Medical ConditionsCardiac & respiratory: Allergic rhinitis
Medical ConditionsCardiac & respiratory: Allergic rhinitis
Allergic rhinitis
Overview
Board takeaway: Assess nasal patency, asthma, and sleep symptoms before treatment; congestion can make nasal nitrous oxide delivery ineffective.
What is allergic rhinitis?
An immunoglobulin E-mediated response to inhaled allergens produces nasal mucosal inflammation. Pollen often causes seasonal symptoms; dust mites, molds, and animal dander can cause perennial symptoms. Asthma, allergic conjunctivitis, and eczema commonly coexist.
Which findings suggest allergic rhinitis?
- Nose and eyes: sneezing, clear rhinorrhea, nasal or palatal itching, congestion, and itchy or watery eyes.
- Associated symptoms: postnasal drip, cough, fatigue, disturbed sleep, and reduced school performance.
- Appearance: allergic shiners, repeated upward rubbing with a nasal crease, chapped lips, and an open-mouth posture.
- Breathing: persistent obstruction may accompany sleep-disordered breathing; ask about snoring and witnessed apnea.
What oral findings accompany allergic rhinitis?
Mouth breathing may contribute to anterior gingival inflammation and dryness. A high palate, increased facial height, or posterior crossbite may coexist but is not specific to allergy. Antihistamine-related dry mouth and dietary exposures may increase caries risk; assess these individually rather than assuming every child has high caries activity.
How does allergic rhinitis change dental treatment?
If symptoms are controlled and the child breathes comfortably, routine care is usually feasible. Severe obstruction, respiratory symptoms, or poor sleep warrants medical assessment and may justify deferring elective care.
- Nitrous oxide: requires adequate nasal breathing; a blocked nose limits delivery.
- Asthma: assess control and rescue readiness separately.
- Sedation: evaluate airway patency, sleep apnea, and current medications with the anesthesia team when indicated. Congestion alone does not select general anesthesia.
- Prevention: address dry mouth, caregiver-supported hygiene, fluoride, and relevant diet exposures.
How is allergic rhinitis treated and what is the outlook?
Medical management may include allergen reduction, saline irrigation, intranasal corticosteroids, and antihistamines. Allergen immunotherapy is an option for selected patients. Symptoms may fluctuate with exposure and age; sustained control improves sleep and daily function. Ipratropium nasal spray reduces rhinorrhea through anticholinergic activity rather than acting as a nasal bronchodilator.