Allergic rhinitis: Why allergies are causing your children's nose and eyes to swell

Allergic rhinitis is a common condition that affects one in every 5 people in the UK, and can make dealing with allergies even more difficult. Expert consultant paediatric allergist Dr Helen Brough explains the condition from start to finish in this informative article, including how it can impact daily life.

Can you detail exactly what allergic rhinitis is?

Allergic rhinitis is allergic inflammation of the nose. It can also cause lots of symptoms; you can get allergic rhino conjunctivitis which also leads to inflammation of the lining of the eyes. When you have allergic rhinitis, it can also affect:

• The inside of your ears;
• It can make you feel itchy at the back of your throat, and;
• Your tongue.

It can cause a bit of a cough. It can sometimes make your nose feel very congested; and in some people that have a predisposition towards asthma, can cause them to have an allergic cough. 

Allergic rhinitis is usually due to an inhalant allergen, such as seasonal allergens, grass, pollens, tree pollens or wheat pollens, or mould.

Then there are perennial allergens all year round, such as

• House dust mite, or;
• Cat dander or dog dander, if the family lives with that animal.  

What are the main causes of allergic rhinitis?

The most common cause of allergic rhinitis in the UK is grass pollen allergy. People who have grass pollen allergy usually get itching, sneezing and congestion, alongside problems with rubbing their eyes or nose, between the months of May to the end of July, August. This can be particularly severe on days that the pollen count is high and there are many different apps that can tell you when the pollen count is high.

Secondly, house dust mite allergies. They can cause worsening symptoms in the winter, when there are more house dust mite around, but are generally causing symptoms all year round. Often, house dust mite allergy causes a lot of congestion, feeling like you just can't get rid of a cold and can sometimes lead to headaches, and dark circles under the eyes. That is something that affects a lot of people in the UK, and then after that, it's tree pollen and some of the other allergens such as pet dander allergens such as wheat and mould.    

What are the main warning signs and symptoms?

I'll start with symptoms so the symptoms that people describe in the nose, is that they feel itchy in their nose, they'll sneeze, they'll have a runny nose and their nose feels very congested and blocked. Also, in the back of the throat, they can feel like mucus is trickling down the back of the throat, and they can actually be clearing their throat a lot. A lot of patients will cough to try and clear the mucus from the back of their throat. That's an important symptom. In terms of the eyes, they get very itchy eyes; sometimes the whites of their eyes can get very red, inflamed and swollen, which is very uncomfortable. Then people complained of itching inside the ears and they complain of itching in the back of the throat, and a dry, irritated cough at the back of their throat as well.  

How is it treated? 

There are three aspects to the management of allergic rhinitis. The first is allergen avoidants. Once you know what you're allergic to, then you can effectively manage that and know how to avoid it. There are some very simple things that you can do for grass pollen allergy, for example. A lot of people dry their clothes outside because they think get a nice, fresh smell to their clothes, but if you do that during grass pollen season, and you're allergic to grass pollen, then all the bedding will be covered in pollen and that causes lots of symptoms at night. Another thing is washing your hair after being outdoors all day, because, again, all the pollen will go in your hair and then you'll be lying on that in your bed and rubbing your eyes into the pollen. House dust mite allergy, again, is very important to know about, because house dust mite can live in most of the soft furnishings in the home. It's almost impossible to avoid house dust mite unless you go to very high altitudes. The main way to avoid house dust mite is to buy mattress, pillow and duvet covers that are specifically designed for house dust mite, and they trap the house dust mite inside because the house dust mite live on human sweat, and then the house dust mite die, and the allergen isn't lifted into the air every time somebody moves in the bed. 

That's the first part. The second part is symptomatic treatment. Symptomatic treatment usually comprises of an antihistamine, that should be a non-sedating antihistamine, so not Piriton, and then the gold standard for symptomatic treatment is nasal steroid sprays, because they treat not just the itching and the running, but also the nasal congestion, which antihistamines won't treat.   

For the eyes, there are some very good eye drops that contain antihistamines and other stabilisers for the allergic cells in the eyes. They can be very effective. Those are the three main treatments that we use for allergic rhinitis. Some adjuncts can also be used, like a saline spray before the nasal steroid spray. Those are the main symptomatic treatments.

Finally, the third aspect of treatment is immunotherapy. That is a treatment where people can effectively take drops or tablets under the tongue, for sublingual immunotherapy and there's also subcutaneous therapy available, which are injections, that changes the way the immune system responds to that allergen. So instead of producing allergic antibodies, they'll produce tolerant antibodies. What does, is over a period of time, it reduces the number of symptoms that they get and it reduces how much medication they require. It's also the only treatment that actually alters the cause of disease, so it's usually a three-year treatment course. After that, you can expect to get a five to ten year benefit of having done the treatment. It's a very effective treatment, it's a safe treatment. Sub lingual immunotherapy very rarely leads to significant side effects, usually just some itching and tingling in the mouth. It's something that I very commonly do in my practice.  

When is the condition considered serious?

Allergic rhinitis really can be a very serious condition. There was a study that looked at children that were sitting their mock exams in January, and then compared their results in the peak of the grass pollen season, around May and June. They found that children who had grass pollen allergy during the exam period were likely to drop a grade from their mock exams. If they were taking sedating antihistamines, they were likely to drop two grades. From an educational perspective, it's very important because it can affect your concentration at school, it can affect your sleep and it can also stop you doing the things that you love such as children often going outdoors and doing sports, is something they can't partake in because they have such severe symptoms. 

Allergic rhinitis can also lead to allergic asthma, so some children that pre-disposed towards asthma, can require inhaled steroids during the period of the grass pollen season because what happens that the pollens don't just go into the nose, they can get all the way down into the lungs and then cause the lungs to contract and to have breathing difficulties. Then allergic rhinitis, which is very chronic, can actually lead to sinusitis where you get filling of the air spaces inside the head with fluid and this can become infected. This can lead to headaches and fevers, and feeling very unwell. All of these things are complications, and just to mention that immunotherapy has also been shown to prevent asthma in children that have allergic rhinitis.   

If you think you may be experiencing allergic rhinitis or would like more information, you can book a consultation via Dr Brough's Top Doctors profile.