Etiology
Exposure to allergens triggers an IgE-mediated type I hypersensitivity reaction.
Pathology
The nasal mucosa typically appears pale and edematous, with increased capillary permeability. Eosinophils, monocytes, and other inflammatory cells infiltrate the tissues, and secretions are typically serous.
Clinical Manifestations
Symptoms
Common symptoms include clear watery rhinorrhea, nasal itching, nasal congestion, and sneezing. Ocular symptoms such as eye itching and conjunctival hyperemia may also occur. Some children may develop a habitual "allergic salute" as a result of persistent nasal itching and frequent nose rubbing. Symptoms in infants and young children are often atypical and may present only as nasal congestion or sleep disturbances.
Signs
The nasal mucosa often appears pale and swollen, with watery nasal secretions visible. In severe cases, children may present with "allergic shiners," characterized by darkened discoloration under the lower eyelids caused by venous congestion. Frequent upward rubbing of the nasal tip can lead to the development of "allergic creases," which are horizontal wrinkles on the skin of the external nose.
Auxiliary Examinations
Allergen skin prick tests or serum-specific IgE testing can help identify the causative allergens.
Diagnosis and Differential Diagnosis
Diagnosis is made by evaluating the medical history, clinical manifestations, physical signs, and examination results. Distinction from acute rhinitis is critical. Allergic rhinitis should be considered when systemic symptoms are absent or mild, nasal symptoms persist or worsen despite symptomatic treatment, or when symptoms are recurrent or triggered by specific factors. Coexisting conditions such as conjunctivitis, asthma, or eczema also support the diagnosis of allergic rhinitis.
Treatment
Treatment for allergic rhinitis in children follows a comprehensive "four-pillar" approach, including environmental control, pharmacological treatment, immunotherapy, and health education.
Intranasal corticosteroids, nasal or systemic antihistamines, and anti-leukotriene agents are considered first-line pharmacological treatments. The choice of medication should take into account the severity of the condition and the child’s age. For long-term benefits, allergen-specific immunotherapy may be employed to improve the patient's quality of life and prevent the progression of allergic diseases.