Red Book 29th Edition, American Academy of Pediatrics
Harriet Lane Handbook, 19th ed
Nelson Pediatric Textbook, 19th ed.
MMWR
CDC
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부모도 반의사가 되어야 한다
www.koreapediatrics.com->drleepediatrics.com
Copyright ⓒ 2014 John Sangwon Lee, MD, FAAP
“부모도 반의사가 되어야 한다”-내용은 여러분들의 의사로부터 얻은 정보와 진료를 대신할 수 없습니다.
“The information contained in this publication should not be used as a substitute for the medical care and advice of your doctor. There may be variations in treatment that your doctor may recommend based on individual facts and circumstances.
“Parental education is the best medicine.
Copyright drleepediatrics.com 2/18/2026
1. Treatment of Allergic Rhinitis: Environmental Control and Allergen Avoidance
Figure 118. Allergic rhinitis is treated by avoiding or eliminating all allergens or factors that can trigger allergic rhinitis as much as possible.
Used with permission from Merck Sharp & Dohme Corp. Foods (allergens) that can trigger allergic rhinitis or other allergic diseases should be avoided as much as possible.
Newborns or infants born to biological parents or siblings with allergies or atopic dermatitis should be breastfed or fed hypoallergenic formulas instead of formula containing milk, milk protein, or soy protein. This prevents allergic rhinitis and properly treats existing allergic rhinitis.
To prevent allergic rhinitis and other allergic diseases, avoid foods that can trigger allergic rhinitis and other allergic diseases, such as milk, eggs, nuts, and chocolate.
Do not keep pets such as dogs, cats, or birds in the home, and avoid contact with them if possible. If you must keep a pet indoors, avoid contact with or inhalation of the animal’s fur, saliva, dander, or feathers.
Photo: Do not keep pets such as birds or dogs indoors.
Copyright ⓒ 2013 John Sangwon Lee, M.D. FAAP
Photo: Goldenrod Avoid exposure to pollen.
Copyright ⓒ 2011 John Sangwon Lee, MD.FAAP
Do not keep plants or trees in a home with children with atopic dermatitis or allergic rhinitis.
Mold and mold thrive in humid environments, so maintain proper humidity levels in your home to prevent mold and mold growth.
Insert washable carpets instead of fixed carpets, as these attract more dust and can foster the growth of dust mites.
Wash curtains frequently.
Keep your home clean and prevent the growth of dust mites. Children with allergic rhinitis or atopic dermatitis should have no other items besides bedding in their bedrooms, if possible.
Cover mattresses and spring boxes with plastic covers to prevent dust mites from growing.
During spring, when flowers are in full bloom, keep windows tightly closed to prevent pollen and mold from entering the home.
When tending plants or mowing the lawn, pollen and mold can be inhaled into the airways, triggering allergic rhinitis, allergic conjunctivitis, or asthma. While it’s difficult to completely avoid contact with these allergens, avoid them as much as possible.
If necessary, wear a mask and goggles to prevent dust from entering your eyes when mowing the lawn.
Avoid areas where legweed grows during legweed season, when it’s in full bloom.
Avoid wearing clothing made of animal fur or feathers, and never use pillows or blankets filled with feathers or down. Reduce house dust mites (house dust mites) with HEPA air filters.
Eradicate cockroaches.
For general treatment of other allergic diseases, refer to each section. See p. 00, General Treatment of Allergies. See p. 00, Avoiding and Eliminating Household Allergens.
2. Drug Treatment of Allergic Rhinitis
Figure 119. Pharmacological treatment of allergic rhinitis, pharmacological action of various types of allergic rhinitis, and the relationship between mast cells and histamine secretion.
Reference: Fisons Pharmaceuticals
3. Treat allergic rhinitis with oral first- or second-generation antihistamines.
When an antigen-antibody reaction occurs, histamine granules may be released from mast cells and basophil cells into various organs or localized areas of the body. Allergic rhinitis or anaphylaxis can be triggered by a complex interaction of histamine granules, IgE, cytokines, leukotrienes, and other biochemical substances within the body.
Normal histamine receptors are found on cells scattered throughout various tissues throughout the body.
Drugs that block histamine granules secreted by mast cells from binding to these receptors, thereby preventing allergic disease, are collectively called antihistamines (commonly referred to as antihistamines).
Based on this physiological basis, antihistamines are used to treat the symptoms of allergic rhinitis.
While treating allergic rhinitis with antihistamines can improve various symptoms and signs, it does not completely cure allergic rhinitis (see Figure 119).
Furthermore, the therapeutic effects of antihistamines often do not appear immediately. Antihistamines are divided into first-generation and second-generation antihistamines.
Antihistamines commonly used in clinical practice in the past, such as Periactin, Chlor-trimeton, Benadryl, and Pyribenzamine, are first-generation antihistamines.
