Allergic rhinitis is one of the most commonly diagnosed health disorders among children. Commonly called hay fever, allergic rhinitis is an inflammation of the inner lining of the nose that occurs when an allergic individual encounters an airborne allergen such as pollen, mold, dust mites or animal dander.

Symptoms of allergic rhinitis include runny nose, nasal congestion, breathing difficulties, coughing and itchy, watery eyes. Many people view allergic rhinitis as a nuisance that is unlikely to seriously harm children. However, allergy symptoms can have a profound effect on a child’s health, behavior and ability to learn.

In 80 percent of cases, allergic rhinitis develops in a person before the age of 20. Boys are more likely to develop allergic rhinitis than girls. Several studies have found that, as with asthma, rates of allergic rhinitis and other allergies appear to be climbing among children. The reason for this is not yet fully understood.

Allergic rhinitis is one of the most commonly diagnosed disorders in children. This inflammation of the inner lining of the nose occurs when an allergic individual encounters an airborne allergen such as pollen, mold, dust mites or animal dander.

Sneezing, coughing, runny nose, sore throat and itchy, watery eyes are among the major symptoms of allergic rhinitis. These symptoms may occur throughout the year (perennial allergic rhinitis) or just at certain times of year (seasonal allergic rhinitis) when mold and pollen counts are high. Seasonal allergic rhinitis does not usually develop until after age 6, while perennial allergic rhinitis is frequently seen in younger children.

A child develops allergic rhinitis after being exposed to an allergen and becoming sensitized to it. Once sensitization has occurred, the child will have an allergic reaction the next time the allergen is encountered. Taking steps to minimize a child’s exposure to allergens early in life sometimes can prevent allergic rhinitis from later developing.

The consequences of allergy symptoms can have a profound effect on children. Negative outcomes attributed to allergic rhinitis symptoms include:

• Poor classroom performance and missed school days (peak pollen seasons often occur at both the start of the school year and during final exams)
• Increased irritability and temper tantrums
• Poor concentration habits
• Overactive behavior
• Problems sleeping and fatigue

In addition, allergic rhinitis can be a gateway disorder that leads to other health problems in children, including:

• Asthma. A respiratory disorder that results in constriction of the airways. Allergens associated with allergic rhinitis are frequently triggers for an asthma attack.

• Sinusitis. An inflammation and infection of the mucous membranes lining the sinuses that creates a breeding ground for viral, bacterial or fungal infections.
  
  
• Otitis media.  An ear infection, which can result when nasal allergies cause inflammation and blockage of the eustachian tube (a cavity connecting the nose to the middle ear). Over time, an infection in the middle ear can develop into a thick, sticky secretion that builds up and attaches to the auditory ossicles (three bones of the middle ear that are crucial to a person’s ability to hear). Sometimes, an incision in the eardrum (tympanic membrane) is necessary to cure the condition. This procedure is called myringotomy.

Allergic rhinitis is usually triggered when an allergic individual comes into contact with proteins found in certain airborne particles. These proteins can come from a variety of sources, but usually include:

• Pollen. Small, powdery grains of flowering plants that can easily become airborne. These are most often produced by trees, grass and weeds.
  
  
• Mold and mildew. Tiny fungus spores that can become airborne. These often thrive outdoors in soil, vegetation and rotting wood. They can be found indoors as well, especially in damp areas, basements and bathrooms.
  
  

  

• Dust mites. Microscopic insects that inhabit household dust. They are often found indoors where there is less air circulation and on surfaces like carpets, bedding and stuffed animals.
  
  
• Animal dander. Tiny scales or particles from an animal’s skin. These very often come from a dog or cat.
  
  
• Cockroach debris. Droppings, eggs, saliva and small pieces of outer shell of cockroaches. These can be found indoors, even if an infestation of live pests is not currently a problem.

Like adults, children must be exposed to the allergen and sensitized to it before the allergy develops. Because young children often are exposed to indoor allergens such as molds, dust mites, dander and cockroach debris early in life, they may develop allergic rhinitis associated with these allergens in the initial stage of their lives.

