Allergic rhinitis in children

Allergic rhinitis is an IgE-mediated inflammatory disease of the nasal mucosa, manifested by a complex of symptoms in the form of sneezing, itching, rhinorrhea and nasal congestion.

Allergic rhinitis is considered one of the most common and difficult to treat diseases. This problem is the subject of many publications, but most studies have been conducted on adults. It is believed that the differences between allergic rhinitis in children are insignificant. In this regard, pediatricians mainly pay attention to bronchial asthma, and allergic rhinitis remains out of sight. Moreover, over the past decades, this problem has come under the competence of allergists. However, the number of pediatricians among them is small, and doctors of this specialty do not have endoscopic diagnostics. They do not realize the connection between allergic rhinitis and diseases of the paranasal sinuses, pharynx and ear, and therefore focus on issues of general allergic examination and treatment.

ICD-10 code

• J30.1 Allergic rhinitis due to pollen.
• J30.2 Other seasonal allergic rhinitis.
• J30.3 Other allergic rhinitis.
• J30.4 Allergic rhinitis, unspecified.

Epidemiology

Allergic rhinitis is a widespread disease. The frequency of its symptoms is 18-38%. In the United States of America (USA), allergic rhinitis affects 20-40 million people, the prevalence of the disease among the child population reaches 40%. Boys are more often affected. In the age group up to 5 years, the prevalence of allergic rhinitis is the lowest, an increase in the incidence is noted in early school age.

It is known that manifestations of allergies can occur in the first months of life (usually in the form of eczema), although allergic diseases of the nose are also possible at this age. Most often, these diseases occur at the age of 2-3 years. To a certain extent, this is due to the period of contact with other children and new allergens (kindergarten). The peak incidence of allergic rhinitis occurs at the age of 4. It is known that in 70% of patients, allergic rhinitis begins before the age of 6. Unfortunately, the first visit to an allergist in 50% of these children occurs only at the age of 10-12 years, that is, 5-6 years after the onset of the disease. In half of them, before this age, the main direction in treatment is unjustified antibiotic therapy. As a result, by the age of 14, 15% of children and adolescents have symptoms of allergic rhinitis. Boys suffer from allergic rhinitis more often than girls in all age groups. Thus, in early childhood, allergic rhinitis and rhinosinusitis are in second place after asthmatic bronchitis and asthma, in preschool age their indicators are comparable; and in schoolchildren, allergic rhinitis and rhinosinusitis confidently lead. In addition, at the age of over 7 years, bacterial allergy begins to acquire significance, manifested by delayed-type reactions.

In infancy and early childhood, the causes of allergic rhinitis are most often food allergens (cow's milk, formula, chicken eggs, semolina porridge, medications and reactions to vaccines), and in preschool and school age - inhalation allergens. What factors contribute to the development of allergic rhinitis? First of all, it is heredity.

Positive allergological anamnesis is found in parents with allergic rhinitis in 54% of cases, and with rhinosinusitis - in 16%. It is known that the development of respiratory allergies is facilitated by the anatomical features of the nasal cavity, prolonged contact with the allergen, increased permeability of the mucous membrane and vascular wall, developed cavernous tissue of the nasal conchae, that is, even normal anatomical and physiological situations. The situation worsens with pathological conditions in the nasal cavity, the most common example is the development of acute respiratory infections. This is also confirmed by statistical data: according to them, in 12% of cases, allergic rhinitis begins after an acute respiratory viral infection.

What causes allergic rhinitis?

Classification of allergic rhinitis

A distinction is made between acute episodic, seasonal and persistent allergic rhinitis.

• Acute episodic allergic rhinitis. Occurs with episodic contact with inhaled allergens (e.g., cat saliva protein, rat urine protein, house dust mite waste products).
• Seasonal allergic rhinitis. Symptoms appear during the flowering of plants (trees and grasses) that release the causative allergens.
• Allergic rhinitis, which is a year-round disease. Symptoms are observed for more than 2 hours a day or at least 9 months a year. Persistent allergic rhinitis usually occurs with sensitization to household allergens (house dust mites, cockroaches, animal dander).

Classification of allergic rhinitis

Diagnosis of allergic rhinitis

The diagnosis of allergic rhinitis is established on the basis of anamnesis data, characteristic clinical symptoms and identification of causative allergens (by skin testing or determination of the titer of allergen-specific IgE in vitro if skin tests are not possible).

When collecting anamnesis, it is necessary to clarify the presence of allergic diseases in relatives, the nature, frequency, duration, severity of symptoms, seasonality, response to treatment, the presence of other allergic diseases in the patient, provoking factors. Rhinoscopy is performed (examination of the nasal passages, mucous membrane of the nasal cavity, secretion, nasal turbinates and septum). In patients with allergic rhinitis, the mucous membrane is usually pale, cyanotic-gray, edematous. The nature of the secretion is mucous and watery. In chronic or severe acute allergic rhinitis, a transverse fold is found on the bridge of the nose, which is formed in children as a result of the "allergic salute" (rubbing the tip of the nose). Chronic nasal obstruction leads to the formation of a characteristic "allergic face" (dark circles under the eyes, impaired development of the facial skull, including malocclusion, arched palate, flattening of the molars).

Diagnosis of allergic rhinitis

Treatment of allergic rhinitis

The main goal is to alleviate the symptoms of the disease. The complex of therapeutic measures includes the elimination of allergens, drug treatment, specific immunotherapy and patient education. Treatment of allergic rhinitis is carried out on an outpatient basis.

Treatment of allergic rhinitis begins with identifying possible causative allergens, after the elimination of which, in most cases, rhinitis symptoms decrease.

How is allergic rhinitis treated?

Prevention of allergic rhinitis

• Diet for pregnant women. In case of allergic reactions, highly allergenic foods are excluded from the diet.
• Elimination of occupational hazards from the first month of pregnancy.
• Use of medicines only according to strict indications.
• Stopping active and passive smoking as a factor contributing to early sensitization of the child.
• Breastfeeding is the most important direction in preventing the implementation of atopic predisposition, which must be maintained at least until the 4th-6th month of life. It is advisable to exclude whole cow's milk from the child's diet. It is not recommended to introduce complementary foods before 4 months.

Prevention of allergic rhinitis

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