Allergic Rhinitis in Children

Review Article

Austin J Nurs Health Care. 2014;1(2): 1006.

Allergic Rhinitis in Children

Terri L Schmitt1* and Lynne Palma2

1Department of Nursing, Chamberlain College of Nursing,USA.

2Florida Atlantic University,Christine E. Lynn College of Nursing,USA

*Corresponding author: Terri L Schmitt, Department of Nursing, Chamberlain College of Nursing, USA

Received: August 05, 2014; Accepted: September 08, 2014; Published: September 10, 2014


Alex, a 7 year-old Caucasian male, is brought to the primary care clinic by his mother for a routine well-child check. In obtaining the history the Nurse Practitioner (NP) is made aware of increasing issues with snoring, nasal congestion, ophthalmic itching, frequent sore throat upon wakening, and afternoon fatigue. Home treatment includes over the counter (OTC) cetirizine (Zyrtec) 10mg daily for the last month with minimal improvement, mother reports the medication increases afternoon fatigue and difficulty concentrating at school. Alex has no previous significant medical history, is up-to-date on immunizations, and has no other complaints. Alex’s father had significant asthma and atopic dermatitis as a child. Physical exam reveals a normally developing Tanner 1 school-aged male, who is appropriate in cognition and use of fine and gross motor skills. Tympanic membranes are clear. Palpebral conjunctiva mildly injected bilaterally. The ophthalmic exam is otherwise unremarkable. Nares are patent, but inferior and medial turbinate’s are pale and mildly edematous with scant to moderate clear rhinorrhea. Pharynx with mild cobble stoning and noted clear posterior drainage. Tonsils+2/4 without erythema or drainage. Neck is supple without lymphadenopathy. Heart rate is 88 beats-per-minute. S1, S2 noted and regular without murmur. Lungs clear to auscultation throughout, respirations even and unlabored. The remainder of the physical exam is unremarkable.

Allergic Rhinitis

Allergic rhinitis (AR) is a frequent, yet under treated allergic disease and is one of several common presentations of atopy, the “genetic tendency to develop allergic diseases” [1]. Prevalence of AR is higher in industrialized nations and higher socioeconomic areas due to poor home ventilation, increased environmental pollutants, particularly tobacco and traffic pollutants, dust mites, molds, decline in physical activity, and changes in diet [2,3]. Over 60 million Americans suffer from AR, 10% to 30% of adults, and 10% of children [4-7]. AR affects boys (10.6%) more often than girls (8.6%), Caucasian children (10.3%) more than African American (6.6%) or Hispanic (7%) children, is highest in prevalence during the adolescent years, and lowest in infants to four year olds [3]. The economic impact of AR is estimated to be $3.4 billion in direct medical costs per year and as many as 2 million missed school days annually [5].

AR is reversible, non life threatening, and was previously considered clinically insignificant. However, the relationship of AR to the spectrum of allergic disease, quality of life, and disease burden are significant enough to warrant treatment in affected children. Patients with AR typically average more prescription medications and office visits per year than other patients, yet as many as 1/3 of children suffering from AR never visit a health care provider regarding treatment of the condition [8,9]. The purpose of this article is to provide an overview of AR and its treatment in pediatric patients.


Rhinitis can be allergic or non-allergic (Table 1). AR is an Immunoglobulin-E (IgE) moderated inflammatory disorder of the upper respiratory and nasal passageways characterized by sneezing, itching, rhinorrhea, and/or congestion [6,10]. Diagnosis of AR typically is not made prior to age 2, with peak diagnosis between the ages of 6 to 8, and 80% of cases diagnosed prior to age 20 [5,10,11]. However, children younger than two can present with symptoms, but there is difficulty differentiating AR from infectious upper respiratory infections (URIs), common in younger children [2]. Family history of allergic disease, environmental exposures, and presence of other atopic diseases along with rhinitis increases the likelihood of allergic causes.

Citation: Schmitt TL and Palma L. Allergic Rhinitis in Children. Austin J Nurs Health Care. 2014;1(2): 1006. ISSN : 2375-2483