Reaction to wind-borne pollens of grasses, trees, and weeds leads to seasonal allergic rhinitis, and reaction to house dust mite allergen, pet dander, or mold spores results in perennial allergic rhinitis. The infiltration of such cells characterizes the allergic inflammatory response associated with late-phase responses and bronchial or nasal hyper-reactivity. Symptoms is include chronic recurrent sneezing, nasal congestion, clear rhinorrhea, and pruritus of the nose, eyes, ears, and soft palate. Usually, allergic symptoms immediately follow (within 20 minutes) exposure to the off ending allergen. Perennial rhinitis allergic, with chronic rather than intermittent exposure to allergen, results in significant chronic nasal congestion, sniffing, and snoring but less sneezing than in seasonal rhinitis (which occurs mainly in the morning on awakening). Associations between exposure and onset of symptoms are often less clear in perennial allergic rhinitis. Often, patients with allergic rhinitis have a personal or family history of asthma or atopic dermatitis. A geographic tongue is also common in atopic patients. Digital clubbing, which occurs in infants with severe chronic lung diseases (CLDs) (eg, cystic fibrosis), does not generally occur in infants with an allergy.
Specific allergens to which infants are allergic can be identified by (immediate in the clinic lab) skin tests or by in vitro measure of serum allergen-specific. Elevated serum suggests the presence of allergic disease (the clinicians will tell all to parents about results). Several conditions may be confused in differential diagnosis and the treatment must be individualized.
Disease severity varies very, and the clinician will assess its impact on infants or children before embarking on therapy, especially because some children (and parents) with severe allergic rhinitis often prescribe prescribed medical therapy. Treatment modalities include avoidance of allergens, pharmacologic therapy (systemic and topical therapy), and allergen immunotherapy. Antihistamines (H1 antagonists), which are safe and effective medicines for the treatment and prevention of allergic reactions, are particularly useful in controlling the symptoms of sneezing, nasal pruritus, and rhinorrhea. Although diphenhydramine (Benadryl) and hydroxyzine (Atarax) are extremely effective in relieving acute allergic reactions, these should be avoided in infants and children with allergic rhinitis because they are especially sedating. Topical nasal steroids (mometasone [Nasonex], fluticasone [flonase], budesonide [Rhinocort], beclomethasone [Beconase], and ciclesonide [Omnaris]) are the most effective pharmacologic agents for the treatment.
Allergen immunotherapy, which involves the subcutaneous administration of increasing doses of allergen, is highly effective and safe in infants and children with allergic rhinitis in whom specific allergens (inhalant allergens and bee venom) are identified. Because of the cost in terms of time and pain, allergen immunotherapy is generally reserved for children older than 5 to 6 years of age with moderate-to-severe allergic rhinitis.
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