (non-drowsy)
- Antihistamines ( non-drowsy )
- Nose spray (often with a mild corticosteroid to help the inflammation)
- Decongestant nose spray
- Asthma treatments
- SLIT therapy (sublingual immunotherapy) which involves desensitizing the child by administration of the specific allergen under the tongue.
Are there any natural treatments for allergic rhinitis?
- Nasal sprays. There are a number of saline sprays on the market which do help alleviate congestion. You can also make your own nasal spray using a combination of 1 cup cooled boiled water, ¼ teaspoon of salt and a ¼ teaspoon of baking soda. Mix this in a squeeze bottle or neti pot. The saline helps to flush the sinuses. Once the nozzle is in the nostril remember to point the spray towards the ear on the same side rather than at the nasal bridge. This way the saline will get into the sinus rather than hitting the bone and running straight out.
- There are some studies in which Butterbur and Quercetin have been found to reduce nasal symptoms BUT these products can also cause severe side effects. These side effects include liver damage and mental health issues especially if the treatment is not used in the correct dosage or if treatment continues over a period longer than a few weeks. Children who are allergic to certain plants may react to these two products as well. As a paediatrician, I would not advise the use of these products in children.
Allergic rhinitis affects so many children. In severe cases it may have long term effects on school performance and has been linked to anxiety and depression in children.
Mild cases of AR can comfortably be treated with simple nasal decongestants and antihistamines. Parents would need to monitor the intensity and duration of the symptoms in order to decide whether more intervention is necessary.
There are certainly things which can be done to make spring a happier time for those who react to airborne allergens. What we want is to see our children running around barefoot on the grass and enjoying the sunshine rather than huddled up on the couch feeling like they have been hit by the worst kind of head cold.
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