ENT surgeons are the undisputed ‘Rulers of Snot’, so we focus mainly on Allergic Rhinitis, or AR, more commonly known as ‘hayfever’. AR is part of a group of disorders known as ‘atopy’, which also includes asthma and eczema.
Personally, I dislike the term ‘hayfever’. It seems to trivialize the relentless morning sneezing, facial itch, nasal congestion, embarrassing sniffing and the swollen red eyes of a ‘bad day’ with allergic rhinitis.
So instead, I ask ‘is your child an itchy, scratchy, sneezy sort of kid?’
It’s a phrase I learned from a talented Brisbane ENT, Dr Jonathon Askew, who has a gift for making complicated things seem easy. It works a treat to differentiate those kids with AR needing treatment from those who are on the sometimes-sniffly end of ‘normal’.
To the parents who have to stop and think about it, relax! Your kid is probably ‘sniffly normal’ and going through a bad patch. To be occasionally itchy, sneezy, or snotty is normal, (and medicating normal kids long-term is bad medicine, plain and simple).
My advice? Throw a Kleenex (and perhaps an antihistamine) at ‘em and move on!
But for the parents of truly atopic kids, the answer is usually an emphatic ‘YES!’… Followed closely by, ‘She’s always been like this! / It’s horrendous! / His teachers all complain about the sniffling. / It drives us CRAZY! / He gets such a sore, red nose. / He gets teased dreadfully. / She is TERRIBLE in the morning. / We can’t go to Grandpa’s anymore, because of the cats.’
WHY DOES IT HAPPEN?
Humans are great. We’re fascinating and impressive creatures. But at the heart of it, we’re just sophisticated tubes. Stuff goes in one end and comes out the other while we go about living our daily lives.
The ‘stuff’ going in, however, is more than simply food, drink and air because the lining of the nose, mouth, and throat also provides endless ‘points of entry’ for dusts, moulds, particles and proteins. With each breath, and each mouthful, we internalise a tasty selection of ‘earth flora’ that is filtered, sampled and presented to our ever-curious immune system – before being covered in slime then swallowed, sneezed or spat out. Yum.
The main players in AR are the nasal ‘turbinates’ – fleshy filters that span the side walls of the nose, about the size and shape of a cigarette. Turbinates are the unsung heroes of the face. Ain’t no one staring deeply into them, or singing songs about kissing them but in a single breath they warm the coldest, driest air to body temperature, moisten it and clean it up for delivery to the lungs. They swell and shrink in turn, letting one nasal airway work while the other one rests (remember feeling blocked on one side, then the other?). They swell and weep when infected, and trap irritating particles to expel all over your work colleagues via the irrepressible sneeze reflex. They get really unhappy with the hormones of pregnancy, and very generously accept some of that fluid from your poor swollen feet when you finally lie down after a long day at work. Any of this sounding familiar?
When you consider the ‘normal’ behaviour of the turbinates, it is easy to see how an over-zealous immune response can lead to the misery of allergic rhinitis.
Intractable sneezing? Can do.
Irritated, itchy, relentless running nose? No worries. Gritty teary eyes? Heck, let’s get the neighbours involved too.
ALLERGIC RHINITIS: WHAT CAN YOU DO?
The first thing to know is that, just like asthma, diabetes and eczema – AR is a ‘medical’ condition… That is, you can’t just ‘cut it out’ with surgery, and while there are treatments, there is no cure*. (*more on this later)
Frequently, the particles AR sufferers are allergic to are multiple, and can hard to avoid. So although ‘desensitization therapy’ can provide a ‘cure’ for the toddler with nut anaphylaxis, for the sniffly ‘tween allergic to Grandad’s cat, grass, pollen, House dust and the mould in Mrs Smith’s roof, you are going to need realistic expectations, some ‘At-Home’ measures and some medications to achieve control.
A blood test can demonstrate exactly what your child is allergic to… But all good doctors know that blood testing kids is no party. So, as the heavyweights in AR are usually house dust, animal dander and (where we live) pollen – I usually encourage families to tackle these ‘likely’ allergens first.
Young or old, I engage the kids to do their bit. Owning back the bedroom soft furnishings lies at the core of damping down dustmite AR. Show them some cute, minimalistic Scandi bedroom designs and get about redecorating.
That army of soft toys? Out. Tell the kids to choose their favourite three, but the rest need to go ‘on holiday’ into a sealed storage box. The three they choose need to ‘go swimming’ (set the washing machine cycle to hot – at least 60 degrees), then once dry they ‘go camping’ in the freezer overnight. Decorative cushions, rugs, mats and blankets? Same rule – a favourite can stay but out with the rest.
Keep ‘dust collector’ knick-knacks to a minimum, and encourage kids to get involved in keeping bedroom dust levels low. A moist sock worn like a sock-puppet provides a quick and easy way for older kids to help – tell them to moisten the sock under water, put it on their hand, then run it over all their bedroom flat surfaces. With a bit of music, removing settled dust every evening together becomes a fun bedtime ritual.
Pets need to stay out of the bedroom, and for proven ‘dust-allergics’ not responding to simple measures, you may want to consider removing carpets and polishing up those lovely floorboards, and replacing curtains with blinds.
If spring winds upset your child, get familiar with monitoring the pollen count on your local council website – and avoid hanging your linen and their clothes on the outdoor clothesline on high pollen count days.
I usually recommend an early ‘therapeutic trial’ of a nasal steroid spray for AR sufferers. Where ‘non-nasal’ symptoms like facial itch and ocular symptoms are troublesome, I frequently add an oral antihistamine syrup. As nasal steroids work best when sprayed regularly, I encourage parents to tape the bottle to their kids’ toothbrush, and make it part of their morning routine.
If you’ve done the above and your child’s allergic rhinitis is still poorly controlled, it’s time to get the specialists involved. Your GP will be able to recommend an ENT surgeon and/or an allergist they trust who will guide you in further diagnostic, medical and surgical options.
Yours in Better Health,
Dr Kristy Fraser-Kirk @EvolveENT
Ear and Hearing Surgeon / ENT Surgeon
Bubs, Boogers and Beyond:
Making Medicine Make Sense
Issue 1: Got an ‘itchy, scratchy, sneezy’ kid? Getting to know Allergic Rhinitis.