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Rhinitis – Nothing to Sneeze At
+ Allergic Rhinitis may cause children to have sleep, dental and/or hearing problems
AAIA Quarterly Volume 31 Spring 1995
"Allergy is an inflammatory disease that smolders.”
Dr. P. S. Creticos, Johns Hopkins University School of Medicine.
Like other allergic diseases, the symptoms of rhinitis are caused by inflammation. The most common allergic disease is rhinitis. Most people suffer from seasonal rhinitis, commonly known as hayfever. There is also a chronic or perennial form of allergic rhinitis which bothers people all year long.
There are five stages:
Stage 1 – Some individuals are genetically programmed to become allergic because they are atopic due to an inherited tendency. It is not entirely clear why people react to specific allergens. For example, why does one person react to cat dander while another reacts to grass pollens? There are some clues. The proteins in pollens, animal dander, house dust mite and many other items are highly allergenic. So when an atopic person is repeatedly exposed to an allergenic substance, they become sensitized. Sensitization means that the person will, from then on, react to that substance whenever they are exposed to it.
Stage 2 – Whenever the sensitized person is exposed to their allergen, the “immediate” phase of an allergic reaction is triggered. The chemical chiefly responsible for the early or immediate phase symptoms is “histamine”. When antihistamine medications have been taken preventively before allergen exposure, the allergic reaction does not occur or is minimized.
Stage 3 - In the process of the immediate reaction, the immune system recruits other “soldiers” to protect the body. These immune system cells produce other chemicals, one of which is known as leukotriene. Leukotriene is responsible for the late phase reactions. Very often the symptoms of the late phase reaction, which can appear up to eight hours later, are even more severe than the symptoms during the immediate phase. The late phase reaction is the one which causes the inflammation associated with allergic diseases.
Stage 4 – The inflamed state of the tissues in the nose, eyes, throat and sinuses leaves them vulnerable. Because these tissues are inflamed they will react with allergy-like symptoms when exposed to irritants such as smoke, cold air, perfume, strong odours.
Stage 5 – As the pollen season progresses, it takes less and less pollen to trigger symptoms. At the start of a season, it might take inhalation of 100 pollen grains before symptoms occur. By the middle of the season, the inhalation of only five grains may be enough to active the immune system and cause symptoms.
Seasonal Allergens – pollens, tree, grass, weed, moulds
Perennial Allergens – house dust mite, animal dander, insects, mould spores
Rhinitis Treatment
Many of the old sayings contain so much wisdom. The saying that fits the treatment of allergy is “An ounce of prevention is worth a pound of cure”. There are three phases of treatment.
1. AVOIDANCE
If an allergen can be avoided, then a reaction will not occur. While you can control your allergy to elephants by clearing them out of the house, we do not have that kind of control over pollens. Even so, we can achieve some avoidance measures:
- Keep doors and windows closed and use an air conditioner for temperature comfort.
- Leave pollens outside by remembering that they cling to clothes. Change out of your outside clothes as soon as you come indoors, but not in the bedroom. Shower before going to bed.
- Remove pets if possible because they bring pollen and mold in on their fur.
- Time your outdoor activities to low pollen times.
Remember that on windy days, pollens will be in continual circulation. On rainy days pollen is washed away.
2. MEDICATIONS
Antihistamines:
- work most effectively if taken before exposure, so find out when your pollen season generally starts and begin to dose yourself regularly a week ahead.
- Help the sneezing, runny nose and itchiness, but not the stuffy nose and eye symptoms.
- first generation antihistamines usually cause sleepiness
- second generation antihistamines are contra-indicated with certain prescription medications, so check with your pharmacist before taking them.
- Nose and eyes sprays are available by prescription
Decongestants:
- attack nasal congestion
- have unpleasant central nervous system side effects such as insomnia, jitteriness, etc.
- in the nasal spray form, should not be taken for more than 3 days because they begin to cause swelling rather than shrinking (called “rebound”)
Anti-inflammatories:
e.g,. Cromolyn / Nedocromil work best when taken preventatively as described above for the antihistamines. These medications stabilize the mast cells, preventing the escape of the chemicals of allergy into the body. Provide good therapy for eye symptoms.
e.g., corticosteroid nasal sprays (completed unrelated to the type of steroid you have heard about in sports scandals) prevent allergic reactions. Used as preventative medications, they too work best when taken ahead of the season, as described above for antihistamines. Studies have shown that these nasal sprays, when taken regularly, provide an 85% improvement in symptoms.
3. IMMUNOTHERAPY
Allergy injections are very effective in preventing seasonal rhinitis. However, there is still room for improvement and researchers are closing in on a modified extract which would allow a safe and rapid improvement in allergic disease. This would be truly be preventative therapy.
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Allergic Rhinitis May Cause Children to Have Sleep Problems
There are many forms of sleep problems experienced by children: restless sleep, waking up in the night, nightmares, snoring, tooth grinding and sleep apnea (temporary stoppage of breathing). When these problems run in the family, they think of mouth breathing, snoring or the other symptoms as normal.
Dr. Richard Bernales, Department of Pediatrics, University of Illinois, identified 100 pediatric patients with allergic rhinitis. He gave questionnaires to their parents asking about sleep problems. Eight-eight percent had sleep problems.
In some cases, neither the child nor the parent was aware that the child’s nose was obstructed because of perennial allergic rhinitis. Allergic rhinitis is underdiagnosed and undertreated and many doctors and parents fail to realize that there are adverse health effects from a constantly blocked nose. The condition can lead to the roof of the mouth becoming V-shaped which in turn leads to crooked teeth requiring orthodontic treatment. The condition also leads to hearing problems including intermittent deafness which can lead to behaviour problems, failure in school and difficulty with inter-personal relationships.
A child that mouth breaths, rubs their nose or has a dullness or circles under the eyes is likely a child with allergic rhinitis. Children with sleep disturbances should be checked to see if they have problems with allergic rhinitis.
© Allergy/Asthma Information Association 1995
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