Q: My 8-year-old son is constantly sneezing and blowing his nose. He snores at night, never seems rested, and wakes with dark circles under his eyes. What do you suggest?" Rachel
A: Rachel - I could be wrong, but these symptoms are highly suggestive of allergic rhinitis, otherwise known as "hayfever". He could have a cold, but it would be unusual for it to persist for so long, without any other underlying conditions.
Allergic rhinitis affects up to 30 per cent of adults and 40 per cent of children in New Zealand, and symptoms are often worse in spring and summer. There are two forms, although it is not always easy to distinguish them:
* Seasonal rhinitis - which occurs only during certain seasons, usually spring and early summer; it is classically triggered by outdoor allergens (such as pollens).
* Perennial rhinitis - year-round symptoms; triggered by indoor allergens (including house dust mite, pets, moulds).
Rhinitis symptom include:
* Nasal congestion.
* Watery eyes and nose.
* Itchy throat, eyes and nose.
* Sinus pressure and facial pain or headaches.
* Reduced sense of smell or taste.
Children, such as your son, may present slightly differently, and signs might include:
* Speech problems.
* Dark circles under eyes.
* Sniffing and blinking.
The symptoms are caused when allergens in the air enter the nose, throat and eyes, triggering an immune-mediated reaction. The cells in the nasal passages release a substance called histamine, which is responsible for the above symptoms.
Common allergens include:
* Pollens - from trees in spring, and grass in summer.
* House dust mite.
* Pet hair, fur or feathers.
* Some foods (especially milk, eggs, peanuts).
Anyone can be affected by allergic rhinitis at any age. It is not uncommon for people to grow into it, or indeed out of it. It is closely linked with asthma and eczema - a spectrum of conditions known as "atopy". Hayfever will occur in up to 80 per cent of people who also have asthma, and a family history of "atopy" makes the diagnosis of hayfever much more likely.
Although it is not life-threatening, this condition can make life very unpleasant for sufferers. It can lead to chronic poor sleep, especially in children - and subsequent issues with behaviour and school performance. Flare-ups of rhinitis may also exacerbate any accompanying asthma, and can potentially trigger a very serious attack.
In most situations, a doctor will be able to diagnose hayfever based on symptoms alone. Whether your son's symptoms are "seasonal" or "perennial" will help them work out what allergens he may be sensitive to.
Sometimes a referral for further testing may be considered useful. The most available test for this is skin prick testing - it may help determine possible sensitivity to a specific allergen, but it is not always reliable and may not be appropriate, or helpful, for everyone. Occasionally, a referral to an allergy specialist or an ENT (ear, nose and throat) specialist may be indicated if the diagnosis is in doubt.
There are some fairly basic things that I would recommend for treatment:
* Avoidance of the allergens: If you are able to work out what allergens your son is sensitive to, try to minimise his contact with them. If it seems to be pollen-based (hence worse in the spring and summer months), the following might be useful:
* Avoid being outside for long periods during flowering season and days when the pollen count is high. Two great websites to visit are www.allergy.org.nz (information, advice and a "pollen calendar" charting when key plants are likely to be in flower) and www.metservice.com (daily pollen forecasts).
* Splash his eyes regularly with water, and rub a small amount of Vaseline inside his nose - this will make it harder for the allergens to have an effect.
* Use a clothes dryer for his bedding - the greenie in me hates even suggesting this, but it will minimise any pollen that may have settled on his sheets whilst they are hanging on the line.
For other allergens:
* Keep pets outside and certainly not in his bedroom.
* Remove carpets where possible, and vacuum regularly (carpets are a huge source of dustmite).
* Cover all bedding and remove all but the most essential of soft toys from the bedroom.
Medication: Antihistamines are highly effective for people with occasional, mild symptoms. I would strongly suggest that you use this as a "trial" for your son - the non-sedating varieties such as cetirizine and loratadine are safe, and can be bought over the counter if required. They will give rapid relief if this is the cause of his symptoms.
Longer term, your doctor may suggest a trial of a steroid nasal spray, which will work to suppress all the major symptoms. If treatment does not lead to an improvement, make sure you have further testing done to rule out other underlying issues.
After last week's column on grapefruit, I received questions from readers about the potential risk of pregnancy if you are taking the contraceptive pill, and drinking grapefruit juice. I didn't mention this in the article, as grapefruit will actually increase the efficacy of the pill, making it a more effective contraceptive. However, this can cause more side-effects, so it is probably best to avoid this combination if possible.
- Cathy Stephenson is a general practitioner, medical forensic examiner and mother of three. If you have a question for her email email@example.com
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