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ALLERGIC RHINITIS
IN CHILDREN
Rifan Fauzie
Pediatric Respirology Division
Harapan Kita Women and Children Hospital
Jakarta
 Runny nose

Sneezing/
Nasal sound
itching

Common
problems in
Nasal
blockage pediatric Sore throat
respiratory
tract

Smell Throat
disturbance clearing
Hoarse-
ness
INTRODUCTION
• Allergic rhinitis affects up to 40-42% of children but is commonly
undiagnosed
• Frequently disregarded by clinicians
• Impacts :
• reduce quality of life (QoL)
• impair sleep
• reduce school performance and attendance
• causes bronchial hyper-reactivity
• can progress to asthma

Scadding GK. Paediatrics And Child Health 2008;18:7

INTRODUCTION
• Rhinitis means inflammation of the nasal lining
• Allergic rhinitis : IgE-mediated
• mast cell degranulation
• mediator release
• ingress of inflammatory cells
• Cardinal symptoms :
• nasal itching
• sneezing
• rhinorrhoea 1. Turner PJ, Kemp AS. Journal of Paediatrics and Child Health 2012;48: 302–310
• congestion 2.
3.
Ibero M, et al. Allergol Immunopathol (Madr). 2011
Scadding GK. Paediatrics And Child Health 2008;18:7
THE FUNCTION OF NASAL
1. The gate of the airway
2. Air filter
3. Air humidity regulator
4. Air temperature regulator
5. Smell sensation
6. Sound resonance
Anatomy of the nose
UPPER AIRWAY DEFENSE MECHANISMS
• Respiratory tracts are protected by a mucociliary layer

 columnar, ciliated epithelial cells and goblet cells bathed in mucus

• Foreign particles are trapped in the sticky layer of mucus, and ciliary action propels
the entire mucous layer out of the sinuses toward the nasopharynx

Rabago D, Zgierska A. Am Fam Physician. 2009;80(10):1117-1119

Foreign • Debris, microorganism
particles

Sticky mucus • Trapped

Propels
• Mucocilliary
toward the clearance
nasopharynx

Rabago D, Zgierska A. Am Fam Physician. 2009;80(10):1117-1119

PATHOPHYSIOLOGY
DIAGNOSIS
• Detail history & physical examination
• Nasal and palatal itch together with conjunctivitis
• Rhinorrhoea anterior or posterior (post nasal drip)
• Hyposmia
• Conjunctivitis
• Mouth breathing  nasal obstruction
• Allergic crease : horizontal nasal crease
• Allergic salute : constant rubbing of the nose
Allergic salute
Allergic shinners
Mahr TA, Sheth K. Pediatrics in Review 2005;26:284-9
DIAGNOSTIC TOOLS
• Nasal smear for eosinophils is suggestive but not pathognomonic

• Specific IgE

• Skin Prick Test (SPT)

Mahr TA, Sheth K. Pediatrics in Review 2005;26:284-9

MANAGEMENT
• Avoidance  remarkedly effective
• Nasal douche  normal saline, seawater saline
• Antihistamine  effective for histamine-related symptoms (itching,
rhinorrhoea and sneezing), but not for nasal blockage, which is
predominantly caused by other mediators
• Topical : steroid, antihistamine, decongestant
• Intranasal steroids are the most effective treatment
Scadding GK. Paediatrics And Child Health 2008;18:7
NASAL SALINE IRRIGATION
Mechanism Of Action
• The exact mechanism of action is unknown
• Improve nasal mucosa function through :
◦ direct cleansing
◦ removal of inflammatory mediators
◦ improved mucociliary function  increased ciliary beat frequency
SIDE/ADVERSE EFFECTS
• Appears safe, with no studies reporting serious adverse
events
• Minor adverse effects are common :
◦ a sense of discomfort and nervousness during the first use
◦ < 10 % of self-limited ear fullness, stinging of the nasal mucosa &
epistaxis (rare)
◦ Adverse effects were ameliorated with technique modification
• Similar adverse effects occurred with spray & liquid saline

Rabago D, Zgierska A. Am Fam Physician. 2009;80(10):1117-1119

CONCLUSIONS
• Allergic rhinitis is an airway problem that can decrease children’s QoL
• Comprehensive approach and the awareness of the impact of allergic rhinitis to
children’s health will minimize the undiagnosed
• Therapy to overcome the problems needed as much as safety and efficacy issue
• Nasal saline irrigation has advantages in releasing some upper airway problems
in children including in allergic rhinitis
• Nasal saline irrigation is a safe procedure, convenient, and minor adverse effects
THANK YOU