Allergic Rhinitis

Allergic rhinitis is the most common form of childhood allergy.

Allergic rhinitis can be 1 of 2 types:

• Seasonal (confined to specific seasons)
• Perennial (year round)

Normally the immune system is the body's defense system and acts to protect you. But, in the case of seasonal and perennial allergic rhinitis, your child's body reacts against certain substances (allergens), causing symptoms.

About 50 million people in the US have some type of allergy. 

Patients can be seen by Texas Children's experts in Allergy and Immunology and Ear Nose and Throat (Otolaryngology).

Causes & Risk Factors

Children who have seasonal allergic rhinitis may be allergic to pollen, usually from  plants that do not have showy flowers, such as trees, weeds and grasses. 

Pollen is one of the most common substances that cause allergic reactions.

Many people call this allergy hay fever though the medical term is allergic rhinitis. 

Children who have perennial allergic rhinitis are often allergic to some or all of the following:

• Dust mites
• Mold
• Animals (pet dander)
• Cockroach dust

Genes and the environment play a role, making some children more likely to develop allergic rhinitis, especially if close family members suffer from allergies.

Secondhand smoke and general pollution can cause irritation and make symptoms of allergies worse.

Symptoms & Types

Allergic rhinitis can cause a variety of symptoms, from mild to severe :

• Runny nose 
• Stuffy nose 
• Sneezing
• Itchy, red, watery eyes
• Shiners (dark shadows) under the eyes
• Chronic coughing
• Rashes
• Itchy irritated sore throat
• Swelling in the mouth and airway making it difficult to breathe
• Asthma with wheezing and cough

A severe allergic reaction may cause life-threatening symptoms for your child. A severe allergic reaction is also called anaphylaxis. If your child's throat closes up, if the tongue swells or hives break out, call 911 immediately. This is a medical emergency.

Diagnosis & Tests

There are 2 common tests to determine a child's allergies:

• Skin prick test (A skin prick test is the one used most often.)
• Blood test  

If your child is allergic, cells in the body release histamine and other chemicals that cause allergy symptoms.

What to expect during a skin test:

• An allergist uses a needle to place a tiny amount of a substance that can cause allergies. An example of this substance would be an extract from grass pollen. Different extracts of these substances are placed just below the surface of the skin on either the lower arm or back.
• Swelling and redness occurs if your child is allergic.

What to expect during a blood test:

• A blood test will be used when the results of a skin test are not certain or a skin test cannot be done.
• An allergist takes a sample of blood by inserting a needle into the skin, usually on the arm.

This blood sample measures the levels of antibodies your child's body produces to fight what causes the allergy (high levels mean your child is allergic. Generally, the body produces antibodies to help fight off substances that can be harmful).

Treatment & Care

Your child's doctor may prescribe:

• Antihistamines (oral pills or liquid medicine or nasal sprays that can stop allergic reactions)
• Nasal sprays (antihistamines to reduce allergic reactions or steroid solutions to reduce swelling of the inside of the nose and sinuses)
• Decongestants (to reduce nasal congestion)
• Allergy shots

Antihistamines, available over the counter or by prescription, can have some unwelcome side effects. However, the body may adjust to these side effects over time.

These side effects include:

• Dry mouth
• Drowsiness
• Dizziness
• Loss of alertness and coordination
• Nausea and vomiting
• Restlessness or moodiness (in some children)
• Trouble urinating or not being able to urinate
• Blurred vision
• Confusion

The newer generation of antihistamines are less likely to make your child sleepy.

If your child has ever had a severe allergic reaction, your doctor may prescribe an epinephrine autoinjector (such as an EpiPen or EpiPen Jr.), which you or your child (depending on age) should carry at all times.

Living & Managing

Seasonal allergic rhinitis

Pollen travels easily through the air, making it difficult to avoid. People have no easy way to avoid breathing in pollen even if they stay indoors.

Pollen counts change from season to season so your child may only experience allergic rhinitis at certain times of the year. Make sure your child takes allergy medication during these times.

Perennial allergic rhinitis

Avoid those substances that trigger reactions:

• House dust mites
• Mold
• Pet dander
• Cockroaches

Allergy treatment begins at home and avoidance is one of the best treatments.

Take these measures:

• Make sure your residence has good ventilation.
• Keep your residence cool (between 68 and 72 degrees Fahrenheit).
• Maintain a low humidity in your residence (between 40 and 50%).
• Do not hang clothing outdoors to dry. Pollen may cling to towels and sheets.

Allergy-proof your residence by:

• Regularly cleaning all bed linens with soap and hot water.
• Replace carpet if you can. If not, then regularly vacuum carpet, upholstered furniture and curtains.
• Use window shades rather than curtains or blinds.
• Remove as much clutter as possible as clutter attracts dust.
• Use allergen-proof casings for pillows, mattresses and box springs.
• Use synthetics pillows.
• Clean the air conditioning and heater filters frequently and replace often.