In fact, allergic rhinitis also has the four typical “cold symptoms” of itchy nose, sneezing, runny nose and nasal congestion, so it is not so easy to be recognized. Therefore it is more easily confused with a cold. So what exactly is allergic rhinitis? And how can it be distinguished from a cold?
Allergic rhinitis is a series of nasal symptoms caused by IgE-mediated inflammatory responses in the nasal mucosa after allergic individuals are exposed to allergens, including nasal congestion, runny nose, sneezing, and nasal itching. Allergic rhinitis in children can be divided into perennial and seasonal, with perennial being more common. In children with perennial allergic rhinitis, symptoms can accumulate for more than 0.5 to 1 h daily during the days when they have symptoms. Because the child’s complaints and clinical symptoms are often described by the parents on their behalf, their subjective feelings are often not accurately described and thus are often missed or misdiagnosed in children as upper respiratory tract infections and inappropriately treated with antibiotics.
Etiology: The most common allergens in infants are dust mites, animal dander, hair, saliva, urine, poultry feathers, etc.; in young children, food can also cause allergic rhinitis, with eggs and milk being the most common, nuts, fish, shrimp and crabs may also be the cause; in preschool and school-age children, pollen and fungal spores are gradually increasing as allergens. Some other irritants including fumes, paints, perfumes, odors, insecticides, deodorants, etc. can be the cause of allergic rhinitis in children.
History: Previous symptoms of itchy nose, sneezing, runny nose and nasal congestion. The individual has an atopic constitution and may have allergic diseases such as eczema, atopic dermatitis, allergic conjunctivitis, and asthma. There may also be a history of allergic rhinitis and bronchial asthma in first- and second-degree relatives. There is a causal relationship between symptom onset and possible triggering factors.
Clinical manifestations: The four main symptoms are nasal itching, sneezing, nasal discharge (clear runny nose) and nasal congestion (blockage), and the vast majority have three or more symptoms, but they are mostly atypical in small infants. Nasal itching is a characteristic manifestation of allergy, and the affected children constantly pick their noses with their fingers or palms or rub their noses, and many of them often make movements such as distorting their mouths and shrugging their noses because of nasal itching. Sneezing is mostly obvious in the early morning after waking up, and can be several or even dozens of times in a row.
The nasal discharge is clear water-like, and in very few children, nasal discharge may be the only symptom, but if secondary infection occurs, the nasal discharge may be mucous or purulent. Nasal congestion often changes with position, and children often have to open their mouths to breathe. Coughing can be the main clinical symptom of allergic rhinitis in children because of the backward flow of nasal secretions containing multiple mediators to the pharynx.
Allergic rhinitis in children has certain specific signs that can be important diagnostic clues, including “allergic dark circles” or “allergic shiner” (allergic shiner, a dark gray-blue ring of shadows and folds visible under the child’s eyes), “allergic salute” (allergic salute), and “allergic rhinitis” (allergic shiner). “allergic salute” (allergic salute), “allergic twitch” (allergic twitch), and the appearance of “allergic nasal crease” (allergic crease). Common comorbidities allergic bulb and blepharoconjunctivitis: there may be itching and tearing of the eyes, or with conjunctival congestion and edema. Sinusitis: Allergic rhinitis is often associated with sinusitis and can be present in infants and children. Nasal polyps: rare in children.
Regarding the treatment of allergic rhinitis, avoiding allergens, especially clear or suspected allergens, is the most effective treatment. It can also be combined with medication, such as: antihistamines, glucocorticoid nasal sprays, leukotriene receptor antagonists, mast cell membrane stabilizers, anticholinergics, decongestants, etc. Allergic rhinitis is a type I allergic reaction, that is, a rapid-onset allergic reaction.
Patients with this disease can be temporarily relieved by the use of antihistamines and other drugs, but the underlying cause of the disease cannot be eliminated, and adverse reactions of varying degrees can occur. Desensitization therapy can eliminate the underlying cause of allergic rhinitis and is currently one of the most effective treatments for the disease. The following is a brief description of desensitization therapy.
