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Allergic rhinitis affects up to 50 per cent of children in Singapore aged 4 to 17 years
Runny nose, blocked nose, itchiness, sneezing…these are symptoms typical of the common cold as well as allergic rhinitis, a chronic medical condition especially prevalent among children in Singapore.
But the similarity between the two ends at the symptoms. Unlike the common cold, allergic rhinitis is not caused by a viral infection. Nor does it get resolved in a few days. Allergic rhinitis is due to an allergy and will persist for as long as the allergen is present.
Allergic rhinitis occurs when you breathe in something from your environment, indoors or outdoors, that you are allergic to. This allergen, which could be house dust mites, cigarette smoke, plant pollen or haze, causes the mucous lining in the nose to get inflamed. This in turns leads to symptoms such as sneezing and a runny nose.
Is allergic rhinitis another name for hay fever?
Allergic rhinitis triggered by pollen is called hay fever. Hay fever is particularly prevalent in temperate climates where there are high seasonal levels of pollen.
Allergic rhinitis is very common in Singapore, affecting 24 per cent of the population. While it affects both adults and children, it is particularly prevalent in children aged 4 - 17 years.
In 2010, the prevalence rate for children of this age was estimated to be as high as 50 per cent, according to Associate Professor Anne Goh, Head and Senior Consultant, Allergy Service, KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group.
Can dairy products and eggs cause allergic rhinitis?
Dairy products and eggs do not usually trigger allergic rhinitis, says A/Prof Goh.
“Allergic rhinitis is less commonly caused by food allergies, so there is no real need to avoid foods essential for children’s growth,” she says. “The commonest trigger for allergic rhinitis in Singapore is exposure to the house dust mites. The other common trigger is exposure to cigarette smoke.”
However, if any specific food is suspected to cause an allergic reaction, the child should be evaluated properly before being put on a food elimination diet.
Allergic rhinitis can affect a child’s schoolwork and sports
A prominent symptom of allergic rhinitis in children, especially younger children, is coughing rather than sneezing. Nasal congestion can also be severe, affecting the child’s ability to perform in school and in sports.
“The nasal congestion can affect the child's sleep and can lead to snoring and a dry mouth if the child
mouth-breathes frequently,” says A/Prof Goh. “Children who don’t sleep well will have a poor concentration span the following day and this can affect their ability to perform well in school.”
The nasal congestion, when severe, can also affect the child’s ability to exercise and participate in sports.
Can allergic rhinitis in children lead to more severe allergic conditions such as asthma?
Allergic rhinitis can be associated with other allergic conditions such as asthma, eczema and allergic conjunctivitis, says A/Prof Goh. “About 40 per cent of children with allergic rhinitis will have associated asthma. Conversely, about 80-90 per cent of asthmatic children will have associated allergic rhinitis,” she explains.
In children who have allergic rhinitis and asthma, both conditions will need to be treated separately to control the symptoms.
Allergic rhinitis can be controlled by minimising the child's exposure to allergens
Treatment for allergic rhinitis is long-drawn as symptoms can recur when the allergen is present. Treatment involves identifying and avoiding allergens such as the house dust mite, and managing the symptoms with medication.
Children with mild allergic rhinitis can be treated with oral antihistamines. In more severe cases, nasal steroid sprays can be used.
“The newer non-sedating antihistamines are preferred for the treatment of allergic rhinitis as they do not cause drowsiness the following day, and are safer for longer term use,” says Associate Professor Anne Goh, Head and Senior Consultant, Allergy Service, KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group.
Other treatment options include:
•Leukotriene receptor antagonists: This is a non-steroidal oral medication commonly used in the treatment of asthma
•Immunotherapy: This can help induce tolerance to allergens like the house dust mite.
Can children outgrow allergic rhinitis?
Children do not outgrow allergic rhinitis but symptoms can vary depending on exposure to triggers and allergens, says A/Prof Goh. Some children may find that their symptoms improve as they get older, especially when they become teenagers.
Tips for parents of children suffering from allergic rhinitis
Parents can help keep the child’s symptoms under control with medication and by minimising exposure to allergens. Parents can take the following steps to allergy-proof their house against the most common allergen – the house dust mite:
•Keep the child's bedroom meticulously clean to reduce exposure to dust mites
•Wash bed linen in hot water (> 60 deg. C) and change the sheets every week
•Reduce the number of soft toys in the child's bed
•Avoid having carpets in the bedroom
•Clean curtains regularly – for hygiene purposes, window blinds are a better option than curtains.
Reducing the child’s exposure to the house dust mite and other indoor allergens, as well as regular use of medications, will help control allergic rhinitis symptoms, says A/Prof Goh. The medications can be stopped when the child's symptoms are well managed, and restarted if symptoms recur.