Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Hayfever, Sinus and Ear Disease in Children

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Approximately one child in every five has allergies of some type including eczema, asthma and hayfever. There are many new treatments available for hayfever which have improved the therapy of this allergic nasal condition immensely. The newest therapies include non-sedating antihistamines including Seldane, Hismanal and, just released, Loratidine and Cetirizine. These are all effective antihistamines which dry a drippy nose, itching, sneezing and itchy red eyes. They have no sedation because they do not cross the blood brain barrier and get into the central nervous system. They also do not have cholinergic side effects of the old antihistamines such as constipation, dry mouth and difficulties with voiding. These are presently approved for older children and adults but have been safely used in children in other parts of the world and will soon be approved for young children in the United States as well.

Other new therapies which help us control hayfever in children include cortisone nasal sprays and chromalin nasal spray which is an anti-inflammatory agent called Nasalchrome. These are very safe and decrease swelling and inČ flammation in the nose without any long term side effects. They do not have a "rebound effect" in the nasal tissues such as Afrin and Neosynephrine spray.

A third new treatment which may soon be approved for use in children is an anti-cholinergic medicine such as atropine (or a derivative) dissolved in a salt water spray. This has been used by some doctors for the past several years but has not been marketed by any particular company. A pharmacist can mix this up at present and it is effective, inexpensive and safe. The usual spray which includes 2 mg. of atropine dissolved in 45 cc. of salt water spray such as Ocean mist is particularly effective for a wet drippy nose. Secondary problems commonly associated with hayfever in childhood include sinusitis and otitis, or infections of the sinuses and middle ear cavities. These conditions are very similar in that a closed area which drains into the nose gets blocked up, fills up with fluid and then gets infected. There are many good antibiotics which allow us to treat these conditions adequately in most cases. Long term, however, chronic repeated infections tend to cause fluid to build up and stay in any of the sinuses or the middle ear cavities. This is a common reason for placing ear tubes which is the most common surgery done in America today. Prior to placing tubes, proper antibiotic therapy and occasional pulse doses of cortico-steroids can remove the fluid from some middle ears. Good nasal hygiene with salt water flushing and medicine such as corticosteroid sprays and nasalchrome or chromalin spray may help to prevent the need for sinus or ear surgery. Prolonged fluid in the ears associated with significant hearing loss is a good indication for placing tubes and possibly also for an adenoidectomy if the adenoids are found to be swollen. Swollen adenoids in childhood are commonly associated with recurrent ear and sinus problems and allergies. They can also lead to problems with snoring and abnormal jaw and face growth, and that is another good reason for scraping the adenoids out while the child is getting the tubes done.

All of these conditions are tricky and have many variables to consider, so discuss them thoroughly with your doctor.