Beware of rising trend in chronic allergic rhinitis cases
24 Aug 2022 11:10am
Allergic rhinitis is inherited (passed down through families) and when it is in the chronic stage. - 123RF Photo
Such symptoms are likely caused by allergic rhinitis, an overreaction of the immune system (the body’s defence system that provides protection against non-infectious inhaled particles) to an allergen (any substance that can trigger an allergic reaction, such as pollen, dust mites, animal fur and tobacco smoke).
Allergic rhinitis is inherited (passed down through families) and when it is in the chronic stage, it can cause mucous membranes in the nose, eyes and throat to become badly inflamed and itchy as they work to eject the allergen.
This condition can also be fatal if not treated quickly, according to Sunway Medical Centre Velocity (SMCV) Consultant Ear Nose Throat and Head and Neck Surgeon Dr Juani Hayyan Abdul Karaf.
Longer time to recover from Influenza, Covid-19
In an interview with Bernama recently, Dr Juani said SMCV has witnessed a significant increase in allergic rhinitis cases among young children aged below 12 in the past two years, adding that the numbers are expected to rise further if no swift action is taken by parents.
She said if a child has chronic allergic rhinitis and is then infected by either COVID-19 or influenza, it will take a longer time for the child to recover compared to other people.
This is because when the ongoing chronic inflammation caused by allergic rhinitis inside the nasal cavity and the eustachian tube (a small passageway that connects the throat to the middle ear) is not controlled, the body will take a longer time to fight another infection.
"Not only that, children with underlying or untreated allergic rhinitis are also more prone to getting influenza or COVID-19 as the existing chronic allergic rhinitis inflammation lowers the body’s immune system and also due to the nose condition itself. This will make it easier for the virus to spread, thus worsening the body’s condition.
"As for COVID-19 or influenza, usually it only takes five to seven days for the patient to eventually recover and fever is one of the pronounced symptoms, but for chronic allergic rhinitis, it can take up to one or two weeks to recover and usually with no fever detected. This is also the main difference that parents need to be aware of,” she explained.
OME risk
Dr Juani also warned that a child with untreated year-round chronic allergic rhinitis is in grave danger of suffering from otitis media with effusion (OME) - a collection of non-infected fluid in the middle ear space - which can lead to discomfort and a decrease in the child’s quality of life.
"The eustachian tube drains fluid from the ears to the back of the throat. If it clogs, it can lead to OME, which is the accumulation of fluid behind the eardrum that can disturb the transmission of sound from the outer ear to the inner ear, causing conductive hearing loss.
"Children with OME can also have problems with balance and speech and find it difficult to concentrate as well. If the symptoms worsen, the patient will have difficulty sleeping due to the recurrent ear pain,” she pointed out, adding that it can also cause the eardrum to burst if not treated accordingly and bacterial infection sets in.
Quoting a study conducted by Hospital Canselor Tuanku Muhriz UKM’s Department of Otorhinolaryngology, Head and Neck Surgery, which was published in 2020, Dr Juani said the prevalence of allergic rhinitis with persistent OME in Malaysia was found to be at 80.3 percent.
Recalling a critical case she had previously encountered, she said the case involved a child who nearly lost her hearing ability due to chronic OME.
"I treated this nine-year-old girl back in 2020 when she was rushed to the emergency room with uncontrollable seizure and altered consciousness. During the medical examination, we concluded her ear pus condition was quite serious. We had to treat it with strong antibiotics for two weeks. The drugs crossed the blood-brain barrier, thus enabling the ear and brain to be treated simultaneously,” she explained.
She added that if the child had not been treated immediately, she could not have led a normal life.
"In the worst-case scenario, she could have died if her ear infection had worsened and eventually led to temporal bone infection or brain abscess. Allergic rhinitis is an underlying condition and should be diagnosed and treated as soon as possible," she said.
Treatments available
Allergic rhinitis can be diagnosed by clinical history and symptoms. There are laboratory diagnostic tests for allergy available nowadays to measure the level of immunoglobulin E (IgE), which is a type of antibody. If a person has allergies, the IgE level in their blood will be higher than normal.
"One of the things that we need to know about allergic rhinitis is the type of allergens the patient is allergic to. At SMCV, we will take the blood and test it in our lab to detect the prominent 51 allergens. It covers food allergens, dust mites and animal dander, among others.
"From the blood test results, which can be ready in two hours, we can see the IgE level secreted in the patient’s body, which is responsible for the allergic reaction," said Dr Juani.
Treatments for allergic rhinitis include intranasal corticosteroid sprays that serve as a safe and effective first-line therapy for allergic rhinitis, she said, adding that the steroid in the nasal spray act topically on the inflamed mucosa lining in the nasal cavity; it also acts as an anti-inflammatory agent and reduces the swelling of the mucosa.
A good choice of anti-histamine tablets can also be used to treat allergic rhinitis to reduce the inflammation caused by the allergic reaction in the nose.
Dr Juani also advised the public, especially those living with allergic rhinitis, to make changes to their lifestyle, such as washing their hands often and avoiding touching their face or rubbing their eyes and nose unnecessarily.
"Try to identify your triggers to the symptoms and avoid them. Ensure that your workplace or home environment is in clean condition and not dusty. If you have allergic rhinitis symptoms and it is hindering your daily activities, quickly get a doctor’s advice and start the treatment needed to bring the symptoms under control,” she added. - BERNAMA
