Rhinitis

There are many types of both non-allergic and allergic rhinitis.

A virus or bacteria can cause non-allergic rhinitis. The common cold is an example of viral rhinitis. Expose to harsh chemicals, spicy foods or weather changes and even stress can also cause this condition.

In allergic rhinitis the inflammation in your nose is caused by an allergic reaction to things like pollen, dust, mould or animal fur. Hay fever is seasonal allergic rhinitis.

Symptoms of both non-allergic and allergic rhinitis may include:

• Runny and blocked nose
• Sneezing
• Itching, watery eyes

Symptoms can often be persistent causing sleep problems and impact on daily activities.

Children with rhinorrhoea

Rhinorrhoea - nasal discharge or runny nose - can impact a child's sleep quality. Such children can have reduced school attendance and academic performance. Some studies show that children who suffer rhinitis are at increased risk of developing asthma.

What are the causes of rhinorrhoea in children?

• Allergic rhinitis is due to an allergy to house dust, house dust mites, trees and grass pollens, cat and dog dander and moulds. It is estimated that up to 40% of children are affected by allergic rhinitis.
• Infective rhinitis is usually caused by respiratory viruses. Other causes are bacterial and fungal.
• Non-allergic rhinitis can be idiopathic (unknown cause), vasomotor, hormonal, medications related, ciliary problems (Primary Ciliary Dyskinesia), cystic fibrosis, immune deficiency etc.

What are the symptoms of rhinitis in children?

• Nasal discharge (rhinorrhoea ) – clear, yellowish/greenish. In children, yellowish secretions from only one side of the nose can mean that something is stuck in the nose such as a plastic bead, lego, paper bits etc. If these symptoms are observed, seek an ENT doctor for examination.
• Nasal blockage – very rarely in children rhinorrhoea could be due to nasal polyps. However, the presence of nasal polyps in children raises suspicion of cystic fibrosis.
• Sneezing, stuffy nose, postnasal drip, itchy eyes – associated with allergic rhinitis (Hay fever). Postnasal drip is the sensation of mucus trickling down the back of the throat and can cause children to cough at night.
• Fever, headache and cough in case of bacterial rhinitis (Often called rhinosinusitis)
• Snoring and sleep apnoea – the possibility of enlarged adenoids

What are the available tests?

If the child has associated snoring and sleep apnoeas, there could be adenoid enlargement. Adenoids are tonsil like tissues that sit at the back of the nose. They can harbour bacteria and cause nasal discharge. This is diagnosed using a camera test in an outpatients clinic (flexible nasal endoscopy).

There are blood tests for allergy (RAST IgE). For children older than 6 years, skin prick testing is available. For skin prick testing, it is important that they do not use any antihistamines up to 5 days before the test.

Blood tests for checking immune function (IgG, IgA, IgM levels, complement levels, functional antibodies to H. Influenza/Pneumococcus).

Vitamin D levels – Vitamin D has been shown to have an immunomodulatory effect with a significant impact on immune function.

Treatment:

The majority of children with runny noses are well in themselves. They carry on with their normal activities. It is usually the parents or teachers that get concerned about this condition as they see the children often run around with leaky noses.

Medical treatment:

• Paediatric saline nasal spray (Sterimar nasal spray / Neilmed Sinurinse) – This helps to eliminate inflammatory proteins, bacteria and allergens from within nose and sinuses.
• Regular antihistamines (cetrizine, Loratidine etc)
• Antibiotics if there is an active bacterial infection
• Steroid nasal sprays (Avamys, Nasonex). Over-the-counter decongestant nasal sprays are not recommended. The latest addition to nasal spray (Steroid plus antihistamine) is Dymista (only for children over 12 years of age)
• Immunotherapy – (Oral/Sublingual) This is desensitisation and it involves administration of gradually increasing doses of allergen extracts over a period of years, given by injection or drops/tablets under the tongue

Surgical treatment:

• Adenoidectomy if the child has enlarged adenoids (please refer to Patient Information Leaflets
• Minimal endoscopic sinus surgery (Paediatric FESS) if associated with rhinosinusitis
• In some cases, Coblation Turbinoplasty is recommended to help with breathing.