Many of you may have noticed that your children frequently sneeze, have clear mucus, nasal itching, nasal congestion, and itchy eyes in the evening or after waking up. You may think they have a common cold and wonder why they have it so often. However, a common cold is not the only cause of the aforementioned symptoms. Other possible causes are allergic rhinitis and allergic conjuntivitis. To learn and be able to differentiate the symptoms of a common cold from allergy, let’s find out more about allergic rhinitis.

Allergic rhinitis
Allergic rhinitis is the abnormal nasal mucosal reaction to allergens, leading to chronic inflammation of the lining of the nose. At present, allergic rhinitis is the most common allergy in children, with the prevalence rate as high as 50% in Thai children. The condition is often accompanied by other types of allergies such as allergic conjunctivitis or asthma.

Symptoms
In children, symptoms include nasal itching, sneezing, congested and runny nose as well as itchy and watery eyes which are usually chronic. Symptoms usually flare up at dusk or dawn because of cooler air temperature. Some children may develop loud snoring. Symptom severity in each child varies from very mild to severe sufficient to bother and interfere with daily life.

Is allergic rhinitis common in children or adults?
Allergic rhinitis can affect people of all ages and nationalities, but it is rare in children under 2 years old. After initial exposure to an allergen, it typically takes 2-3 years for allergic symptoms to appear. In most cases, the symptoms first appear during school age or adolescent years. Nevertheless, nowadays more and more children under 2 years old are diagnosed with allergic rhinitis. Air pollution is believed to be a trigger of the early allergic reaction in these toddlers. 

How does allergic rhinitis differ from common cold?
Common cold is an infectious disease. Children with common cold usually have other symptoms beside runny nose that indicate infection such as fever, cough, sore throat, and yellow or green nasal discharge or sputum whereas children with allergic rhinitis do not have those symptoms, but they have clear mucus with itchiness or irritation of the eyes.

The severity of allergic rhinititis
Allergic rhinititis is not fatal. However, if proper treatment is consistently neglected, it can lead to other complications such as sinusitis, otitis media, adenoiditis, and can lead to allergy in other organ such as allergic conjunctivitis and asthma. Children may have poor school performance and listless from inadequate sleep.

What are the common allergens causing allergic rhinititis?
Dust mites and their waste are common triggers of allergic rhinititis, asthma, and allergic conjunctivitis in children. Dust mites thrive in mattresses, bed sheets, pillow cases, blankets, stuffed dolls, carpets as well as cold and damp environment such as bedroom and living room.

How to control and avoid dust mite allergen
You can control and avoid dust mite allergen by:

1. Washing your bedding with soap and water is an effective method because the waste of dust mite is water-soluable. Washing your bedding in water can remove the allergen, but it cannot kill off the dust mites. However, washing your bedding in hot water at 55-60 degree Celcius for at least 30 minutes can kill the dust mites. It is recommended to do the washing at that temperature every 2-4 weeks to eliminate dust mite and its allergen.
2. Cover your bedding with dust mite proof covers can minimize exposure to dust mite allergen and prevent the dispersion of allergen from mattresses, pillows or blankets. Buy cover sheath that is tightly knitted with space between fiber or pore size smaller than the size of a dust mite which is 300 microns and dust mite waste which is 10-40 microns.
3. Nasal irrigation with saline can minimize the exposure to dust mite allergen by removing the retained allergen within your nasal cavity. It is another important treatment besides oral medications or inhalers.
4. Use an air purifier. Dust mite allergen is highly concentrated in specific areas (mattresses or pillows) and will only be dispersed after being fluffed . Due to its large size, allergen particles quickly settle onto the ground within 5 minutes; an air purifier placed at a distance may not be effective. However, it is useful for catching smaller allergens such as pollen, fungal spore, cat or dog dander which can hang in the air longer.
5. Home environment modification Carpets collect indoor allergens and dust mites can thrive well in carpet fibers. There is no effective way to completelly remove dust mite allergen from carpet yet, except to remove the carpet itself. Cleaning the bedroom floor with a damp mop can eliminate allergen better than a dry mop. The bedroom should be airy, accessible to sunlight and free from clutters such as books which can collect allergens. Furnitures, curtains, toys, and stuffed animals should be fiber-free.

