Q. My almost 4-year-old grandson often suffers from a runny nose and sneezing. When these symptoms start, he is given an antihistamine such as loratadine or cetirizine. While these do seem to help, he often later develops a cough and fever. I wonder if he is suffering from nasal allergies/allergic rhinitis. My first question is whether regular use of antihistamines would help prevent these symptoms, and if these can be used long term. Also, would saline or steroid nasal sprays be helpful? Any advice would be appreciated, as he is missing many days of preschool as a result of his symptoms.
A. "Rhinitis" is the general term we use to describe symptoms of runny or stuffy nose, sneezing, and itching of the eyes and nose. This is the nose's natural response to inflammation and irritation. Rhinitis can result from multiple sources such as nasal allergies (called allergic rhinitis), infections (called infectious rhinitis/ common cold or flu ), or irritants (called non-allergic rhinitis). Allergic rhinitis is also commonly known as hay fever, although it does not directly cause fever unless there are associated complications such as sinusitis (bacterial sinus infection). The term "hay fever" is very misleading and has historical origins. Sinusitis is an infection or inflammation of any of the 4 pair of sinus cavities (8 sinuses in total), which can worsen symptoms of nasal allergies and may be the source of the fever. Also, uncontrolled nasal allergies can lead to other complications including fatigue, ear infections, recurrent sore throats, cough, altered sleep patterns, irritability, and poor school performance. Allergic rhinitis can be broken down into two different types based on symptoms and testing: seasonal, when symptoms occur in spring, summer and/or early fall; or perennial, when symptoms occur year-round. Seasonal symptoms are caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores. Perennial symptoms are generally caused by allergic sensitivity to house dust mites, animal dander, cockroaches, and/or mold spores.The best way to find out what kind of rhinitis your grandson may be suffering from is to see an allergist. An allergist is a doctor who is an expert in the diagnosis and treatment of rhinitis along with other diseases and conditions caused by allergies (encompassing the specialty of allergy/immunology). Sometimes several causes of rhinitis can exist together in the same person such as allergic rhinitis along with non-allergic rhinitis, or anatomical abnormalities. An allergist can perform allergy testing to see if allergic sensitivity is playing a role in his symptoms. Once the type of rhinitis is diagnosed, the best treatment options can be discussed, including avoidance measures, medicines, and possibly allergy shots. One class of medications is antihistamines (such as loratadine and cetirizine that you mentioned). Just like the name implies, antihistamines reduce the body s response to histamine, which is a chemical that the body uses to produce inflammation. Some antihistamines can cause people to be sleepy or have symptoms from the drying effect of the medicine. Nonetheless, they are well tolerated and are safe to use long term. This type of medicine often helps to improve symptoms in patients with nasal allergies, but may not be enough to control symptoms alone. Other medicines such as steroid nose sprays can be helpful if antihistamines are not working. Saline rinses are also helpful in people with irritant/non-allergic rhinitis. In summary, there are many ways of treating rhinitis, and each person s treatment should be tailored based on their symptoms, and whether or not allergic sensitivity is present.You also mentioned that your grandson often has a cough along with his nasal symptoms. Cough can be caused by a number of things including rhinitis, reflux of acid from the stomach, or inflamed airways (as in asthma). Often cough at night or after exercise can be a sign of airway inflammation or asthma, which an allergist can also help diagnose and treat. If asthma is recognized early, appropriate treatment can keep symptoms from becoming worse and allow a person to lead a normal life, without limitation!