The child with ‘sinus’ symptoms: what to make of confusing messages.
MANY children suffer from symptoms of the nose that recur frequently, which in our multiethinic society is variously labelled as “sinus”, “flu”, “selsema”, “shang feng”, etc.
In my experience, many patients confuse infections, virus and bacterial, with true allergy, and subsequently mix up concepts of disease and treatment options.
I shall only touch on allergic rhinitis, which is a big enough topic in itself.
Here are some issues that I feel parents are often confused about.
Who are the bad guys in allergic rhinitis?
People generally have no problem understanding the concept of an infection. The patient is the good guy; the bad guys are the microbes, whether bacteria, viruses or fungi. Clear-cut good versus evil.
We stop the bad guys with antibiotics or whatever drug is used to interfere with the life cycle of the microbe.
On the other hand, allergy is a phenomenon in some, but not everyone, when the body’s immune system – or the intrinsic defence system – reacts against what are essentially harmless things.
Examples of harmless things perceived as the enemy include dustmites, cat and dog hair, and plant pollens, i.e. the allergens.
In other words, the patient’s immune system overreacts like a drama queen. The allergen may be considered a trespasser, but the patient’s immune system is the aggressive party, its actions leading to symptoms.
Thus, treatment for allergy is directed at the immune system’s aggression. This is where some people have difficulty getting their head around the concept of allergy, because drugs are not directed at whom they thought was the bad guy.
Do air pollution and air-conditioning make allergic rhinitis worse?
Patients commonly report that their sneezing and runny-nose get worse when going out under the sun, and that air-conditioning worsens their allergic rhinitis.
They are half right. Changes in humidity, temperature and certain air pollutants have an independent irritant effect on the nasal mucosa.
Air pollutants may be divided into indoor and outdoor categories. Examples of such irritants include cigarette smoke and car exhaust fumes.
Irritation makes the mucosa swell up, worsening the symptoms of allergic rhinitis, but, strictly speaking, the allergic rhinitis is not affected.
Irritation from air-conditioning may make the swelling look like allergy, but they are two distinct processes.
Turning off the air-conditioning is a common response by parents, but on balance, I favour having airc-onditioning. Many people will remember how difficult it is to sleep on hot nights. High temperatures will only become more common with urban heat islands and global warming.
What about foods that we take?
Food substances may cause oral and systemic (asthma and eczema) allergic symptoms.
It is said that food substances only rarely directly make allergic rhinitis worse. Once again, it is inhaled substances that serve as allergens for allergic rhinitis.
However, certain foods may modify the immune system, so that it becomes more reactive, thereby also making allergic responses more intense.
This is an indirect way, in contrast to the direct allergen way.
So, in short, there is no need for “pantang” in allergic rhinitis.
Most people swim in swimming pools with chlorine, so reference will only be made to these. Chlorine-related gas sits just above the surface of the water. This gas serves as an irritant, just like air pollution and air-conditioning.
Allergic rhinitis is not made worse, but the symptoms are temporarily worsened.
Swimming is an excellent form of sport and exercise, and a child should not be deprived of the opportunity to swim.
Research on chlorine has been done mainly in countries with winter and indoor swimming pools.
The chlorine gas thus lingers around in indoor pools, but in the context of Malaysia, they are almost always outdoor pools. Therefore, the irritation of chlorine is not as severe.
How safe are steroid sprays?
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 to these fears, as in my clinical practice, I do not see these happen. The real side-effects of steroids occur with orally ingested or injected, high-dose steroids taken for months on end.
Steroid sprays are topical, meaning the drug stays locally with negligible absorption into the body.
However, I respect the fears of parents. I 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, start again!
Are allergy tests really necessary in allergic rhinitis?
The common allergy tests include blood tests to look at levels of IgE antibodies to specific allergens, and skin prick testing.
For the blood tests, the higher the IgE 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 mosquito bites).
The bigger the swelling, the more severe the allergy. Children may not take too 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 dustmites, 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 tests 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.
Can I take anything to boost my child’s immune system?
Parents often ask me if supplements or vitamin C could be taken to prevent allergic rhinitis.
Vitamin C has often been touted by parents 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 as I cannot make any logical connection between vitamin C and allergic rhinitis.
As I have described above, allergy is an overreaction of an “aggressive” immune system. Therefore, taking supplements that supposedly boost the immune system can only serve to make the immune more “aggressive” and only make the allergic reaction stronger. To me, it does not make much sense to do that.
Dr Lim Wye Keat is an ear, nose and throat (ENT) surgeon. This article is courtesy of the Malaysian Association of Paediatric Surgery. For further information, e-mail email@example.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.