As children grow older and spend more time outdoors, they are increasingly likely to be exposed to additional potential triggers for allergic rhinitis, including grass, tree and weed pollens that may trigger reactions once the child becomes sensitized to them.

Family history plays a big role in determining a child’s future allergy problems. Children are far more likely to develop conditions such as allergic rhinitis if they come from families with a known history of allergic reactions – whether or not the allergies are rhinitis-related. However, children who come from allergy-free families still can develop allergies.

First-born children appear more likely to develop allergic rhinitis than their peers, according to some research. Boys are more likely than girls to develop allergic rhinitis, but this evens out during adulthood. It also appears that children are more at risk for developing allergies if they are exposed to tobacco smoke and dusty environments early in life. The reason for such trends is not completely understood.

Allergic rhinitis symptoms occur less often in infants and young children than in adults. When they do occur, symptoms may cause the child to become irritable and interfere with feeding.

Allergic rhinitis involves swelling in the sinuses and in the passage leading from the throat to the middle ear. Because of this, the most common symptom associated with allergic rhinitis is frequent and prolonged sneezing. Other common symptoms in children and adults may include:

• Itchy and runny nose
• Redness, swelling and itching of the eyes
• Itchy and sore throat
• Coughing
• Ear infections and sinus infections

Some symptoms are particularly likely to appear with children and infants. Hallmark symptoms of an allergy in infants include:

• Recurring ear infections
• Diarrhea and vomiting
• Excessive drooling or spitting
• Labored breathing
• Stuffy nose

Allergy symptoms particular to children include:

• Allergic shiners. This is a bluish-brownish discoloration around the eyes that appears when a child is battling symptoms on an ongoing basis.
  
  
• Skin flushing. In children, this is most likely to appear on the ears and cheeks.
  
  
• Face elongation (adenoidal face). A lengthening of the face that occurs over time from mouth breathing. Children with allergic rhinitis may breathe from the mouth due to ongoing nasal congestion. Over time, the force of the air entering the mouth can change the way the soft bones of the face grow. This can result in an elongation of the face.
  
  
• Allergic salute. The motion by which children with an itchy and runny nose frequently push upward on the nose with the palm of their hand. This motion eventually creates a crease across the bridge of the nose.
  
  
• Related chronic conditions. Children with allergies may experience recurrent sore throats, chronic nasal congestion and chronic ear infections.
  
  
• Disrupted sleep patterns. Excess mucus secretion and nasal tissue swelling can make breathing more difficult for children when they lay down. Children may gasp for breath or cough at regular intervals, causing sleep loss.

Allergic rhinitis symptoms often vary in severity depending on the child and the environment. They may last throughout an entire season (with seasonal allergic rhinitis) or throughout the entire year (with perennial allergic rhinitis). 

Rhinitis allergies usually flare up in the spring when plants begin to bloom and release pollen. However, this may vary by geographical location.  Some trees begin to pollinate as early as January in the southern United States. By late spring, grasses are pollinating – followed by weeds in the summer and fall. Warmer climates will see outdoor mold spore growth peak by midsummer. Travel, such as from New York to Florida during the winter, can also trigger symptoms in people out of their usual season.

People susceptible to indoor molds, dust mites and pet dander often suffer allergy symptoms throughout the year.

A physician trying to diagnose allergic rhinitis will conduct a full physical examination of the child as well as compile a medical history and a list of symptoms. Although many of the symptoms associated with allergic rhinitis mimic those of the common cold and upper respiratory infection, the presence of eye-related symptoms and lack of fever often suggest the presence of an allergy. If the physician suspects an allergy, allergy tests may be administered to pinpoint which allergen is triggering symptoms.

Identifying allergens is crucial, because avoidance is the best treatment for allergic rhinitis in children as well as in adults. However, avoidance is not always possible and medications may be used to relieve symptoms or reduce the frequency of allergic reactions. While some allergy medications are available over-the-counter (OTC), parents should never give any medicine to a child without first consulting a physician.

Over-the-counter antihistamines and decongestants are available in child doses, but they may make children drowsy and affect performance in school. Also, over-the-counter decongestants should not be used for more than a few consecutive days. Overuse of these drugs can lead to a “rebound effect” in which symptoms actually get worse. Prescription oral antihistamines and nasal sprays containing cromolyn sodium are often used to treat children because they are effective and offer the lowest risk of side effects.

