Rhinitis in Young Children

1
Rhinitis in Young Children

• Hugo Van Bever
• Singapore

Cambodia, February 20, 2010.
2
Cumulative prevalence of rhinitis in Singaporean
children

1 - 2 yrs-old 2002 -2003

4 - 6 yrs-old 2000

6 7 yrs-old 2001

12 15 yr-old 2001
3
Chronic rhinitis in preschool children

• - NO DEFINITION (ARIA?) not for preschool
  children
• gt 1 - 2 months at least 1/2 hr per day (?)
• - A SYNDROME ? a combination of
• - rhinitis
• - sinusitis rhino-sinusitis
• - adenoidal hypertrophy
• - dysfunction of Eustachian tube

4
Chronic rhinitis in asthmatic children
1. INFANTS gt 90 2. PRESCHOOL CHILDREN 70
3. SCHOOL CHILDREN 50
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Symptoms

• - nasal congestion (blocked nose)
• - nasal discharge (runny nose)
• - sneezing
• - itch ( salut allergique )
• conjunctivitis

6
Chronic rhinitis in preschool children

• ETIOLOGY
• 1. Hyperreactivity (intrinsic - postviral) (gt
  60 )
• 2. Allergy ( 30 )
• 3. Specific diseases (lt 1 )
• - CF
• - ciliar dyskinesia
• - immune deficiency

7
Allergy in childhood asthma-rhinitis
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Allergens

• 1. House dust mites
• 2. Cockroaches
• 3. Pets (dog cat)
• 4. Pollen
• 5. Moulds
• 6. Food

9
SPT in young children ( lt 3 yrs old) suffering
from rhinitis
10
Chronic rhinitis in preschool children
Adenoidal hypertrophia Otitis (acute -
chronic) Sinusitis (acute - chronic) OSAS
Chronic rhinitis
Bronchial hyperreactivity ASTHMA
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Acute sinusitis
Chronic sinusitis
12
Psycho-social impact of allergic rhinitis in
children.

• sleep problems (OSAS)
• learning problems
• social problems

13
Treatment of chronic rhinitis in preschool
children

• 1. Causal treatment (allergic rhinitis)
• - avoidance of allergens
• - immunotherapy (SLIT)
• 2. Symptomatic treatment
• - nasal washes (saline)
• - intranasal medication
• - antihistamines (1st choice)
• 3. Chirurgical treatment

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Chronic rhinitis in preschool children

• INTRANASAL MEDICATION
• 1. saline
• 2. decongestants
• 3. cromoglycate
• 4. levocabastine
• 5. corticosteroids

1. Limited data in young children (few
studies) 2. Young children hate them !
15
Intranasal medication in young children
a daily fight !!!
Low compliance
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Treating chronic rhinitis in young children

• 1. a sweet syrup
• 2. once daily

17
The role of SUNC
???
18
Singaporean University of Nose Cleaning (SUNC)
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Intranasal corticosteroids
20
Intranasal and intrabronchial corticosteroids in
preschool children

• ASTHMA RHINITIS
• beclomethasone diprop.
  
• budesonide -
• fluticasone prop.

21
Intranasal corticosteroids in preschool children

• INDICATIONS
• 1. Chronic rhinitis
• 2. Chronic sinusitis
• 3. Hypertrophia of adenoids
• 4. OSAS

22
Antihistamines 1st choice in preschoolers

• 1. easy to administer (better compliance)
• 2. effective (studies in preschool children)
• 3. good safety data ( ? ETAC, EPAAC)

23
The 3 generations of antihistamines

• - 1st
• chlorpheniramine, clemastine, promethazine,
  hydroxyzine, oxatomide, azatadine, ketotifen,
  etc
• - 2nd
• terfenadine, cetirizine, loratidine,
  astemizole, etc
• - 3rd
• levocetirizine, fexofenadine, desloratidine

24
Antihistamines - indications
level of evidence

• 1. Allergic rhinitis
• 2. Urticaria
• 3. Anaphylactic reactions
• 4. Eczema (?)
• 5. Asthma (?)

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Side effects of 2nd generation antihistamines

• 1. Less central nervous system toxicity
• 2. Terfenadine and astemizole can cause cardiac
  toxicity in children.
• - Ventricular arrhythmias
• - torsades de pointes

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3rd generation antihistamines

• LEVOCETIRIZINE - FEXOFENADINE - DESLORATIDINE
• 1. Metabolites
• 2. 24-hour effectiveness fast onset
• 3. Non-sedating
• 4. No cardiac effects
• 5. No hepatic metabolism

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Antihistamines in children lt 3 years

• 1. Limited number of studies !
• 2. No safety studies on 1st generation
  antihistamines
• 3. Association with SIDS ?
• 4. Safety studies in young children
• cetirizine - levocetirizine gt ketotifen gt
  loratidine
• 5. Cetirizine has an extensive safety
  file (ETAC ? n 399)
• (EPAAC ? n 255)

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ConclusionManagement of allergic rhinitis in
young children

• 1. Allergen avoidance ? impossible
• 2. Immunotherapy (SLIT) ? earlier in life
  (?)
• 3. Medication ? antihistamines
• 4. Intranasal corticosteroids daily fight !