Allergic Rhinitis

Symptoms

• Frequent sneezing
• Clear nasal discharge
• Itchy nose
• Nasal congestion

Other symptoms may include itching on the roof of the mouth, itchy throat, postnasal drip, dizziness, fatigue, ear fullness (due to swollen ear pressure equalization tubes). Additionally, other allergic conditions may be present such as red eyes, allergic conjunctivitis, itchy rash, chronic cough with symptoms that come and go.

Causes

1. Genetics If parents or siblings have allergies, there is a higher chance of developing these conditions.
2. Allergens These are substances around us that can enter the body through various routes such as inhalation, ingestion, or contact. Studies show that the most common allergen causing symptoms is dust mites, followed by mold, grass pollen, insect droppings and fragments, dust, pet hair, and dander.
3. Contributing factors such as children with chronic atopic dermatitis, mothers who smoke during pregnancy, household smokers, toxic fumes, and factory smoke.

Complications

If allergic rhinitis is left untreated for a long time, complications may arise such as sinusitis, middle ear infection, asthma, and nasal polyps in older children or adults.

Treatment and Prevention

Divided into 2 main methods:

1. Behavioral management includes

• Avoiding and limiting exposure to allergens
• Maintaining health and exercising

Eliminating and avoiding allergens

This is considered the primary treatment. If done effectively, it yields the best results. Reducing allergens significantly improves symptoms and reduces medication use. Recommendations for eliminating common allergens are as follows:

• Inside the home, focus on dust removal, especially in the bedroom. Keep furniture to a minimum, avoid carpets, cover mattresses and pillows with plastic or dust mite-proof covers. Wash bed sheets and pillowcases frequently. Avoid dust-collecting materials such as old books and stuffed toys.
• Avoid keeping furry pets such as dogs and cats.
• Eliminate insects inside the home, especially cockroaches.
• Remove mold by cleaning black stains in bathrooms, especially under bathtubs. Besides avoiding allergens, also avoid irritants that worsen symptoms such as cigarette smoke and strong odors.
• Maintaining health and exercising regularly, along with adequate sleep, can help reduce allergy symptoms.

2. Medication treatment: Several groups of drugs are used to treat allergic rhinitis

Oral medications

• First-generation antihistamines Examples include chlorpheniramine, which is inexpensive and fairly effective but causes drowsiness, dry mouth, and dry throat.
• Second-generation antihistamines These do not cause drowsiness or dry mouth/throat and have a long duration of action (12-24 hours), allowing 1-2 doses per day. However, they are more expensive.
• Decongestants help reduce nasal mucosa swelling and improve breathing but may cause side effects such as palpitations, so caution is advised in patients with heart disease or hypertension.
• Nasal sprays are divided into 3 groups:
  • Antihistamine nasal sprays act directly on nasal tissues, work quickly and last long, with minimal systemic absorption. They are effective for sneezing, nasal itching, and clear nasal discharge but not for nasal congestion.
  • Steroid nasal sprays effectively reduce allergic rhinitis symptoms and can be used long-term with minimal systemic absorption. Possible side effects include dry nose, nasal irritation, and sometimes nosebleeds.
  • Decongestant nasal sprays provide quick relief of nasal congestion but should not be used continuously for more than 1 week to avoid rebound congestion (increased nasal blockage requiring more frequent use).

Allergy Immunotherapy (Allergy Shots)

Currently, allergy immunotherapy can be used to treat two allergic diseases: allergic rhinitis and asthma. Doctors inject the allergen that the patient is allergic to, gradually increasing the dose to reduce the body’s response to the allergen, thereby reducing allergy symptoms. The treatment is administered weekly for at least 3-5 years. If the patient does not respond within 1 year, the treatment is discontinued.

Indications for this treatment

• Patients with severe symptoms who cannot avoid allergens
• Patients with long-standing symptoms who still require medication despite allergen avoidance
• Patients whose symptoms cannot be controlled with oral or nasal medications

Patient criteria for allergy immunotherapy

1. Patients with allergic diseases such as allergic rhinitis, allergic conjunctivitis, asthma, and atopic dermatitis must undergo skin prick testing or specific IgE blood testing to identify the causative allergens.
2. Patients who continue to have moderate to severe allergy symptoms despite appropriate medication and environmental allergen avoidance, or who experience side effects from allergy medications.
3. Patients must be consistent in receiving the vaccine as it is a long-term treatment requiring at least 3 years.

Types of treatment

1. Subcutaneous immunotherapy (SCIT): Allows injection of more than one allergen and is suitable for patients allergic to multiple allergens. Possible side effects include severe allergic reactions (anaphylaxis) because allergens are injected directly into the body.
2. Sublingual immunotherapy (SLIT): Increasingly used due to fewer side effects and can replace injections. Treatment outcomes are comparable to allergy shots. 

Summary

Allergic rhinitis is not a serious disease but is chronic and can affect quality of life, especially if not properly diagnosed. It may lead to unnecessary frequent use of antibiotics or severe complications such as asthma and snoring.

Allergic diseases are increasing in prevalence. If you suspect your child has allergies, consult a specialist.