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What is an allergy?

An allergy indicates an excessive inflammatory response by the body to a “foreign body” – this may be an inhaled allergen such as pollen in the air, or an ingested allergen such as milk.  The response by the body varies from sneezing and blocking of the nose (hayfever) to constriction of the lung airways (asthma).

Is my child allergic?

Up to 40% of children in Western Australia have manifestations of allergy, such as eczema, asthma, or hayfever.  If one or both parents, or a brother or sister have an allergic condition, there is a high probability that your child may also develop an allergic condition.  This could be nasal congestion, sinusitis, large tonsils and adenoids causing obstructive sleep disorder, eczema, or asthma.

The allergic child’s facial appearance

Doctors can often diagnose a child as looking allergic just by their facial appearance.  They commonly look tired, with allergic shiners or dark rings under their eyes with a crease or line.  They often have an open mouth, sniff, rub their nose (allergic salute) and develop a box shaped upturned nose with a crease on it as well.  Their cheekbones may not develop well and they may have flattened cheeks, orthodontic problems and a large dry lower lip.  They often have a white or pale area around the nose and mouth.

What are the ENT complications of allergy?

The allergic child often has an increased incidence of ear infection and “glue ear”, and there is often an associated sinusitis, especially in winter.  The tonsils and adenoids may enlarge significantly causing airway obstruction and the obstructive sleep disorder.

How is allergy managed?

Depending on the age of the child, we can do allergy testing by skin testing (for airborne allergens such as grasses, pollens, mould or dust mite/cat/dog hair) at age 3 years and above, or avoidance/provocation testing for food allergies (milk, wheat, yeast, eggs, citrus, soya milk) at a younger age.  Blood testing (RAST tests) can be done at a younger age, but do not always correlate with food allergies.  ”Vega testing” is unscientific and is useless.  Nasal sprays such as Rynacrom, Nasonex,or Rhinocort are useful for nasal allergies and antihistamines are helpful in short courses.

Occasionally, because of obstruction to the eustachian tube, sinus outlets or airway by a combination of allergy and infection, surgical clearance is necessary. This may involve grommet tube insertion, sinus surgery, or tonsillectomy and/or adenoidectomy.  It is important to realize that we cannot cure allergic conditions by surgery alone.  Ongoing medical treatment and even desensitization (either sublingually or by injection) may be necessary.

Nasal steroid spray

Although nasal steroid sprays contain microdoses of steroid, they are quite safe if used as prescribed.  The commonly prescribed nasal sprays for allergic rhinitis (whether hayfever, or year round or perennial allergic rhinitis) are Nasonex spray, Rhinocort AQ, or Avamys nasal sprays.  My regimen is to use one  spray in each nostril once daily from August to Christmas (hayfever season), and occasionally in April and May. Often after a month of daily Nasonex use, the spray can be used once every second day. The sprays should not be used year round unless specifically prescribed in that way.  Occasionally when starting the course, a decongestant spray such as Otrivin Jr MD nose spray is used 10 minutes before the steroid spray to allow decongestion.  Vaseline  or Nozoil spray used in the nostrils once daily prior to the steroid spray will prevent the nose from drying out or bleeding, which occurs sometimes.

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