The 30-second triage: Identifying undertreatment of allergic rhinitis (AR) in children

Introduction

Allergic rhinitis (AR), often called hay fever is a common condition that affects 24% of the Australian population, including 13% of children.¹ Data indicates a rising prevalence of AR throughout childhood in Australia, from 7% at age 6 years, 18% at age 11 years, and increasing to 24% by age 18 years.²

AR is an immunoglobulin E (IgE)-mediated allergic condition where the nasal lining develops an immune response to allergens such as dust mites, pollens, animal dander and mould.³

Typical symptoms of AR include persistent sneezing, clear rhinorrhoea, nasal itching, and nasal congestion.^4,5 Ocular symptoms such as itching, eye redness, and tearing are also common.⁶ Other potential symptoms include upper lip itching, postnasal drip, coughing and a frequent need to clear the throat.^3,6

In addition to the more common symptoms, children may present with what’s known as ‘allergic facies’ — Dennie-Morgan lines (small creases or lines of skin located just below the lower eyelid), the allergic salute (upward rubbing or wiping of the nose with fingers or the hand), allergic shiners (dark, bluish-purple circles under the eyes caused by chronic nasal and sinus congestion), periorbital oedema and mouth breathing.⁶ Parents may also report snoring, disordered breathing and obstructive sleep apnoea.⁷

Undertreated AR

Despite its prevalence, AR in children is often overlooked and underdiagnosed. This is partly because children are often unable to describe their symptoms⁷ and presentations are mistaken for recurrent upper respiratory tract infections.^3,7
Parents may also dismiss AR as ‘just allergies’, and manage it episodically or reactively, rather than a chronic, inflammatory condition requiring o