Only one first-generation antihistamine can be selected to treat allergic rhinitis.
While first-generation antihistamines can be effective in treating allergic rhinitis, they can also cause side effects such as sedation and hypnosis.
Therefore, second-generation antihistamines are currently the primary treatment for allergic rhinitis. Claritin, Astemizole, Cetirizine, Fexofenadine, and Loratadine are second-generation antihistamines.
Second-generation antihistamines are effective in treating allergic rhinitis, but may have less sedative and hypnotic effects.
Treating allergic rhinitis with first-generation antihistamines virtually eliminates symptoms such as runny nose, sneezing, itchy nose, and watery eyes.
However, second-generation antihistamines have minimal decongestant effects on the nasal mucosa. This is a drawback of second-generation histamines for treating allergic rhinitis.
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Image 121. Corticosteroid nasal sprays (nasal sprays), such as Vansenase, Beclomethasone, Budesonide, or Fluticasone, which are applied to the nasal mucosa, can be used to treat allergic rhinitis.
Used with permission from Schering Corporation Kenilworth, NJ 07033, USA and the Encyclopedia of Pediatric and Family Medicine
Image 120. Corticosteroid nasal sprays (nasal sprays), such as Beclomethasone, Budesonide, or Fluticasone, can be used to treat allergic rhinitis.
Used with permission from Schering Corporation, Kenilworth, NJ 07033, USA and the Encyclopedia of Pediatrics and Family Medicine
For this reason, some doctors treat allergic rhinitis with a first-generation antihistamine in the evening and a second-generation antihistamine during the day.
Occasionally, treatment is also administered with a combination allergic rhinitis medication containing a second-generation antihistamine and a nasal decongestant (e.g., Claritin-D).
Figure 122. Allergic rhinitis can be treated with tablets or syrups of second-generation antihistamines, such as astemizole, cetirizine, fexofenadine, or loratadine. Copyright ⓒ 2011 John Sangwon Lee, MD.FAAP
Photo 123. Second-generation antihistamines, such as astemizole, cetirizine, fexofenadine, or loratadine, can be used to treat allergic rhinitis.
Copyright ⓒ 2011 John Sangwon Lee, MD.FAAP
Side effects can occur regardless of whether you use a first- or second-generation antihistamine, and these side effects vary depending on the antihistamine type.
While first-generation antihistamines can cause side effects such as drowsiness, difficulty concentrating, and dry mouth when treating allergic rhinitis or other allergic conditions, second-generation antihistamines typically have fewer of these side effects. Allergic rhinitis can be effectively treated with antihistamines, but sometimes simultaneous treatment with two types of antihistamines can be more effective.
Depending on the symptoms and severity of allergic rhinitis, one or two first-generation antihistamines can be selected for treatment.
When treating allergic rhinitis with first-generation antihistamines, treatment may initially be effective. However, after continued use, the treatment effect may no longer be observed. This may lead to the need for continued treatment with that first-generation antihistamine, as directed by a physician.
If a single antihistamine is effective in treating allergic rhinitis, continued treatment with that medication can be continued as needed.
Furthermore, while treatment with one type of antihistamine may initially be very effective, prolonged treatment with that antihistamine may gradually decrease or even disappear altogether.
Therefore, sometimes a different type of antihistamine is used. Long-term treatment with antihistamines can lead to antihistamine resistance.
When treating allergic rhinitis with antihistamines, the ideal treatment principle is to select the appropriate antihistamine according to the doctor’s prescription.
Treating allergic rhinitis with second-generation antihistamines, such as loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra), desloratadine (Clarinex), and others, is highly effective and rarely causes drowsy, hypnotic side effects. Therefore, first-generation antihistamines are generally not used to treat allergic rhinitis.
4. The following second-generation antihistamines can treat allergic rhinitis: Claritin (Loratadine),
Claritin-D,
Zyrtec (Zyrtec, Zyrtec tablets, Zytaq, Cetirizine),
Allegra (Fexofenadine),
Desloratadine (Desloratadine/clarinex)
XYZAL oral solution
Other second-generation antihistamines
These second-generation antihistamines have less sedative effects and cause significantly less drowsiness than first-generation antihistamines.
They are currently primarily used to treat mild allergic rhinitis.
Claritin-D is also available as a combination treatment for allergic rhinitis, combining second-generation antihistamines with Sudafed.
5. Alpha-adrenergic agonists can treat allergic rhinitis. Pseudoephedrine is a type of alpha-adrenergic agonist.
Sudafed is a commercially available pseudoephedrine and is an alpha-adrenergic agonist.
Treating allergic rhinitis with Sudafed significantly improves nasal congestion caused by nasal mucosal congestion.
These medications are called nasal decongestants.
