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The Informed Parent

Allergy vs Vasomotor Rhinitis

by John H. Samson, M.D., F.A.A.P.
Published on Apr. 09, 2012

Reprinted from the ALLERGY HANDBOOK, Pediatric Medical Center

This is an extremely common pediatric problem. Yet, the solution for it is not always as simple as the parents would like.

First, children do not have chronic colds. A cold, meaning a viral infection of the nose and throat, lasts on an average of five days. The average elementary school child gets about three to five colds per year. Whether they are treated or not, they improve readily. Let us remove the world “cold” because it is misleading. What he has is a chronic or recurrent watery discharge from his nose, with nasal congestion. This is also known as serous (clear discharge) rhinitis (inflammation of the nose).

We must look at the common causes of this condition. The two most common causes are allergy and vasomotor overreactiveness of the tissue lining of the nose and throat. The latter condition involves overreaction to an irritating stimulus or environmental change.

In allergic rhinitis the child has antibodies (specific proteins) in the blood stream that react with specific substances and provoke the body to release factors that cause the lining of the nose to swell, itch and produce excess mucus. In vasomotor rhinitis the irritating substance affects the lining of the nose directly. No antibodies are needed.

Everyone is aware of allergies to airborne pollen, dust, fungus, animal dander, and food. The patient inhales, eats, or touches the substance he is allergic to. It enters the blood stream and the reaction occurs. Many parents are not aware of the non-allergic vasomotor rhinitis. This condition is provoked by sudden changes in environmental temperature, changes in barometric pressure, chlorinated pool water, perfumes, flower scents, smoke, vapors from volatile liquids, as well as anxiety and fatigue. Surely you have heard someone say “I’m allergic to air conditioners,” or “I’m allergic to perfume,” or “Every time the weather changes I get allergies.” These people are describing non-allergic vasomotor rhinitis. The specific reaction they complain about may have no relation to allergy.

When confronted with this type of patient the physician must separate allergy from non-allergy. The treatment varies between the two diagnoses. Both patients would look the same. Thus, the physician might resort to laboratory tests and allergy skin tests to separate the two conditions. At times the two co-exist in the same patient. Thus, your physician may find clear cut evidence of allergy, manage the allergy component perfectly, and still have some symptoms. These then must be controlled separately from the allergy management.

In the past a child was given small shots of gamma globulin, but more recent studies have demonstrated these children are not deficient in gamma globulin. Before the advent of the newer test procedures all of these children were called ”allergic children”. As you would guess, they did not improve under the usual allergy treatments.

There is usually a strong family tendency to both types of rhinitis. Frequently in caring for the child the parent realizes he or she has non-allergic rhinitis which he has been trying to manage unsuccessfully for years as an allergy.

Ignoring the problem is not wise, as these children tend to get secondary infections in the nose and ears due to the congestion. Furthermore, if allergy is the problem, not only the nose but the child’s general well being may be affected. Irritability, headaches, poor school performance and mild behavior problems may also be present associated with the allergy.

Do take the child to his doctor so he can be properly diagnosed and treated. He is not having repeated simple colds. 

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