Allergic Rhinitis

What Triggers Allergic Rhinitis

The triggers for allergic rhinitis are allergens like molds, pollen, cockroaches, dust mites, and animals. If your child’s triggers are pollen and molds, you may notice that their symptoms are worse during certain seasons. We call that seasonal allergic rhinitis (or hay fever).

If your child’s symptoms occur all year, that is referred to as perennial allergic rhinitis. Year-round allergies are typically caused by indoor allergens such as pets, some molds, dust mites and cockroach. Unfortunately, your child can have both seasonal and perennial allergies.

How Do We Diagnose Allergic Rhinitis?

We will take a detailed allergic history including a description of your child’s symptoms, their triggers, and the environment in which your child lives. We perform a physical exam and most likely test for allergies using skin prick testing. The skin prick testing will help us determine what your child is allergic to and that will help guide us to make a plan for avoidance of that allergen. A plan for treatment of your child’s symptoms will be discussed.  

What is the Treatment for Allergic Rhinitis?

The most important step to manage allergic rhinitis is to avoid the allergens that cause your child’s symptoms. For example, if your child is allergic to tree pollen, it is important to take steps to avoid exposure to the pollen. Tree pollen is highest during the spring so you would be advised to limit outdoor activities during the time when the pollen count is highest and to sleep with windows closed in the bedroom, if possible. Our allergists and nurses take their time to help you learn how to successfully avoid your allergens. It can be very difficult to avoid your child's allergens. In the case that it is not possible to fully avoid the allergen or your child still has symptoms while avoiding the allergen, there are medications that can help to control their symptoms.

One medicine that helps to decrease allergic rhinitis symptoms is a nasal steroid spray. Other medications that can decrease your child’s symptoms are antihistamines or anti-leukotrienes. They can decrease the symptoms of allergic rhinitis in some children. If your child’s allergy symptoms are difficult to control, your allergist may recommend allergen immunotherapy (allergy shots). Immunotherapy can make your child less sensitive to their allergens. It may involve a series of injections or, in a few cases, medication that is given under the tongue (sublingual immunotherapy). Immunotherapy is especially helpful in cases of seasonal allergic rhinitis or in children with asthma when their asthma is made worse by certain pollens, dust mites, or mold.

Minimizing Exposure to Allergens

Once you have determined what your child's allergic rhinitis triggers are, there are steps you can take to minimize your child's exposure to particular triggers.

Outdoor Pollens & Molds

• Stay indoors during the midday when the pollen count is highest.
• Use air conditioning if possible.
• Keep windows closed during seasons when pollen and mold are highest.
• Avoid sources of mold (wet leaves, lawn mowing and sandboxes).

Indoor Molds

• Keep bathrooms, kitchens, and basements well-ventilated.
• Clean bathrooms, kitchens, and basements regularly.
• Do not use humidifiers.
• Reduce indoor humidity to less than 50%. Use a dehumidifier if needed, particularly in damp basement areas. Set the humidity level for less than 50% but above 25%. Empty and clean the unit regularly.

House Dust Mites

• Encase pillow(s), mattresses and box springs in an airtight allergen-proof cover.
• Avoid using blinds as window coverings; instead use shades or curtains and wash monthly.
• Avoid sleeping or lying on upholstered furniture.
• Wash bed covers, clothes and stuffed toys once a week in hot (130ºF) water.
• Put books and toys in sealed containers and limit the number of stuffed animals in the bedroom.
• If you have central air/heat, place filters on registers in your child’s bedroom.
• These actions are not essential, but will also help control dust mites:
  • Remove carpets laid on concrete.
  • Remove carpets from bedrooms.
  • Avoid using a vacuum or being in a room while it is being vacuumed.
  • Use a vacuum cleaner with a powerful suction and a HEPA filter.

Cockroach Allergen

• Use insect gels or traps to eliminate cockroaches from the home.
• If spraying, air out the home for a few hours afterwards.
• Avoid eating outside of the kitchen or dining room.
• Place all packaged food that has been opened in a sealed plastic bag.

Animal Dander

Dander refers to flakes in the skin, hair or feathers of all warm-blooded animals including dogs, cats, birds, and rodents. There is no such thing as an allergen-free dog. The length of a pet's hair does not affect dander production. The allergen is in the saliva, urine, and dander of all pets.

• Remove animals from the house or school classroom.
• If you must have a pet, keep the pet out of your child’s bedroom at all times.
• If there is forced air heating in the home with a pet, place filters over air ducts.
• Wash the pet weekly.
• Limit visits to friends or relatives with pets.
• Remove wall-to-wall carpeting in homes with pets.

Smoke

• Do not smoke.
• Use an indoor air cleaning device (with a HEPA filter).
• Avoid using a wood-burning heat stove or fireplace in your home.
• Avoid using kerosene heaters.

Strong Odors & Sprays

• Do not stay in your home while it is being painted. Allow enough time for the paint to dry before returning.
• Avoid perfume and perfumed cosmetics such as talcum powder and hair spray.
• Do not use room deodorizers.
• Use non-perfumed household cleaning products whenever possible.
• Reduce strong cooking odors (especially frying) by using a fan and opening windows.

Weather

• Have your child wear a scarf over the mouth and nose in cold weather or on windy days.

What is Allergen Immunotherapy?

Allergy immunotherapy (also called allergy shots) is given in two phases. In the build-up phase, tiny amounts of the allergen are injected under the skin of the upper arm. The amount of allergen increases slightly over time. Injections are given once or twice a week until the target dose is reached. When the target dose is reached, the second phase begins. The second phase is called the maintenance phase. During the maintenance phase, your child will likely get an injection once a month for 3-5 years.

Your doctor will discuss whether or not allergy shots are an option for your child. They will also discuss the risks and benefits before starting immunotherapy.

Sublingual immunotherapy (SLIT) is another way to treat allergic rhinitis. Currently, it is only used with certain allergens and only in some children. Tablets with increasing doses of your child’s allergens are given daily under your child’s tongue. Your allergist will work with you to understand if this type of allergen immunotherapy is right for your child.

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