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Patient Information

Allergic rhinitis in children

https://kingstonhospital.nhs.uk/information/allergic-rhinitis-in-children

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This gives you information on allergic rhinitis and how you can help your child with their allergy.

What is allergic rhinitis?

Allergic rhinitis is the inflammation of the inside of the nose.  It is caused by an allergen (something your child is allergic to). Common allergens are pollen, dust, mould and some animals.

Allergic rhinitis happens when your child’s body reacts as though these allergens are harmful. This means your child’s body produces allergic antibodies (a protein that fights bacteria) to ‘get rid of’ these allergens.

If this happens, it causes chemicals to be released in your child’s body which trigger the symptoms of allergic rhinitis.

Most children have mild symptoms (see the What are the symptoms? section). These can affect their sleep, play and school activities. Fortunately, most symptoms can be treated easily and effectively.

Types of allergic rhinitis

Seasonal allergic rhinitisYour child’s symptoms appear at particular times of the year.

They can be caused by an allergic reaction to pollen from grass, trees and weeds during the early spring and summer months. This type of allergic reaction is known as hay fever.

Hay fever usually affects children over 5 years, but sometimes younger children can be affected. The severity of symptoms varies, but is usually worse if there is a high pollen count.
Perennial allergic rhinitisYour child’s symptoms appear all year round.

They are usually triggered by an allergy to things that your child might be exposed to at any time of the year. These can include house dust mites, pets (including birds), or mould.

What are the symptoms?

Child with tissue

The symptoms include the following:

  • itchy eyes or throat
  • sneezing, blocked or runny nose
  • watering, red eyes (also known as allergic conjunctivitis)
  • headaches, blocked sinuses
  • shortness of breath
  • tiredness
  • the feeling of mucus running down the back of the throat (often called ‘post nasal drip’).

How do you know my child has allergic rhinitis?

Your GP usually makes a diagnosis.

They ask you and your child about their allergy symptoms and triggers.  They also examine your child’s nose, eyes and throat.

Occasionally allergy tests are performed in hospital if the diagnosis is unclear. For example skin prick tests to find out what allergens might be causing symptoms of allergic rhinitis.

Why is it important to treat allergic rhinitis?

It is important to treat allergic rhinitis because it is uncomfortable for your child and may make sleep and concentration difficult.

If left untreated it can also make other conditions (such as asthma) much worse.

What is the treatment?

The following measures can be effective and improve your child’s quality of life.

Avoiding allergens (an allergen is a trigger that causes an allergy)

It is important for your child to avoid allergens.  Tests can be useful to find out which allergens might cause your child to have symptoms of allergic rhinitis. It is relatively easy for your child to avoid some allergens, but it may be difficult for them to avoid other allergens.

Pollen

It can be difficult to avoid exposure to pollens. Try some of the following tips to see if they help.

  • Check weather reports for the pollen count and try and keep your child indoors if the count is high.
  • If possible, avoid letting your child going out on windy days or after thunder storms.
  • Ask your child to wear sunglasses to protect their eyes.
  • On high pollen days, suggest that your child showers when they get home.  It will also help if they rinse their eyes often with free-flowing water.
  • Keep your child inside if the grass is being mown.
  • If your child is sensitive to particular weeds or trees growing outside their bedroom window, have them removed. You can replace them with low allergen plants.
  • Avoid taking your child on picnics in parks or open grassland during the pollen season.
  • Keep windows closed at home and in the car. If possible, use re-circulating air conditioning in the car.
  • Try to plan family holidays out of the pollen season, or holiday at the seaside.
  • Don’t dry your children’s clothes or bedding on a drying line outside when the pollen count is high.
Pets

Allergic reactions caused by pets are triggered by exposure to the pet’s dead skin, saliva and urine – not the pet’s fur.

It is easy to avoid some animals, such as horses and other people’s pet cats or dogs. Families are understandably reluctant to give away their own pets when they cause allergic symptoms.

If you cannot permanently remove a pet from your home, the following tips might be helpful.

