How to manage allergic rhinitis in my 8-year-old daughter?

Question

Hello doctor,

My 8-year-old daughter has severe allergic rhinitis that keeps getting worse every spring and is now affecting her throughout the year. She wakes up every morning with a stuffy nose, sneezing fits, and dark circles under her eyes due to poor sleep. Her pediatrician recommended Cetirizine and Loratadine, but neither has helped much. Allergy testing showed that she is allergic to dust mites, pollen, and cat dander, even though there are no pets at home.

She is now mouth breathing most of the time, and her teacher has mentioned that she often falls asleep in class because she cannot breathe properly at night. She is also getting frequent sinus infections and has required four courses of antibiotics in the past six months. Fluticasone nasal spray was tried, but she dislikes using it and says it causes nosebleeds.

According to the ENT specialist, her adenoids are enlarged, and removal has been suggested. However, there is concern about surgery at such a young age. The allergic rhinitis is also triggering her asthma, and she now needs her inhaler more often. The question is whether allergy shots can be started at this age. There is significant concern because this condition is affecting her school performance, and she cannot play outside with other children without becoming unwell.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Currently, your child is suffering from moderate to severe allergic rhinitis, which is significantly affecting school activities and daily functioning.

First of all, appropriate treatment of allergic rhinitis should be started, as chronic allergic rhinitis (AR) can lead to enlargement of the adenoids. As mentioned, the symptoms are worsening due to multiple aeroallergen sensitivities. Since oral antiallergic medicines have not been effective, intranasal corticosteroid therapy has a good response in moderate to severe allergic rhinitis. Therefore, Fluticasone nasal spray should be used with the correct technique and appropriate dose.

Normal saline nasal spray should always be used before applying the steroid nasal spray, as it helps clear nasal passages and improves the effectiveness of the medication.

Yes, allergy shots, also known as allergen immunotherapy, can be started, as they are recommended after five years of age.

Montelukast can be started at night, as it may help control allergic rhinitis symptoms and associated asthma. The adenoids should be reassessed after adequate medical therapy before considering surgical removal. If the child’s weight is provided, it will be easier to calculate the correct medication dosages.

I would also recommend the following investigations:

Chest X-ray (CXR).
Complete blood count (CBC).

The following conditions also need to be ruled out:

Allergic rhinitis.
Asthma.

If symptoms worsen or do not improve, immediate medical consultation is advised. Also, preventive measures include avoiding known allergens such as dust mites and pollen as much as possible.

I hope this helps.

Thank you.