Symptoms of pollinosis

Symptoms of pollinosis begin with rhinoconjunctival symptoms. The onset of the disease coincides with the pollination of plants that are an allergen for the child, allergy symptoms, as a rule, recur at the same time every year. Itching and burning of the eyes appear, simultaneously with itching or before it, lacrimation, swelling of the eyelids, hyperemia of the sclera are noted. Itching may be in the nose area, scratching of the nose with hands is observed (the so-called "allergic salute"). Paroxysmal sneezing, profuse watery discharge from the nose, difficulty in nasal breathing are characteristic. Clinical manifestations persist throughout the flowering period of plants that are allergens. In winter and autumn, patients do not present complaints. A significant difference between pollen conjunctivitis and other inflammatory diseases of the mucous membrane of the eyelids is the scarcity of discharge.

Isolated rhinitis is extremely rare. Usually the pathological process spreads to the paranasal sinuses, nasopharynx, auditory tubes, larynx. Complaints of itching in the ears, pharynx, trachea, choking, coughing, desire to clear the throat. Attacks of sneezing and a sensation of something foreign in the throat due to sharply increased sensitivity of the nasopharynx can occur from dust, odors, drafts. Along with the main clinical manifestations of pollinosis with polyvalent sensitization, there may be seasonal urticaria, Quincke's edema, allergic dermatitis.

Damage to the mucous membrane of the nose without involvement of the paranasal sinuses in children is very rare. In patients with pollinosis, sinusitis usually occurs without specific clinical symptoms. Children complain of nasal congestion, sneezing attacks, itching in the nose, eyes, and throat. Objectively, puffiness of the face, swollen nose, maceration of the skin of the nasal vestibule are noted. Eosinophils predominate in the cytogram of the contents of the sinuses and nasal cavity. Eosinophilia increases during the period of exacerbation and decreases during the process of attenuation. An important distinctive feature of pollen rhinosinusitis is the absence of dystrophic changes in the mucous membranes even with many years of disease.

In nasopharyngitis, complaints are about a painful burning sensation and itching in the pharynx, with rhinoscopy, diffuse edema of the mucous membrane of the nasopharynx and its lymphoid formations (adenoids). Swollen adenoids can cover the mouths of the Eustachian tubes and in such cases, complaints of ear congestion and hearing loss characteristic of Eustachitis appear. Otoscopy reveals retraction of the eardrum.

The main complaint of patients with allergic tracheobronchitis is an obsessive, paroxysmal cough, often accompanied by vomiting in children. A. D. Ziselson observed bronchial asthma in 39% of children with hay fever, while pollen asthma without concomitant rhinoconjunctivitis was not observed in a single child. According to T. S. Sokolova et al., pollen asthma developed in 22% of untreated children with hay fever and only in 4.7% of treated children. In children, an attack of bronchial asthma is usually preceded by a precursor period. In hay fever, this period is characterized by an aggravation of the severity of rhinoconjunctival and asthenovegetative syndromes, and the appearance of a spasmodic cough. Knowledge of the patient-specific features of the pre-attack period makes it possible to carry out preventive therapy.

Bronchial asthma in patients with isolated pollen sensitization is characterized by a clear seasonality of exacerbations, coinciding with the time of pollen of the corresponding allergens after a number of years of manifestation of hay fever in the form of rhinoconjunctival syndrome, tracheobronchitis. Attacks of bronchial asthma develop with massive inhalation of pollen allergens during a walk, which is of great importance for diagnostics and specifically pollen etiology of asthma. In children with combined household and pollen sensitization, periods of asthma exacerbation occur year-round, while in the spring-summer period the intensity of antigen stimulation increases due to the effect of pollen allergens, and in the autumn-winter period dust allergens and epidermal (contacts with pets) are important.

A. D. Ziselson noted manifestations of allergic dermatitis in 29% of cases among 300 children with pollinosis, but pollen etiology of skin lesions was proven only in 14%. The author explains the relatively high frequency of allergic dermatitis of pollen etiology in childhood by age-related immaturity of the barrier functions of the skin, its increased vulnerability. In children with pollen etiology of allergic dermatitis, exacerbations of the skin process had a clear, recurring seasonality from year to year, coinciding with the flowering period of plants, and the skin syndrome, as a rule, was combined with rhinoconjunctivitis.

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