Rhinitis in Children

There are useful guidelines for management of allergic rhinitis, seasonal allergic rhinitis (SAR), and nasal spray technique, on the BSACI website at www.bsaci.org

 

Diagnosis:

A detailed history is vital for diagnosis and identifying the likely allergen e.g. house dust mite, pollens, cat, dog, horse, hamsters etc

Younger children – no tests usually needed, history gives an obvious source a lot of the time.

If older patient – Specific IgE from Primary Care based on history eg House dust mite and other common aeroallergens can be helpful, but if there is a clear trigger tests are not required 

 

Management:

• Nasal saline douching e.g. Sterimar in older patients
• Nasal steroids - there is good safety data for long term use in children for fluticasone (from age 4), mometasone (from age 6) and budesonide (from age 12)
• Antihistamines - for optimal results give continuously or prophylactically e.g. prior to exposure to known allergen as opposed to ‘as required’.  Desloratidine licensed from age 1; cetirizine (SAR) and loratidine from age 2; fexofenadine (SAR) and cetirizine from age 6; fexofenadine from age 12.
• Different antihistamines can be trialled, and some children need ‘double dosing’
• Leukotriene receptor antagonists may have a role, particularly if child has concomitant asthma

 

Paediatric ENT Referral

Very limited surgical options for allergic rhinitis.

• Persistent nasal symptoms, likely secondary to rhinosinusitis overlay:
• not responding to an adequate trial of medication, and
• fail to meet the criteria for allergy referral.

 

Refer to Allergy Clinic:

Patients with very troublesome symptoms with poor quality of life, who are already on optimal treatment as per BSACI guidelines and already seen by ENT team.

 

No need to refer if:

• Families are asking for referral to see if pets need re-housing / can be purchased
• Families are asking for tests to prove that mould / old pet hair is causing a problem in rental properties or another family member’s house

 

 

 

Page Review Information

Date:                                 04 July 2025

Review Date:                    04 July 2027

Specialty Lead GP:          Dr M Schick, RMS 

Authors:                            Simon Bedwani, Consultant Paediatrician, RCHT

    Dr S Burns GP RMS