ALLERGIES

PART 2.


STIFFLING THE SNIFFLE

In the previous article dated December 20, 2012, we dove deep into understanding a common problem faced by children with runny noses - Allergic Rhinitis. After the surge of information on common triggers, tips on avoiding and how Allergic Rhinitis can affect your child, you are now probably wondering what can be done to actually treat this syndrome. The following suggestions in this TWO-PART series of frequently asked questions may come in handy to you especially if your child suffers from the constant sniffle.

IS AN ALLERGY TEST REALLY NECESSARY FOR MY CHILD?

The common allergy test include blood test to look at levels of lgE antibodies to specific allergens and skin prick testing. (If you have already read the previous article dated 20/12/2011, you would have learnt that when in contact with an allergen, your child's immune system cells would release antibodies, specifically Immunoglobulin E (lgE).

Basically for the blood test, the higher the lgE levels, the more severe the allergy. Skin prick testing is tricky to do, as this involves actually breaking the skin with a sharp needle to allow solutions of allergens to seep into the skin, resulting in red swellings (like mosquitoe bites). The bigger the swelling, the more severe the allergy. Children may not take to kindly to a needle prick.

Whatever the outcome of the allergy testing, the treatment is the same across the board. In other words, if a patient is allergic to dust mites, the same antihistamines and steroid sprays apply as for dog hair or for fungus. All roads lead to Rome, one may say. therefore, are allergy test really necessary in allergic rhinitis?

The short answer is no, but bear in mind that allergy testing may have other applications and purposes in the treatment of asthma and eczema.

HOW IS ALLERGIC RHINITS TREATED?

Firstly, just do nothing and wait-and-see. If symptoms of allergic rhinitis are mild and tolerable, very little may be achieved by giving medications. Therefor, blowing your nose, slapping on a grin and getting on with it is all that is really required.

The second option is to medicate. There is vast array of medications. The commonest include antihistamines and steroid sprays. Each may come with pseudoephedrine* making the drug more efficient in decongesting the nose. The most powerful drug class are nasal corticosteroid sprays. It could be said that steroid sprays are my favourite medication to alleviate the symptoms of allergic rhinitis. Steroid sprays work to reduce all symptoms of allergic rhinitis and have been so good that nothing else really comes close to its efficacy. There are other than the two above.

The third method is surgery (for severe cases). Surgery is really only needed when medications have either failed to achieve its aim, or when the patients feels the change in symptoms is unsatisfactory. Surgery to reduce the size of the nasal turbinates or making the septum straighter (septoplasty). Endoscopic sinus surgery makes the channels leading into the sinuses, which may help to reduce headaches and reduce the chances of infection of the sinuses.

Please note that surgery will not eliminate allergic rhinitis. Keep in mind that an allergy-reaction will always be determined by the over-reactive immune system and environmental factors. No amount of surgery will do this, but surgery does help to lighten the burden of a particular symptom. Antihistamines and steroid sprays may still be needed after surgery.

HOW SAFE ARE STEROID SPRAYS REALLY?

Very safe, is the succinct answer. Much is written in the internet about the side effects of steroid sprays. Examples of these include thinning of mucosa, bleeding and growth retardation. I do not subscribe strongly these fears, as in the clinical practice they have yet to actually come across such cases. The real side effects of steroids occur with orally ingested or injected, high dose steroids taken for an a continual basis from months on end. Steroid sprays on the other hand are topical, meaning that the drug stays above the skin surface with negligible absorption into the body.

However, the doctor respect the fears of parents. The doctor compromise by allowing parents to stop the steroid spray once symptoms are better after two or three months. But, inevitably, symptoms will return about two weeks or more after cessation of the spray. If symptom recurrence is bad enough, you can start again!

WHAT ELSE CAN I DO IF I DON'T LIKE MY CHILD TO BE ON A TON OF MEDICATIONS? WILL TAKING VITAMIN C HELP?

Naturally there are alternatives to antihistamines and steroid sprays. Since dust mist is still the commonest cause of allergic rhinitis, strategies against dust mite are widely used. Examples include cleaning and changing mattress sheets every week and washing them in hot water, dust mite covers for pillows and mattresses, powerful vacuum cleaners, chemicals to kill dust mite, air-filters, air ionisers etc. My personal opinion is that these are either too expensive or take too much effort. From a purely pragmatic viewpoint, tolerating symptoms or taking medications are still the most cost-effective.

Physical exercise has been said to "cure" symptoms of allergic rhinitis. Any strenuous physical activity will result in the nose's mucosa shrinking, which allows more air to be inhaled. This normal physiological response is temporary and in noway result in permanent nasal block resolution of allergic rhinitis.

Parents often vouch for Vitamin C as the cure-all for many ailments. Claims that Vitamin C wards off viral infections have come under scrutiny recently and they are starting to look dubious. I have not seen anything to support the use of Vitamin C for allergic rhinitis. I cannot make any logical connection between Vitamin C and allergic rhinitis.

The above article are a personal views of the author.