Allergies are on the rise! No one has quite figured out all the answers at this point. There’s the “hygiene hypothesis”, which we spoke about previously and other areas of intense on-going research beyond the scope of this post.
A parent wondered aloud recently and asked if her 13-month old son could be having nasal allergies? My answer was, Yes. This surprised her and this is why. This parent realized and correctly so that you can only respond with allergy-type symptoms to something you’ve been exposed to and subsequently sensitized to. The baby at 13-months old has barely gone through his first allergy season and presumably his very first exposure to the annual tide of environmental allergens (trees, weeds, grasses) and really unlikely to be reacting now, let alone mount an allergic response barely after the first year of exposure.
This parent is factually correct. The development of allergy symptoms often has many factors and is seldom a singular reason. Features of seasonal allergic rhinitis usually do not occur until the fourth or fifth year of life on the average. A number of exposure cycles are sometimes required before the cascade of bodily changes which eventually manifest as allergy peak. This 13-month old however was having nasal allergy type symptoms with sneezing, clear runny nose and frequent eye-rubbing not from seasonal “outdoor” allergens - but from perennial “indoor” allergens!
Perennial allergic rhinitis sufferers go through an accelerated cycle of exposure and subsequent sensitization easily due to the ubiquitous nature of the offending allergen in their immediate environment at home usually. The body’s allergy cascade could be sufficiently primed and put in effect within the first year of life. House dust mite, pet/ animal dander, mould, cockroach infested environments are common causes. Airway irritants like cigarette smoke are also harmful to the airway structures and can directly cause injury that may manifest with allergy type symptoms in the early stages. My patient referenced above lives in an environment where cigarette smoke is present and a number of pet animals are also present in the home. These factors together present poor air quality around this child and have inevitably led to the evolution of allergic rhinitis at a young age.
There is a direct relationship between allergic rhinitis and asthma symptoms. Both conditions tend to reinforce each other and early control with an “all-of-the-above” approach to controlling symptoms with medications and improving the quality of air in the home are often very helpful.
Smoking cessation is an important component of the treatment plan. Smoking away outdoors as we often see is welcome. We realize in addition that the cigarette smoke irritants stay on the clothing, hair etc and can still be inhaled by the infant. Smoking cessation helplines are available nationwide and we encourage parents who smoke desirous of stopping to avail themselves of the opportunity. It's shockingly more of a challenge when the trigger is the pet animal. I’ve heard of a case though where the family decided to get rid of the Pediatrician rather than the offending pet! - we hope that won’t be the case this time.
'Diji Vaughan, MD