Rhinitis is defined as "inflammation of the membrane lining the nose, characterized by nasal congestion, rhinorrhea, sneezing, itching of the nose and/or postnasal drainage".   Allergic rhinitis is defined as mild if there is no sleep interruption, no impairment of daily activities, and no troublesome symptoms.   Moderate-to-severe involves one or more of those factors.  Intermittent allergic rhinitis involves symptoms for fewer than 4 days per week or for a duration of fewer than 4 weeks.  Persistent disease involves symptoms that occur more than 4 days per week and are present for longer than 4 weeks.

Up to 42% of children have allergic rhinitis by the age of 6 years.  It is more common among children who have: asthma or eczema, a mother who has asthma or smokes (one or more packs per day in the child’s first postnatal year), parental allergies and exposure to house dust mites.  Whether exposure to pets during first year of life protects against the development of allergic disease later in life is controversial.

Allergic rhinitis typically begins in childhood, persists throughout adolescence and early adulthood, and tends to improve in older adults.  On physical examination, most but not all children have some nasal obstruction with pale to bluish nasal mucosa, enlarged turbinates, clear nasal secretions, and pharyngeal cobblestoning.  Many have allergic shiners (darkening of lower eyelids) and an allergic crease (transverse skin line below bridge of nose) caused by constant rubbing upwards from the palm of the hand ("allergic salute").  Some children have chronic mouth breathing, which can lead to craniofacial abnormalities and orthodontic disturbances.   Allergic rhinitis must be distinguished from other conditions, such as large adenoids (associated with severe symptoms that are unresponsive to therapy) or a foreign body (a unilateral nasal obstruction with purulent nasal discharge).

Although it may be easy to dismiss the disease symptoms as trivial, patients often experience headaches, fatigue, impaired concentration, reduced productivity, loss of sleep, and decreased emotional well-being and social functioning -- all of which can affect school success. 

Treatment includes antihistamines (oral and intranasal; sedating and non-sedating), oral leukotriene receptor antagonists (Singulair is an example of that class of drugs), and intranasal corticosteroid sprays.  Immunotherapy (allergy shots) have been shown to decrease symptoms when administered appropriately.

(Mahr TA, Sheth K. Pediatrics in Review. 2005; 26:284-289.)   -- H.T.