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[HOME] [Annual Report] [CALENDAR] [NANAY-California] [NANAY-Michigan] [NEWS UPDATE] [Caregiver Support] [SERVICES] [Web links] [Webmall] | Treatment Options For Nasal Allergy In Children Allergic rhinitis (Nasal allergy) is an extremely common disease
that frequently affects children. Approximately
one in five children will have symptoms of allergic rhinitis by the time they are 2 or 3
years old, up to 40% have symptoms by age 6, and up to 30% will be affected during
adolescence. A prominent symptom in children is nasal congestion, sometimes associated
with mouth breathing, nasal voice, or sometimes snorting. Sneezing, nasal itch, nasal
discharge (with sniffing or nose-blowing), itchiness in the eyes and throat, and coughing are common associated symptoms which
are frequently annoying and can interfere with daily activities. Children who suffer
from allergic rhinitis do not sleep well, do not feel well, and often do not look well,
which lowers their self-esteem. It also interferes with learning and concentration, and
can affect performance in school. Approximately 1.5 million school days per year are
lost because of allergic rhinitis. When left untreated, it can predispose to more serious
respiratory diseases which include middle ear infection, sinusitis, sleep disorders,
recurrent nose bleeds, long-standing cough, and asthma. The treatment of allergic
rhinitis focuses on controlling the causes and symptoms associated with the disorder.
Allergic rhinitis can be seasonal, occurring mostly during the pollenating seasons, or it
may be perennial, caused by allergy to house dust mites, animal dander, and molds. The
first step to control allergic rhinitis is to reduce or avoid exposure to the offending
agent. For
those who have perennial or persistent rhinitis, efforts to prevent the symptoms include:
When
the allergic rhinitis cannot be adequately controlled by avoidance measures, three
types of medications are usually given to children: 1) antihistamines; 2) decongestants;
and 3) anti-cholinergic agents that inhibit nasal secretion. These drugs treat some of
the symptoms of allergic rhinitis but are not effective against the underlying
inflammatory response to allergy, which is usually controlled by steroids. Antihistamines are
relatively rapid-acting drugs that are effective for controlling sneezing, watery eyes,
itching, and nasal discharge, but are less effective for relieving nasal congestion. The first-generation
antihistamines (like benadryl, actifed, chlortrimeton, dimetane and dimetapp)
can cause sleepiness or sedation, and are more likely to cause side effects such as dry
mouth, gastrointestinal upset, and irritability. The newer, second-generation
antihistamines do not cause sedation.
However, two of these second-generation antihistamines, Terfenadine (Seldane) and
Astemizole (Hismanal) can be toxic to the heart if taken in amounts that exceed the
recommended dose, or if taken with certain antibiotics like erythromycin. The FDA is considering removing the availability
of terfenadine because of this side effect, and because its safer metabolite, Fexofenadine
(Allegra) is now available in the market. In 1996, two newer antihistamines,
Loratadine (Claritin) and Cetirizine (Zyrtec) became available in liquid
formulations and were approved for children at least 6 years of age. Decongestants (ephedrine,
pseudoephedrine) constrict the vessels in the nasal mucosa and can relieve nasal
congestion, but have no effect on itching, sneezing, or nasal discharge. Combination
products of antihistamine/decongestant are
more convenient and less costly. Side effects of oral decongestants include
nervousness, insomnia, irritability, palpitations and fast heart beats. Overuse of
nasal spray decongestants can cause "rebound" nasal congestion. The use of
decongestants may be restricted for older children who participate in organized sports,
because of their doping effects. Clinical studies have shown
that the anticholinergic agent ipratropium bromide (Atrovent) as an intranasal
spray can inhibit the production of nasal secretions,
but it has no effect on nasal itching,
sneezing, or congestion. Infrequent side effects include nosebleed, blood-tinged mucus,
and nasal dryness. Intranasal (topical)
steroids most effectively relieve nasal congestion, nasal secretion, itching and sneezing,
and do not produce the clinically important side effects of systemic steroids. Beclomethasone dipropionate (Beconase) is the most frequently prescribed intranasal steroid, which has been available in the U.S. for more than 16 years. Except for Fluticasone (Flonase) which is given to children 12 years or older, the newer steroidal nasal sprays such as Budesonide (Rhinocort), triamcinolone (Nasacort), and the new formulation of Beclomethasone (Vancenase) are currently approved for children 6 years old or more. Intranasal steroids are much more
effective than antihistamines, decongestants, and anticholinergic agents, although they
have a slower onset of action (producing results within 24 hours after initiating therapy,
with further improvement during the next few days). Maximal relief may not be obtained for
as long as 2 weeks, so that decongestants or antihistamines may be used for temporary
relief in the early stage of steroid
treatment. The most commonly reported side effects are headache, inflammation of the
throat, nose bleed, and nasal drying. At
recommended doses, intranasal steroids are generally free from serious side effects.
Nevertheless, it is recommended that the nose be examined periodically during long-term
use of intranasal corticosteroids. [Meltzer EO. Treatment Options for
Allergic Rhinitis in Children. Clinical Pediatrics (1998); vol. 37, pp. 1-10]. |
NANAY Inc. is supported by Florida Older Americans Act, Alliance for Aging for Miami-Dade and Monroe Counties, Florida Department of Transportation, Miami-Dade Alliance for Human Services, Dept of Health and Human Services, Miami-Dade County Office of Community and Economic Development, North Miami CDBG, Association of Asian Pacific Community Health Organizations (AAPCHO), National Asian Women's Health Organization (NAWHO), AETNA Foundation and United Way (Miami-Dade Reg. # 161126)
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