Managing Severe Allergic Rhinitis in Infants and Young Children

Severe Allergic Rhinitis in Infants and Young Children

Dear Dr.
Hsiao,
Hello! I have two sons, one just turned one year old and the other just turned four.
I have taken both children to see both Western and Traditional Chinese Medicine practitioners, and they have both been diagnosed with allergic rhinitis.
Their conditions are the same, and the adults are also affected, making it difficult for us to rest at night.
Before being diagnosed with allergic rhinitis, my older son had an episode of acute otitis media, followed shortly by a severe throat infection and pneumonia that required a week-long hospitalization.
Both children experience nasal congestion, runny noses, and often have a snoring sound, breathing through their mouths while sleeping, accompanied by coughing that is quite forceful.
My younger son, in particular, has trouble sleeping and tosses and turns.
When using a bulb syringe to clear his nose, no mucus comes out, and he only expels yellow mucus when he sneezes.

Since everyone says that long-term treatment with Traditional Chinese Medicine is less harmful to the kidneys and less likely to cause a cold and weak constitution, the elders in our family have suggested we give both brothers Chinese herbal medicine.
My older son has been taking Chinese medicine for a month, but his nasal symptoms remain unchanged.
The younger son is currently being treated with Western medicine (as he had multiple bowel movements daily while taking Chinese medicine, and I was hesitant to continue it due to his young age), but there has been no improvement either.
At night, he either coughs or has nasal congestion, which makes us very anxious.
I am worried that their symptoms are severe enough to lead to asthma (as their grandmother has asthma).

How long will they need to take medication before their condition improves? Is it possible to cure this condition completely? Is it better to use Chinese medicine or Western medicine? Are corticosteroids or antibiotics used in the treatment with Western medicine? How should we care for them at home? Would using dust mite-proof mattress and pillow covers effectively improve their sleep quality? Which materials currently available on the market are best? (I have heard that there are now pure cotton options available.) Where can I find relevant nursing information (the outpatient doctors and nurses have limited time and do not provide enough detailed information)?
Thank you for your assistance!
A worried mother,
March 12, 2008

Xinji de mama, 30~39 year old female. Ask Date: 2008/03/12

Dr. Xiao Kaiwen reply Pediatrics

Allergic constitution requires persistence and patience to combat.
Children are more likely to change their constitution (unlike adults, who find it more difficult to do so), and there is a possibility for improvement or even complete resolution.
Conversely, if left unaddressed, it may worsen and potentially develop into asthma.
Currently, Western medicine has made significant advancements in the treatment and management of allergic conditions.
Corticosteroids are one of the medications used for treating allergic constitution, and some parents worry about their impact on growth.
However, when used under the guidance of a pediatric allergy specialist, they are considered safe.
In fact, children who remain in a highly allergic inflammatory environment (each allergic episode causes inflammation) may actually experience growth issues.

We are less familiar with traditional Chinese medicine, but approved Western medications undergo rigorous scientific testing before being marketed, providing a higher level of assurance.
In Taiwan, many people are affected by dust allergies, so using dust mite-proof bedding and covers is necessary.
It is advisable to choose well-known brands that are widely accepted for better assurance (but this should be combined with other home care measures for allergic conditions).
With the advancement of the internet, relevant nursing information should be accessible.

Reply Date: 2008/03/12

More Info

Managing severe allergic rhinitis in infants and young children can be quite challenging, especially when symptoms persist despite various treatments. Your concerns about your sons' health are valid, particularly given their history of respiratory issues and the potential for developing asthma, especially with a family history of the condition.

Understanding Allergic Rhinitis:
Allergic rhinitis is an inflammatory condition of the nasal passages caused by allergens such as pollen, dust mites, pet dander, and mold. Symptoms typically include nasal congestion, runny nose, sneezing, and itchy eyes. In children, these symptoms can lead to mouth breathing, sleep disturbances, and even complications like sinusitis or ear infections, as you've experienced with your older son.

Treatment Options:
1. Medications:
- Antihistamines: These are often the first line of treatment for allergic rhinitis. They can help relieve symptoms like sneezing and runny nose. Non-sedating antihistamines (like cetirizine or loratadine) are generally preferred for children.

- Intranasal Corticosteroids: These are very effective for reducing inflammation in the nasal passages and can significantly improve symptoms. Fluticasone and mometasone are examples that are commonly used in children.

- Leukotriene Receptor Antagonists: Montelukast is sometimes used, especially if there are concerns about asthma.

- Decongestants: These can provide temporary relief but should be used with caution and not for extended periods, especially in young children.

2. Long-term Management:
- Allergen Avoidance: Identifying and minimizing exposure to allergens is crucial. This includes using dust mite-proof covers for bedding, regular cleaning, and maintaining low humidity levels in the home.

- Immunotherapy: If symptoms are severe and persistent, allergy shots (immunotherapy) may be considered. This treatment gradually desensitizes the immune system to specific allergens.

3. Complementary Approaches:
- Nasal Saline Irrigation: This can help clear nasal passages and reduce congestion.

- Humidifiers: Using a humidifier in your child's room can help keep the air moist, which may ease breathing, especially during sleep.

Duration of Treatment:
The duration of treatment can vary significantly based on the severity of symptoms and the effectiveness of the chosen therapies. Many children benefit from ongoing treatment, especially during allergy seasons. Regular follow-ups with a pediatric allergist may be necessary to adjust treatment plans as needed.

Home Care:
- Using dust mite-proof covers for pillows and mattresses can indeed help improve sleep quality. Look for covers made from tightly woven fabrics that are breathable, such as cotton or a cotton-polyester blend. These can effectively reduce allergen exposure.

- Regular cleaning of the home, including vacuuming with a HEPA filter and washing bedding in hot water, can also help manage allergens.

Resources for Further Information:
For more detailed information on managing allergic rhinitis, consider consulting reputable sources such as:
- The American Academy of Pediatrics (AAP)
- The American Academy of Allergy, Asthma & Immunology (AAAAI)
- The Asthma and Allergy Foundation of America (AAFA)
These organizations provide guidelines, educational materials, and resources that can help you better understand and manage your children's allergies.

In conclusion, managing severe allergic rhinitis in young children requires a multifaceted approach that includes medication, allergen avoidance, and ongoing monitoring. It’s essential to work closely with healthcare providers to tailor a treatment plan that suits your children’s specific needs and to ensure that their symptoms are effectively managed.

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