The webinar focused on the impact of allergic rhinitis (AR) in paediatric patients and effective management strategies. Accredited for one (1) CPD point, this session is designed for healthcare professionals practicing in South Africa.
The nose serves a crucial role in breathing, functioning as an air conditioner that warms and humidifies the air we inhale. It also protects the lower airways and contributes to vocal resonance. In AR, the nasal cavity becomes inflamed, leading to symptoms such as a runny or blocked nose, postnasal drip, itching, and sneezing.
Prevalence and onset of AR
AR is an immune system-mediated condition (IgE-mediated) affecting 10%-40% of children and adults worldwide, with prevalence varying by country. In South Africa, for example, the prevalence among 13- to 14-year-olds increased from 30.4% in 1995 to 38.5% in 2002. Typically, AR begins in childhood or adolescence, peaks between ages 20 and 40, and then declines. Around 80% of cases develop by age 20.
Association with asthma and other conditions
There is a strong link between asthma and AR. Around 38% of AR patients have asthma, while 85% of asthmatics have AR. This connection is due to the shared anatomy and physiology of the nose and lungs.
Poorly controlled asthma is common in patients with AR, significantly impacting their quality of life (QoL). Atopic dermatitis also shows a strong correlation with AR - the more severe the dermatitis, the higher the likelihood of AR. Comprehensive examination of patients includes checking their skin, chest, and eyes.
Immune response and triggers
Genetically susceptible individuals develop AR when exposed to specific environmental proteins like pollen or dust mites. The immune response involves producing specific IgE antibodies, which bind to mast cells in the nasal mucosa.
Upon inhaling allergens, these mast cells release immediate mediators like histamine, causing symptoms such as itching and sneezing. Delayed mediators, such as leukotrienes, contribute to chronic inflammation and symptoms like nasal congestion and postnasal drip. Common triggers include pollen, house dust, pets, cockroaches, mould, cigarette smoke, strong smells, weather changes, and respiratory infections.
AR is now classified based on symptom frequency and duration into intermittent or persistent. Intermittent AR occurs less than four days a week or for less than four consecutive weeks, while persistent AR occurs more frequently.
Impact and diagnosis
Mild cases involve minimal disruption to daily life and can often be managed over the counter. Moderate to severe cases, whether intermittent or persistent, significantly affect sleep, daily activities, school performance, and overall quality of life, requiring more comprehensive management.
Patients living with AR experience bothersome symptoms that significantly affect their QoL, prompting parents to seek medical consultation. Diagnosing AR is straightforward, relying on clinical history and specific IgE tests via skin or blood, with the exclusion of other rhinitis causes.
Typical symptoms include a runny nose, nasal congestion, sneezing, and itching of the palate, nasal passages, or throat. Ocular symptoms such as red, itchy, watery eyes are also common.
Patients may have a postnasal drip cough that mimics asthma but is not asthma. Sleep disruption is frequent, with about 45% of children experiencing it, leading to difficulty sleeping, waking up tired, or struggling to wake up in the morning.
Daily activities and school performance can be impaired, with children potentially becoming irritable, tired, having difficulty concentrating, and performing poorly at school. Teachers might report restlessness or symptoms resembling attention deficit hyperactivity disorder. Additional signs include frequent nose rubbing, nasal wrinkling, mouth breathing, dry lips, and associated complications like sore throats, sinus infections, and frequent ear infections.
Examination and management
During an examination, look for signs such as an elongated face, darkness around the eyes (allergic shiners), and a nasal crease. The inferior turbinates may be enlarged and pale. Inside the mouth, look for a high-arched palate and misaligned teeth, often needing orthodontic attention. The pharyngeal wall may show cobblestone changes due to postnasal drip.
Children living with AR often exhibit symptoms year-round, with clear mucus and sneezing distinguishing them from common colds, which are short-lived and may include low-grade fever, muscle aches, and mild headache.
Management involves identifying and avoiding triggers, using appropriate medications, and regular follow-up examinations. Educating patients and their families, ensuring proper medication selection, and maintaining adherence to treatment plans are crucial for effective management.
To watch the replay video, scan the QR code or click here. The webinar is accredited for one (1) CPD point. Once you have watched the video, send an e-mail to john.woodford@newmedia.co.za and request to have your CPD point allocated to your profile on the HPCSA database. Include the webinar name and your HPCSA number in your e-mail.
