Sneeze Symphony

October 19, 2018
Sneeze Symphony
Consider the following scenario: our child, usually at pre-school to primary school-going age, waking up in the morning with intense bouts of sneezing, runny nose, watery eyes and violent rubbing of his or her nose. These episodes happen, for the most part, in the morning and are a daily occurrence. The poor child also suffers from ongoing asthma and eczema, which does not seem to abate despite multiple medications.

I suspect this scenario rings a bell with many of us. It is as one in three of children suffer from some degree of persistent nasal symptoms.

We often hear the terms resdung and sinus being bandied around when describing a series of nasal symptoms from nasal blockages to headaches and facial pains. As an Ear, Nose and Throat Specialist, I often delve into it a little bit more so that I know what is actually afflicting my patient when they mention those two aforementioned terms.

What is resdung, really?
Resdung can be divided into two related, often co-existing, but nonetheless distinct, conditions;
  • Rhinitis, which, by definition, is the inflammation of the inner lining of the nasal cavity; and
  • Sinusitis which is the inflammation of the sinus cavities around the nose within the skull.
Rhinitis, in turn, can be divided into two; one, Allergic Rhinitis (AR) which is rhinitis caused by external irritants (or allergens) such as dust, fumes, certain foods etc; and Non-Allergic Rhinitis which is usually triggered by change in climate rather than irritants.

For the purposes on this article, the focus will be on Allergic Rhinitis as children are affected more by this sub-category of rhinitis. You may ask why children are more affected by AR. The simple explanation to that is that children’s immune system is constantly being exposed to new allergens or irritants hence it tends to react more aggressively. In adults, unless they are overtly allergic to specific substances such as certain drugs, the immune system ‘adapts’ to many allergens thus reacting in a less violent manner.

What are the symptoms of AR?
The typical symptoms of AR include sneezing (especially in the mornings), nasal itchiness, runny nose and nasal blockage that is usually caused by exposure to certain allergens. Commonly seen in children, though not exclusively so, patients with AR often rub their noses which can sometimes cause a horizontal crease in the middle of their nasal bridge. Patients with Non-Allergic Rhinitis display similar symptoms though they experience less sneezing and itchiness.

How is AR diagnosed?
Normally a doctor would diagnose AR based on clinical symptoms as elaborated above. If a patient also has other allergic-type problems such as asthma and eczema, it would further support the diagnosis of AR. Specifically, an Allergic Panel test would be very useful in not only the diagnosis of AR but also in the treatment strategy.

How is AR treated?
For effective treatment of AR, allergy avoidance is essential. In order to determine the offending allergens, an Allergic Panel test should be done. This is a blood test that would test our blood against over 30 common allergens. Once the offending allergens are identified, these need to be avoided in combination with usage of medications such as anti-histamines and nasal steroid sprays. Once the symptoms are well-controlled, the medications can then slowly be tapered down usually over the course of a few weeks to a few months.

Does AR need surgery?
Generally, surgery is not required for AR or Non-Allergic Rhinitis unless there are structural problems within the nose such as bony deviations or abnormal growths that are not adequately treated with medications.

In a nutshell, Allergic Rhinitis is common but is often a poorly managed condition in children. AR is a very treatable problem provided the treatment plan is properly devised and planned. Allergy avoidance is often underestimated, even by many medical practitioners, but it is a vital component in the management plan. The success of the management of other conditions related to hypersensitivity such as asthma, would be influenced by how well the rhinitis is controlled or treated.

Dr. Iqbal Farim Rizal Wong
Consultant ENT Surgeon
Columbia Asia Hospital – Petaling Jaya

This article first appeared in New Straits Times, 16 October 2018