  • Keep pets outside as much as you can, or limit them to one room in the house, preferably one without a carpet.
  • Keep pets out of bedrooms.
  • Wash pets once a fortnight.
  • Groom dogs outside.
  • Wash bedding and soft furnishing if the pet has spent time on it.
House dust mites

House dust mites are microscopic insects which breed in household dust. They can be difficult to control. You can do the following to limit the number of dust mites.

  • Use anti-allergenic mattress and pillow covers.
  • Regularly clean cushions, soft toys, soft furnishings and carpets.
  • Use synthetic pillows or blankets instead of woollen and feather bedding.
  • Use a vacuum cleaner with a HEPA filter.  This helps to reduce dust.
  • Use a damp cloth to wipe surfaces.  Dry dusting can spread allergens.
  • Concentrate on cleaning areas in the home which are used most frequently by your child.
Mould spores

Mould releases spores (cells) which can cause allergy. Moulds can grow outdoor (on rotting leaves) or indoors (where there is excessive moisture). Moulds favour damp, musty conditions.

Do the following to help prevent these conditions from causing mould.

  • Keep your home dry and well ventilated.
  • When cooking and using the bath or shower keep internal doors shut to stop moist air spreading.
  • Use extractor fans.
  • Avoid drying clothes indoors or packing clothes or bedding too tightly in cupboards.
  • Don’t ignore damp and condensation at home. Seek advice on how to tackle it.

Medical treatment

Most medical treatment suggested here needs a prescription from your GP.  Always ask your GP for advice and treatment if necessary.

Oral (by mouth) antihistamines
  • Antihistamines are the best known type of allergy medication. Chlorphenamine (brand name Piriton) is available from a pharmacy without prescription for children above the age of 1 year.
  • Antihistamines used to have a reputation for making people drowsy, but many modern antihistamines are non-sedative and safe to use.
  • Cetrirzine and loratidine are examples of non-sedating antihistamines which can be bought from a pharmacy, without prescription, for children above the age of 2 years. Be aware that some branded versions of these medicines may advise restricting use to children who are older than 2 years.
  • Your child needs to take antihistamines regularly during the pollen season to ensure that they work properly, even if your child seems to be symptom-free. This is because your child might seem OK in the morning but may develop allergy symptoms later in the day.
Nasal sprays

Nasal sprays deliver antihistamines or steroids directly to the nasal passages (the passages of the nose).

Nasal antihistamines

  • These help with symptoms of itching and sneezing, but they should only be used for short periods of time.

Steroid nasal sprays

  • These are used to control inflammation in the nasal lining and can help relieve eye symptoms. They are the most commonly used option for regular use during the season when your child has the most symptoms.
  • They are rarely used for children under four years old.
  • They can take several days to work properly, but once they do, they are effective at reducing allergic rhinitis symptoms caused by airborne allergens.
  • This medication is particularly useful if the child starts using it before they are exposed to allergens. For example, children with allergic rhinitis will gain most benefit if steroid sprays are started a few weeks before the pollen season.
  • Remember to read the instructions on the medication packet and follow them closely.
Eye drops
  • Eye drops can be particularly useful if eye symptoms are one of the main symptoms of allergic rhinitis.
Immunotherapy
  • Immunotherapy is a specialist treatment that aims to stop the immune system from treating allergens as a threat.  It is only used when all other treatments have failed.
  • Immunotherapy is prescribed for children with severe types of allergic rhinitis who are not responding to maximum medical treatment. It is also prescribed for children who have an allergy combined with hard-to-control asthma.
  • Immunotherapy cannot be prescribed by your GP.  It is only used in a hospital with a specialist allergy department.

More information

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Itchy Sneezy Wheezy Project information on allergic rhinitis
https://www.itchysneezywheezy.co.uk/RhinitisVideos.html

NHS information on hay fever
https://www.nhs.uk/conditions/hay-fever/

Allergic rhinitis in children - Kingston Hospital Download PDF


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