Treatments
Allergic rhinitis treatments include:

• 1. Avoid exposure to known If the culprit allergens are not known, see your doctor for a blood test or skin prick test to identify them.
• 2. Strictly adhere to the prescribed medications regimen. Medication for allergic rhinitis include:
  • Oral medications:
    • Antihistamines can help reduce sneezing, itchy and runny nose, or itchy eyes. Current generation of antihistamines have been formulated to allow once a day dosing without causing daytime sleepiness. They come in both the pill and syrup forms which can be conveniently and suitably prescribed to children in different age groups.
    • Antileukotrienes inhibit leukotrienes released from immune cells which cause inflammation of the lining of the nose. They are often prescribed together with antihistamines and corticosteroids nasal spray to children with severe allergic rhinitis. This type of medication can help relieve sneezing, itchy, runny and congested nose and can be given to children younger than 2 years old who should avoid the use of corticosteroid nasal spray.
  • Corticosteroid nasal sprays directly suppress nasal inflammation and can be effectively used in children like the oral medications. They have additional property of alleviating nasal congestion with minimal side effects as they are local topical medication whereas oral corticosteroids can cause adverse systemic effects in other organs.

How to use corticosteroid nasal spray

1. Shake well and remove the cap before use.
2. For first time use, pump the bottle 3-5 times until you see the fine mist from the nozzle. If the nasal spray has not been used longer than 2 weeks, shake the bottle and reprime it by discarding 1 puff before use.
3. Always rinse your nose with saline and wipe clean before using a nasal spray.
4. Hold the spray bottle upright with your index and middle fingers position on the shoulder of the bottle and place the thumb at the bottom. Insert the nozzle into a nostril pointing the tip towards the inside corner of your eye on the same side. Tilt your head forward slightly so the mist is directed right into the nasal cavity. Use your right hand to spray into the left nostril and vice versa.
5. Refrain from blowing your nose for 15 minutes after using the nasal spray.
6. Recap after use.
7. Do not swallow your saliva and always rinse the mouth after using the nasal spray.
   • Decongestants (oral, drops, or spray) This type of medication is for nasal congestion relief only. It cannot ease sneezing, itchy and runny nose, itchy eye, or inflammation of nasal lining. Decongestant drops or spray can prevent side effects of oral decongestants including anxiety and palpitation.
   • Nasal irrigation is a procedure to wash your nose by spraying or instilling saline into the nasal cavity. It is an important treatment for children with allergic rhinitis. The benefits of nasal irrigation include:
     • Reduce retained dust mite allergen.
     • Flush out thick, sticky mucus which cannot drain out on its own.
     • Decrease germs in the nasal cavity.
     • Clear out pus from sinus cavities.
     • Moisten and soothe nasal irritation.
     • Enhance the efficacy of corticosteroid nasal spray.

• Sterile saline. Home saline preparation by mixing 750 mL of boiled or clean drinking water with 1 teaspoon of noniodised salt. Mix well before use.
• 35 mL. Nasal syringe

How to rinse your nose with saline

1. Pour sterile saline into a container and use a nasal syringe to draw up the saline until it is full
2. Stand or sit leaning over a sink or a water receptacle. Insert the tip into a nostril and snugly close the nostril opening.
3. Hold your breath and gently spray the saline into the nasal cavity until it drains out on the other nostril. It takes about 10 seconds to rinse your nose with each 35 mL saline.
4. Gently blow both of your nostrils. Spit the saline and post-nasal drip out.
5. Repeat the procedure on each side of the nostril until there is no mucus or nasal congestion. Rinse your left and right nostrils alternately. Avoid rinsing one side of the nostrils several times in a row because it can cause an earache.

Precautions

• Do not forcefully rinse your nose with saline.
• Gently blow your nose after each nasal rinse.
• Do not perform a nasal wash in an uncooperative child, because it can cause saline choking.
• Use the home-prepared saline within 2 hours.
• Do not use plain tap or boiled water to rinse your nose because they do not have salt concentration suitable for the nasal cavity.   
• Do not rinse your nose if it is prone to bleeding or your doctor does not recommend it.

How to clean nasal irrigation device

1. Clean the syringe with soap or dishwasher water after each use,  thoroughly rinse it with tap water, and leave it dry indoor.
2. Do not boil or wash the syringe with hot water as the heat can damage the device.

How often should I do nasal irrigation or rinse?

• At least twice a day, upon arising in the morning and before going to bed.
• When you have thick mucus or nasal congestion.
• Before using corticosteroid nasal spray.

Is nasal irrigation safe?
A correctly performed nasal irrigation is harmless to children. Rinse the nose on an empty stomach or at least 2 hours after meal to prevent vomiting or choking.

• 3. Eat all 5 food groups, have adequate sleep and exercise regularly. Allergic rhinititis cannot be cured and can recur if children are reexposed to allergens or have infection of the respiratory system. However, a good hygiene practice can enable them to lead a normal life and schooling just like healthy children.