Paeds Allergic rhinitis

Question 1

What is allergic rhinitis?

Answer 1

An IgE-mediated inflammation (Type 1 hypersensitivity) of the nasal mucosa caused by exposure to allergens, presenting with symptoms like sneezing, nasal congestion, rhinorrhoea, and itching

Question 2

What are the main symptoms of allergic rhinitis in children?

Answer 2

Sneezing, nasal congestion, clear rhinorrhoea (runny nose), nasal itching, postnasal drip, reduced sense of smell, and sometimes itchy/watery eyes

Question 3

What are common triggers for allergic rhinitis?

Answer 3

Pollen (seasonal), house dust mite, animal dander, mould spores, and other environmental allergens

Question 4

What is the first-line pharmacological treatment for mild allergic rhinitis in children?

Answer 4

Non-sedating oral antihistamines (e.g., cetirizine, loratadine)

Question 5

What is the first-line pharmacological treatment for moderate to severe or persistent allergic rhinitis?

Answer 5

Intranasal corticosteroid sprays (e.g., beclometasone, fluticasone, mometasone)

Question 6

When are both antihistamines and intranasal corticosteroids used together?

Answer 6

For moderate/severe symptoms not controlled by monotherapy, or when both nasal and eye symptoms are significant

Question 7

When should a child with allergic rhinitis be referred to a specialist?

Answer 7

If symptoms are not controlled with maximal medical therapy, if diagnosis is uncertain, for consideration of allergen immunotherapy, or if there are complications such as recurrent nasal polyps, recurrent infections, or multisystem allergy

Question 8

What are red flags for urgent ENT referral in allergic rhinitis?

Answer 8

Unilateral symptoms, blood-stained discharge, nasal obstruction with facial pain or swelling, periorbital cellulitis, or suspicion of malignancy