Nasal decongestants come in oral tablets and liquid syrups,
a spray that can be sprayed directly into the nasal cavity,
and nasal drops that can be administered as drops.
Some medications contain only a nasal decongestant,
while others combine antihistamines with a nasal decongestant, called combined nasal decongestants.
Oral pseudoephedrine, commonly used today, is a type of nasal decongestant. This medication does not contain an antihistamine.
When used for treatment, it does not have an antihistamine effect, but rather a nasal mucosal decongestant effect.
Nasal mucosal decongestants, such as oral pseudoephedrine, temporarily constrict the capillaries in the nasal mucosa, reducing runny nose and temporarily relieving nasal mucosal congestion, thus opening up the nasal airway.
Sudapedrozome can be used to treat allergic rhinitis symptomatically, or a combination medication containing an antihistamine and Sudafed can be used symptomatically.
6. Mixtures of first-generation antihistamines and alpha-adrenergic agonists can be used for treatment.
Periactin, Chlor-trimeton, Benadryl, and Pyribenzamine are first-generation antihistamines. Among these, allergic rhinitis can be treated with just one first-generation antihistamine.
There are also combination allergic rhinitis treatments that combine a first-generation antihistamine with a nasal decongestant.
Examples include
Rondec,
Actifed,
Naldecon,
Novafed,
Triaminic, and
Dimetap.
Allergic rhinitis can be treated with just one of the combination medications listed above.
“Allergy medications” used to treat allergic rhinitis may contain a single antihistamine, or they may contain a combination of an antihistamine and a nasal decongestant. Cold medications that relieve symptoms may also contain antihistamines and decongestants of this type.
Therefore, they are sometimes used as a combination medication for allergic rhinitis.
It’s important to note that these types of medications should only be used for allergic rhinitis or colds as prescribed by a doctor.
Children under the age of 2 to 4 should not be treated with these types of cold medications.
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Photo 125. Cromolyn nasal spray, an intranasal spray, can prevent allergic rhinitis.
Copyright ⓒ 2011 John Sangwon Lee, MD.FAAP
Antigen immunotherapy is also called “immunotherapy” or “immunotherapy” (see Immunotherapy).
Moderate to severe allergic rhinitis that is not effectively treated with appropriate allergic rhinitis medications
Severe allergic rhinitis requiring systemic corticosteroid therapy
Severe allergic rhinitis that is not effectively treated with appropriate corticosteroid therapy
Allergic rhinitis items 1-4, when sinusitis and/or asthma and allergic rhinitis coexist, can be treated with antigen immunotherapy.
Allergic rhinitis can be purified and extracted from allergens that can trigger allergic rhinitis, such as cat or dog hair and dander, plant pollen, or house dust mites (house dust mites). When various purified and extracted antigens are applied to the skin surface or injected intradermally in children with allergic rhinitis or other allergic diseases, the skin reaction can be analyzed to determine which antigen is causing the child’s allergic disease.
Children with allergic rhinitis can be treated with antigen immunotherapy by subcutaneously injecting extremely small amounts of purified and extracted antigens identified through skin reaction tests.
Immunotherapy is initially initiated with a very small dose of the antigen and gradually increased to the maintenance dose.
After increasing to the maintenance dose, immunotherapy is typically continued for 2 to 6 weeks at the maintenance dose. This type of antigen immunotherapy is said to alleviate the symptoms of allergic rhinitis by approximately 2/3.
This method of immunotherapy, which uses antigens to prevent the recurrence of allergic rhinitis, is called antigen immunotherapy, immunotherapy, or immunotherapy.
Although antigen immunotherapy seems theoretically the ideal treatment for allergic rhinitis, it is not the first choice for various reasons. As previously explained, when allergic rhinitis symptoms fail to improve despite appropriate treatment with medications, allergen removal and avoidance, and environmental management, or when symptoms are so severe that they interfere with sleep, cause inattention at school or at home, and significantly interfere with daily life, allergic rhinitis is typically treated with antigen immunotherapy.
However, allergic rhinitis in infants and toddlers under the age of 3 is typically not treated with antigen immunotherapy.
Studies have also shown that treating allergic rhinitis with antigen immunotherapy in infants, school-aged children, and adolescents aged 4-14 years significantly reduces the risk of asthma.
Systemic side effects occur in approximately 5-10% of patients with antigen immunotherapy, some of which can be life-threatening. Furthermore, the significant cost of treatment is a drawback.
Antigen immunotherapy is typically administered by intradermal injection, but in the West, sublingual immunotherapy is sometimes used, placing the antigen under the tongue. Recent research suggests that treating allergic rhinitis with immunotherapy can significantly reduce treatment costs. Specifically, sublingual allergy immunotherapy, which targets the tongue, can significantly reduce treatment costs (Source: Pediatrics News, December 2008).