In cases of more severe allergic rhinitis, children may need to take corticosteroids. These are anti-inflammatory drugs that do an excellent job of preventing the inflammation that leads to allergy symptoms. However, these drugs are suspected to at least temporarily suppress growth rates in some children. For that reason, caution must be exercised.

Corticosteroids also can be used in conjunction with an antihistamine to both improve treatment effectiveness, and reduce the level of the corticosteroid needed.

Finally, if medications fail, a doctor may suggest allergy shots (immunotherapy) to tame symptoms. Allergy shots involve regular injections of a small dose of an allergen over a period of months. The goal is to gradually increase the child’s tolerance of a particular allergen.

Administering this therapy safely in children is more challenging, because young children are not always able to communicate signs of a potential reaction to a physician. Younger children also have smaller respiratory reserves, which puts them at greater risk of respiratory side effects.

The most effective way to control allergy symptoms is avoidance. By controlling the environment and minimizing exposure to known allergens, parents can greatly limit the number and severity of allergic reactions. While this treatment method is not easy, there are several basic steps that can reduce the exposure to allergens that trigger allergic rhinitis. These steps include:

• Breastfeed infants for at least a year. Many healthcare experts long have argued that early breastfeeding is likely to protect the child from developing allergies. However, studies undertaken since the 1980s have provided a body of conflicting information about whether breastfeeding is more likely or less likely to protect infants from developing these conditions. Regardless, virtually everyone agrees that the health benefits of breastfeeding far outweigh any potential negative aspects.
  
  
• Keep allergic children indoors as much as possible during the pollen season (high pollen counts), and windy and humid days.
  
  
• During allergy season, try to keep windows and doors closed at home and in the car.
  
  
• Use air conditioning in the home and car, which cleans and dries out air.
  
  
• Use air filters that can remove allergens from the air, such as HEPA filters.
  
  
• Use a dehumidifier to prevent the growth of mold by reducing humidity.
  
  
• Avoid having children help with yard work that could stir up pollen and molds – such as mowing the lawn or raking leaves.
  
  
• Avoid hanging laundry outdoors to dry because pollen can collect on fabrics.
  
  
• Remove rugs from a child’s bedroom. Hardwood floors and linoleum hold less dust. Use plastic blinds instead of cloth drapes and allergen-proof covers for pillows, mattresses and box springs. Wash bedding once a week in hot water – at least 130 degrees Fahrenheit (54 degrees Celsius).
  
  
• Keep pets out of the child's bedroom and keep the bedroom door closed. Fish tanks and bowls should be kept out of the bedrooms of children with mold allergies because these containers generate moisture.
  
  
• Wash pets frequently to minimize the amount of allergens on their skin and coats.
  
  
• Make sure children shower frequently to wash airborne allergens from their hair and skin.
  
  
• Give children washable toys and stuffed animals.
  
  
• Prevent cockroach infestations by taking the following steps: storing food in sealed containers, washing dirty dishes immediately, not leaving crumbs on the counter or floor, and keeping garbage well-sealed.  

Parents should also notify the staff at their child’s school about the child’s condition. This enables parents and school employees to work together toward reducing the child’s exposure to allergens while in the classroom. Parents should also alert teachers to the fact that allergic rhinitis and its treatments may affect the child’s concentration level and overall performance at school.

Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their child’s doctor the following questions related to allergic rhinitis and children:

1. Do my child’s symptoms indicate allergic rhinitis?
   
   
2. What methods will you use to diagnose my child?
   
   
3. Does the condition pose a danger to my child’s overall health?
   
   
4. What are my child’s treatment options?
   
   
5. What is likely triggering my child’s allergic rhinitis?
   
   
6. Will my child experience symptoms year-round or just at certain times of year?
   
   
7. What steps can I take to help prevent symptoms in my child?
   
   
8. Is it likely my child will outgrow the condition?
   
   
9. Are my other children more likely to develop allergic rhinitis because this child has it?
   
   
10. Will breastfeeding help prevent allergic rhinitis in my child?