Desensitization therapy, also known as specific immunotherapy, is a treatment method in which the antigenic substance of the major allergens that cannot be avoided in life is made into a leaching solution, and then this leaching solution is given to patients with allergic rhinitis as a subcutaneous injection in gradually increasing doses and concentrations. By repeatedly injecting this leachate into patients with allergic rhinitis, it can promote the production of antibodies in their bodies, thereby improving their immune reactivity and reducing their clinical symptoms.
The duration of treatment with this method for patients with allergic rhinitis is long (the total course of treatment is about 2 to 3 years), but the final results achieved will be more satisfactory. After effective desensitization, the patient will not develop the disease when exposed to the allergen again, or will develop the disease but the symptoms can be greatly reduced. Moreover, desensitization therapy can effectively prevent allergic rhinitis from developing into asthma, which is difficult to achieve with drug therapy. Therefore, patients with severe or frequent allergic rhinitis should undergo desensitization therapy as early as possible to better control their condition.
Desensitization therapy mainly includes subcutaneous drug injection therapy and sublingual drug therapy. Patients with allergic rhinitis can choose these two therapies according to their condition.
A. Which allergic rhinitis patients are suitable for the desensitization therapy of subcutaneous injection of drugs?
1. Patients who are frequently exposed to allergens and have frequent attacks.
2.Patients suffering from seasonal allergic rhinitis (such as pollen-phase allergic rhinitis).
3.Patients with lower respiratory tract symptoms such as suffocation and shortness of breath after contact with allergens.
4.Patients whose condition is not effectively controlled after the use of antihistamines and moderate doses of intranasal glucocorticoids.
5. Patients who do not wish to undergo long-term drug treatment.
6.Patients who have severe adverse reactions after drug treatment.
7.Patients who have developed asthma or are likely to develop asthma.
Which allergic rhinitis patients are suitable for the sublingual desensitization therapy?
1.Patients who are allergic to mites and pollen.
2.Patients who have failed to control their condition effectively after drug treatment.
3. Patients who have experienced systemic adverse reactions during the implementation of subcutaneous drug desensitization therapy.
4. Patients who have poor compliance with desensitization therapy with subcutaneously injected drugs.
At the same time, domestic and foreign experts agree that desensitization therapy should be contraindicated in patients being treated with beta-blockers, patients with other immune diseases or malignancies, patients with poor compliance to treatment (e.g., those with psychiatric disorders), and women during pregnancy. In addition, patients with allergic rhinitis should pay attention to the following matters during desensitization therapy.
①Desensitization treatment must be carried out in a regular hospital and a specialist should be asked to draw up the dose, number, site and method of desensitization injections.
② Pay attention to keeping warm when the temperature changes (especially pay attention to the warmth of the head), and pay attention to adjusting the temperature and humidity of the living room.
③Should maintain a happy and relaxed mood.
④Physical exercise and nasal massage should be insisted on to strengthen the immunity of the whole body and the nose.
In addition, Chinese medicine also has a very good effect in the treatment of allergic rhinitis, in the acute attack period to give drugs suction nasal method and nasal plugging method to relieve nasal congestion and other symptoms; in the remission period to take Chinese medicine decoction can also be through the overall identification, regulate the function of the internal organs to start, to achieve the purpose of the cure, there are good results. Usually life can also be assisted by some food therapy to improve the body, such as.
1. white onion and red dates chicken porridge: 10 red dates (remove the core), white onion 5 stems, chicken with bones 100 grams, 10 grams of coriander, 10 grams of ginger, 100 grams of round-grained rice. Boil round-grained rice, chicken, ginger, red dates first, and then add white onion and coriander to the porridge, seasoning to take, once a day.
2. Gods porridge: 6 grams of ginger, 6 white onions with beard, 60 grams of glutinous rice, 10 ml of rice vinegar, first wash the glutinous rice and cook with ginger, when the porridge is cooked, put in the white onions, and finally into the rice vinegar, and then cook a little to eat.
