World Allergy Day | Children's "Self-report" on allergic rhinitis

Author: Zhou Yimei: The 989th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army

Reviewer: Huang Yueying, Deputy Director Pharmacist, 989th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army

Hello everyone, I am a child with allergic rhinitis, also known as pediatric allergic rhinitis, which is a non-infectious chronic inflammatory disease of the nasal mucosa mediated mainly by immunoglobulin E (IgE) after an atopic individual is exposed to an allergen (allergen) [1]. Is it a bit confusing? Simply put, I only favor children who are particularly sensitive to specific substances. These specific substances are my favorite allergens. They may be hidden in the air, such as pollen, fungi, dust mites, animal dander, etc.; they may also be certain foods. For example, some children who are favored by me often have symptoms such as nasal congestion, runny nose, itchy nose, and sneezing if they eat eggs, shrimps, peanuts, etc. or drink milk. However, people often confuse me with my brothers - colds, non-allergic rhinitis, sinusitis, etc. Let me briefly introduce myself to avoid people mistaking me again.

Figure 1 Copyright image, no permission to reprint

Acute rhinitis is also known as the common cold. It can also cause symptoms such as sneezing, nasal congestion, and runny nose. The fever is not obvious or only low fever[1]. Rhinitis caused by influenza can also cause coughing, runny nose, and nasal congestion, but its main symptoms are fever, accompanied by systemic symptoms such as headache, muscle aches, and fatigue[1]. Unlike them, my arrival often makes children "polite" - "allergic salute", which makes parents laugh and cry. "Allergic salute" means that the children frequently rub their noses, often push the nose tip or nose wings upwards with their hands, and constantly use paroxysmal sneezes to express "missing", and a series of sneezes are followed by a large amount of clear nasal discharge. Apart from this, what else is different between me and them? Oh, by the way, for example, the duration of a cold is generally 7 days, and I usually "accompany" the children for longer.

Do you think I’m awesome? Actually, there are ways to “cure” me. To stay away from me, the first thing is to control the environment and avoid or reduce contact with allergens and various irritants; the second is drug treatment. Only a combination of prevention and treatment can “cure” me. If I seriously affect a child’s daily life, including sleep, study, and other daily activities, then medication is needed. But if you mistake me for a cold and try to “drive” me away by using antibiotics, you are totally wrong. Although I am not afraid of antibiotics, “hateful humans” have developed many other drugs to “drive” me away[2].

Figure 2 Copyright image, no permission to reprint

For example, if they want to "expel" me when I am weak, they will choose my "nemesis" - the second-generation antihistamines. "Damn humans" have found that second-generation antihistamines can not only successfully "expel" me, but also have significantly less side effects on the human body than the first generation, and are safer, but are not suitable for infants under 6 months old. Children with persistent rhinitis (symptoms of rhinitis occur ≥4 days/week and last ≥4 weeks) can choose nasal corticosteroids. If the second-generation antihistamines or nasal corticosteroids alone are ineffective, the two drugs should be used in combination.

Figure 3 Copyright image, no permission to reprint

After I became stronger, human experts were more inclined to use a step-down treatment method to "expel" me based on the actual diagnosis and treatment in China [3]. The first step of this method is to use a second-generation antihistamine and nasal glucocorticoid combination treatment for children with sneezing or runny nose as the main symptoms. For children with nasal congestion as the main symptom, leukotriene receptor antagonists or short-term nasal decongestants will be added as needed. The second step is to control me through the above combination treatment, and human experts recommend reducing the treatment to a single drug for the child. The third step is to further control me through monotherapy, and human experts recommend reducing the treatment to an on-demand treatment for the child. If the second-generation antihistamine is used for monotherapy in the second step, the efficacy evaluation should be conducted once every 2 weeks; if nasal glucocorticoids are used, it is recommended to be conducted once every 2 to 4 weeks.

In addition, some Chinese medicine practitioners will use syndrome differentiation to select common Chinese patent medicines such as Tongqiao Rhinitis Granules and Xiangju Capsules to “expel” me [4].

What makes my scalp tingle is that more and more people realize that if they want to successfully "expel" me, they must not take any medicine, whether it is Western medicine or Chinese patent medicine, without authorization, and it is best to take medicine according to the doctor's advice. Even if they still fail to "expel" me after using the above methods, they will consider immunotherapy.

However, I will never tell you that if you want to "cure" me, the most important thing is to take precautions, stay away from allergens and foods that cause allergies, and actively prevent and treat acute respiratory diseases. However, there is no need to be overly afraid of me. You should maintain a good attitude, exercise more, and enhance your resistance.

References:

[1] Rhinology Group of the Editorial Committee of the Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Rhinology Group and Pediatrics Group of the Chinese Society of Otorhinolaryngology Head and Neck Surgery. Guidelines for the diagnosis and treatment of allergic rhinitis in children (2022, revised edition) [J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2022, 57(4): 392-404.

[2] Editorial Board of Chinese Journal of Pediatrics, Chinese Society of Pediatrics. Expert consensus on diagnosis and treatment of allergic diseases in children[J]. Chinese Journal of Pediatrics, 2019, 57(3): 164-171.

[3] Chinese Medical Association Allergy Physicians Branch, Chinese Medical Association Pediatric Physicians Branch Otorhinolaryngology Committee, Chinese Association for the Promotion of Human Health Science and Technology Children's Allergy Branch. Chinese expert consensus on step-by-step treatment of allergic rhinitis in children [J]. Chinese Journal of Preventive Medicine, 2022, 56 (9): 1182-1189.

[4] Zhao Xia, Zhang Jie, Qin Yanhong, et al. Guidelines for the diagnosis and treatment of allergic rhinitis in children with integrated traditional Chinese and Western medicine[J]. Journal of Nanjing University of Traditional Chinese Medicine, 2023, 39(3): 274-284.