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 to be the most common and difficult to cure diseases. A considerable number of publications have been devoted to this problem, but most studies have been carried out for people of mature age. It is believed that the differences in allergic rhinitis in children are negligible. 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 fallen into the competence of allergy doctors. However, the number of pediatricians among them is small, endoscopic diagnostics doctors do not own this specialty. They are not aware of the relationship of allergic rhinitis to 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 caused by pollen of plants.
• 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 his symptoms is 18-38%. In the United States (USA), allergic rhinitis affects 20-40 million people, the prevalence of the disease among children reaches 40%. Boys are more often ill. In the age group up to 5 years, the prevalence of allergic rhinitis is the lowest, the incidence of morbidity is noted at an early school age.

It is known that allergy manifestations can occur already in the first months of life (more often in the form of eczema), although at this age allergic diseases of the nose are possible. 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 falls to a 4-year-old age. It is known that in 70% of patients with allergic rhinitis begins at the age of up to 6 years. Unfortunately, the first appeal to an allergist in 50% of these children happens only at the age of 10-12 years, that is, 5-6 years after the onset of the disease. At half of them before this term the main direction in treatment is unreasonable antibiotic therapy. As a result, at the age of 14, 15% of children and adolescents observe 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, at the preschool age their rates are compared; and in schoolchildren allergic rhinitis and rhinosinusitis are confidently leading. In addition, at the age of more than 7 years begins to acquire the importance of bacterial allergy, manifested by reactions of a delayed type.

In infancy and early childhood, allergic rhinitis is most often caused by food allergens (cow's milk, milk mixtures, chicken eggs, semolina, medicines and vaccine reactions), and in preschool and school - inhalation. What factors contribute to the development of allergic rhinitis. First of all, it is heredity.

Positive allergic anamnesis is revealed in parents with allergic rhinitis in 54% of cases, and in rhinosinusitis - in 16%. It is known that the development of respiratory allergy contributes to the anatomical features of the nasal cavity, prolonged contact with the allergen, increased permeability of the mucosa and vascular wall, developed cavernous tissue of nasal concha, that is, even normal anatomical and physiological situations. The situation deteriorates with pathological conditions in the nasal cavity, the most common example is the development of acute respiratory disease. This is confirmed by statistical data: according to them in 12% of cases of allergic rhinitis begins after a previous acute respiratory viral infection.

What causes allergic rhinitis?

Classification of allergic rhinitis

There are acute episodic, seasonal and persistent allergic rhinitis.

• Acute episodic allergic rhinitis. Occurs with episodic contact with inhalant allergens (for example, the protein of the saliva of the cat, the protein of the urine of rats, the products of the life-activity of house dust mites).
• Seasonal allergic rhinitis. Symptomatic appears during flowering of plants (trees and grasses), which release causative allergens.
• All-year-round allergic rhinitis. Symptoms occur more than 2 hours a day or at least 9 months per year. Persistent allergic rhinitis usually occurs when sensitized to household allergens (house dust mites, cockroaches, animal dander).

Classification of allergic rhinitis

Diagnosis of allergic rhinitis

The diagnosis of allergic rhinitis is established based on the history of the disease, the characteristic clinical symptoms and the detection of cause-significant allergens (for skin testing or the determination of the titer of allergen-specific IgE in vitro in the event that it is impossible to carry out skin tests).

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. Conduct a rhinoscopy (examination of nasal passages, mucous membrane of the nasal cavity, secretion, nasal concha 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 back of the nose, which is formed in children as a result of an "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, a violation of the development of the facial skull, including an incorrect bite, arch-shaped palate, flattening of 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. Allergic rhinitis is treated on an outpatient basis.

Treatment of allergic rhinitis begins with the detection of possible cause-significant allergens, after elimination of which in most cases the symptoms of rhinitis decrease.

How is allergic rhinitis treated?

Prevention of allergic rhinitis

• Compliance with the diet of a pregnant woman. When allergic reactions from the diet exclude highly allergenic products.
• Elimination of occupational hazards from the first month of pregnancy.
• Use of medicines only for strict indications.
• Cessation of active and passive smoking as a factor contributing to early sensitization of the child.
• Natural feeding is the most important direction in the prevention of atopic predisposition, which must be kept at least until the 4th-6th month of life. It is advisable to exclude from the ration of the baby whole cow milk. Do not recommend the introduction of complementary foods up to 4 months.

Prevention of allergic rhinitis

[1], [2], [3], [4], [5]