The prevention of pediatric allergic rhinitis is quite important.
A. Avoiding allergens
The most fundamental health care measure for pediatric allergic rhinitis is to understand the substance that causes your child’s allergy, i.e., the allergen, and try to avoid it. When symptoms occur mainly outdoors: outdoor activities should be limited as much as possible, especially contact with flowers or decaying leaves or willow, and you can wear a mask when you go out, or you can go to a beachfront with fewer allergens.
When the symptoms of pediatric allergic rhinitis occur mainly indoors, the following points can be noted.
1. If the child is allergic to fur or mites, remove all down pillows and duvets, vacuum the environment at home instead of sweeping the floor with a broom, and open the bedroom doors and windows frequently to keep the air fresh and flowing;
2. If you are allergic to chemical gases, you should pay special attention to the decoration of your home environment and try to use green decorative materials;
3, if the allergy is very strong, you can use anti-allergy drugs, there are local and systemic, about 2 years old children can use local nasal spray; endosulfan, Renocort, Burke sodium, etc.;
4.If allergic rhinitis is induced after a cold, the main thing is to exercise physical fitness and reduce the cold, which can also play a preventive role;
5. If the allergy is seasonal, for example, children will have allergic symptoms in September and October, it is best to take preventive treatment a month or two in advance, so that even if allergic rhinitis occurs, the symptoms will be much reduced.
Anti-allergy medication for pediatric allergic rhinitis
The actual allergic rhinitis is basically similar to that of adults, which are all hormonal drugs that are prone to drug resistance. The medication will not only fail to solve the rhinitis problem, but will also bring about the toxic side effects of the medication. In particular, the internal organs of adolescents are not yet mature, and the damage caused by drugs to internal organs should not be ignored. Taking a particular anti-allergy drug for a long time and in large doses will not only make the drug ineffective, but also cause adverse reactions.
There is a wide variety of anti-allergy drugs and their indications are not the same. Therefore, when choosing anti-allergic drugs, antihistamines should be given priority, but do not take a particular anti-allergic drug for a long time and in large doses, otherwise it will not only make the drug ineffective, but also cause adverse reactions and even lead to death.
① Benadryl: This drug is widely used for pruritic allergic diseases, such as urticaria and atopic dermatitis. Its adverse reactions are commonly dizziness, drowsiness, lethargy, occasional rash, and long-term application for more than 6 months can cause anemia.
② Paracetamol: compared to Benadryl, its adverse reactions such as drowsiness and dry mouth are mild, but hallucinations and irritability can occur in pediatric overdose. For adults, it is contraindicated in patients with prostatic hypertrophy and pyloroduodenal obstruction. Paracetamol can also induce epilepsy, so it is prohibited for patients with a history of epilepsy, and it is not advisable to drive vehicles or perform highly concentrated work during medication.
③Keratan: Used for acute and chronic allergic rhinitis and other allergic skin diseases. Its adverse reactions are weakness, dry mouth, rash, hematuria, abdominal pain, labored breathing, numbness and other reactions in individual patients.
④Ketotifen: Ketotifen belongs to the inflammatory mediator blocking class of asthma treatment drugs. It can be used to treat allergic rhinitis and allergic dermatitis. Its adverse effects are mainly drowsiness and lethargy, and long-term use can enhance appetite, which can lead to weight gain.
⑤ Cromoglycate: This drug is a preventive anti-allergy drug, mainly used for the prevention of allergic bronchial asthma, or allergic rhinitis, allergic eczema and other diseases. Its adverse effects are symptoms of pharyngeal and bronchial irritation, such as coughing and nausea, and even inducing recurrent asthma attacks. Therefore, pediatric allergic rhinitis requires a reduction in the number of doses given and a gradual reduction in dosage after the drug has taken effect, and it should never be stopped suddenly.
