Spring is in the Air

Spring is in the Air – March is here, and the beginning of Spring comes with it. Spring brings enjoyable weather, blooming flowers, green grass, and outdoor activities. Alas, that means more POLLEN – Sneezing – Allergies.

Flora, a child of six, loves flowers and outdoor play, but she often gets a runny nose, bouts of sneezing, and an itchy nose with a cough. This happens every year during the Spring and lasts into the summer. It improves when the weather gets cool. She coughs all night and sometimes has a wheeze. She is constantly wiping her nose and has darkened areas under her eyes.

Flora has many of the symptoms of allergic rhinitis or allergies.

What is allergic rhinitis or allergies?

Allergic rhinitis, or allergic rhinosinusitis, presents with attacks of sneezing, runny nose, stuffy nose, mouth breathing, and can have itchy eyes, nose, and mouth palate. Also frequent are postnasal drip, cough, irritability, and fatigue. It is a widespread complaint affecting 10 to 30 percent of children and adults.

Signs and symptoms:

Sneezing
Rhinorrhea – runny nose.
Nasal obstruction – nasal congestion
Nasal itching.
Postnasal drip.
Cough.
Irritability
Fatigue.
Itching of ears or palate
Itching, burning, tearing of the eye
Snorting, sniffing, and clearing throat frequently

Classifications:

Seasonal

Occurs at a particular time of the year. Seasonal allergy rhinitis is usually caused by pollen from trees, grasses, weeds, hay, weed pollens, or mold. Symptoms of seasonal allergic rhinitis are predictable and reproducible from year to year.

Perennial

Present year-round. Allergens like dust mites, cockroaches, mold spores, or animal dander trigger perennial allergic rhinitis. Perennial symptoms are also seen with occupational allergen exposure.

Nonallergic forms of rhinitis

Vasomotor, pregnancy, Afrin medication overuse) can be triggered by changes in weather and temperature—increased blood as in pregnancy or from overuse of nasal sprays.

Occupational:

Latex, plant products (e.g., baking flour), sensitizing chemicals, and certain animals for people working in farms and vet clinics

Allergic Rhinitis Physical findings

Patients may present with the following:

“Allergic Shiners,” swelling under the eyes with darkening.

allergic shiners in child - also with deniies lines — Photo By Fitzpatrick AM – Fitzpatrick AM, Gaston BM, Erzurum SC, Teague WG. National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program. Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide. J Allergy Clin Immunol. 2006;118(6):1218–25. doi: 10.1016/j.jaci.2006.08.019, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=100284664

“Dennie-Morgan” lines folds or wrinkles below the lower lids.

Dennies lines - folds - wrinkles under eye on lower lid seen in allergies — Photo By SplatterGirl – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15126575

“Allergic Salute” wrinkle on the nose caused by repeated rubbing and pushing the nose tip up with the hand.

Child doing the allergic salute wiping his nose — Photo By Numpierrez – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=47555265

Allergic conjunctivitis – swelling of eyelids with itching, tearing, redness, burning, and sensitivity to light. Symptoms are usually bilateral.
Sinusitis – allergies cause nasal mucosa to swell, leading to sinus infection.
Asthma – Children often present with cough and wheeze, more prominent with exertion.
Atopic dermatitis (eczema) – dry, itchy, flaking skin

Atopic dermatitis fold of elbow — Photo By James Heilman, MD – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10429479

Other conditions – eustachian tube dysfunction, serous, and acute otitis media. Nasal obstruction can also cause sleep-disordered breathing and lack of smell.