The patch contains medical magnetic powder + pure Chinese medicine extract preparation, which can reduce inflammation and dispel pain, improve discomfort, enhance the body’s cellular vitality, and have a good rehabilitation effect.
Allergic rhinitis patients are better off not touching and feeding pets. Contrary to general knowledge, animal hair mostly does not cause allergies, while proteins in animal dander, saliva and urine tend to cause allergic symptoms, when invisible proteins can enter the human eyes or lungs and nasal cavity through the air. A cat or a dog can produce a large amount of allergic substances every week, so it is important to avoid contact with pets.
In addition, children with allergic rhinitis should pay attention to a proper diet, especially during acute attacks when they should eat less or no food such as fish, shrimp, eggs and milk, beef and lamb, caffeinated beverages, chocolate, cold drinks, stimulating foods, specially treated or processed foods and foods containing artificial colors, vanillin, benzaldehyde, eucalyptol, monosodium glutamate and other food additives. Children with allergic rhinitis eat more of the following foods: more foods containing vitamin C and vitamin A: spinach, cabbage, chard, white radish, etc.; warm foods such as ginger, garlic, leek, cilantro, etc.; glutinous rice, yam, dates, lotus seeds, yiren, brown sugar and cinnamon, etc.
Allergic rhinitis and cold will have itchy nose, sneezing, runny nose and nasal congestion these symptoms, so how to identify the two in the end? The following points can help you distinguish.
1, the cause: allergic rhinitis has the cause of allergy to a substance; the cause of the cold is a viral infection.
2, the onset of the season: allergic rhinitis, also known as seasonal rhinitis, mostly in the spring onset; the onset of the cold all year round.
3, triggers: allergic rhinitis is contact with allergic substances; cold is triggered by cold, fatigue and other resistance to antimicrobial resistance decline.
4, symptoms.
1) Sneezing continuously: allergic rhinitis develops suddenly, often with continuous sneezing, and it is not uncommon to have a dozen sneezes at once; the onset of the cold is progressive and gradually worsens, with inflammation of the nasal mucosa as the main cause, although it also sneezes, but generally does not sneeze continuously, and is mostly monogenic.
2) Itchy nose is more serious: allergic rhinitis itchy nose is more unbearable, it seems like there are always ants crawling in the nose, the baby is young, sometimes will not say, but if you see the baby always scratch the nose should be careful; cold will also have nasal itch, but not as serious as allergic rhinitis.
3) Can’t stop the runny nose: when allergic rhinitis strikes, there will often be a lot of clear water nasal mucus “pouring” down; while the early stage of the cold will also have clear water nasal mucus, but the amount will not be very large.
4) Less general discomfort: colds are often caused by bacterial infections, so they are often accompanied by fever and other general discomfort; allergic rhinitis generally does not have this situation, but mainly local symptoms.
5) Nasal examination: allergic rhinitis nasal mucosa is mainly edema, pale; while the cold is obvious with mucosal congestion and edema.
5) Treatment: Allergic rhinitis is treated with anti-allergic drugs, while the cold is treated with symptomatic treatment without special drugs.
6. Course of disease: allergic rhinitis has a short course, with rapid onset and disappearance of symptoms, but it is prone to recurrence; the cold is a self-limiting disease, generally cured in about a week.
Finally, I would like to add a special mention of allergic cough, which is often seen clinically in children whose families may not know much about this disease. In fact, although allergic cough is a type of asthma, the onset is mild and inhalation treatment with adrenocorticosteroids is not generally acceptable to parents and may not be necessary.
Oral small doses of aminophylline not only have the effect of relieving bronchospasm but also have anti-inflammatory and immunomodulatory effects. It has been reported both at home and abroad that lower concentrations of theophylline (5~10 mg/L) can exert its anti-inflammatory and immunomodulatory effects. Some studies have confirmed that oral administration of small doses of aminophylline can achieve good efficacy in the treatment of allergic cough, which is also based on its pharmacological basis.