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Sources and references;
Resident & Staff Physician, August 2003, Vol. 49, No. 8
The Johns Hopkins Hospital, The Harriet Lane Handbook, 18th edition
Nelson text book, 15th edition
Asthma, January/February 2000 p. 10
Encyclopedia of Pediatric Family Nursing – Parents Should Become Half-Doctors, Lee Sang-won
The Johns Hopkins Hospital, The Harriet Lane Handbook, 18th & 19th editions
Red Book, 29th edition 2012
Nelson Text Book of Pediatrics, 19th Edition
Infectious Disease of Children, Saul Krugman, Samuel L. Katz, Ann A. Gerhon, Catherine Wilfert
Volume 18 Pediatric and Adolescent Otolaryngology References and Sources
Emergency Care Transportation of Sick and Injured Children, American Academy of Orthopaedic Surgeons
Emergency Pediatrics: A Guide to Ambulatory Care, Roger M. Barkin, Peter Rosen
Gray’s Anatomy
Habilitation of the Handcapped Child, The Pediatric Clinics of North America, Robert H. Haslam, MD
Pediatric Otolaryngology Sylvan Stool
Hearing Loss in Children, The Pediatric Clinics of North America Nancy Roizen, MD and Allan O. Diefendorf, PhD
Recent Advances in Pediatric Otolaryngology The Pediatric Clinics of North America
Pediatric Otolaryngology. The Pediatric Clinics of North America, David Tunkel, MD, Kenneth MD Grundfast, MD
Atlas Pediatric Physical Diagnosis Frank A. Oski
Korean Textbook of Pediatrics, Hyo-Seop Ahn
Dictionary of Medical Terms, Korean Medical Association
Other
References
If necessary, you may obtain and use these medications without a doctor’s prescription in the United States.
In any country, you can obtain detailed information about medications not listed in this table by referring to the scientific name instead of the brand name.
Searching for the scientific name of a medication on the internet, such as Google, can be particularly helpful.
16. Corbulation: Allergic rhinitis can be treated with turbinate reduction therapy.
Coblation Turbinate Reduction Treatment
Chronic rhinitis can cause nasal mucosa congestion and blockage of the nasal airway.
Allergic rhinitis can also cause other causes, such as irritation, inflammation, and thickening of the nasal turbinates.
This surgical treatment reduces the volume of swollen and inflamed turbinates without damaging nasal tissue.
This treatment can be considered when partial nasal airway obstruction due to allergic rhinitis has failed despite all other medical treatments. (Source: Pediatric News, July 2007.)
If there is any discrepancy with the information above, please consult your child’s pediatrician.
17. The age at which allergic rhinitis begins in children and adolescents varies depending on the trigger – I.
The age at which allergic rhinitis first develops varies depending on the trigger.
Allergic rhinitis can affect 20-30% of children and adolescents (ages 0-18), and the incidence is increasing. Allergic rhinitis can be a painful condition and can be quite expensive to treat.
Children with allergic rhinitis are prone to complications such as sinusitis, nasal polyps, otitis media, sleep problems, and asthma.
Milk, eggs, wheat-based foods, cockroaches, cats, dogs, and house dust mites (house dust mites) are well-known triggers for allergic rhinitis.
Sleep disturbances, obstructive sleep apnea, attention deficit disorder, learning disabilities, and decreased productivity can all be caused by allergic rhinitis.
18. The age at which allergic rhinitis begins in children and adolescents varies depending on the trigger – II.
Although allergic rhinitis can occur before the age of 1, it is generally accepted that true allergic rhinitis rarely develops before that age.
This is because the primary antibody responsible for allergic rhinitis is IgE, which develops later than IgG, IgA, and IgM antibodies. Allergic rhinitis caused by pollen typically develops about three years after exposure to pollen, so it typically doesn’t occur before the age of three.
Perennial rhinitis (year-round allergic rhinitis) caused by house dust mites (house dust mites) rarely occurs before the age of nine.
Allergic rhinitis caused by milk or milk-based products accounts for approximately 0.3% of allergy cases.
The incidence of allergic rhinitis in children with atopic dermatitis is over 0.3%.
As many as 50% of children under two years of age with allergic rhinitis may develop asthma. However, the incidence is much higher.
19. Current Treatments for Allergic Rhinitis
Second-generation antihistamines, such as fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec), are non-sedating histamines and rarely produce sedative effects during treatment with these antihistamines.
Azelastine (Astelin) has both antihistamine and anti-inflammatory properties and is used as an intranasal spray for allergic rhinitis.
Corticosteroid nasal sprays, such as beclomethasone, budesonide (Rhinocort Aqua), dexamethasone, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide, are used as nasal sprays for allergic rhinitis.
Non-corticosteroid nasal sprays have anti-inflammatory properties.
These are topical allergic rhinitis treatments used as nasal sprays to treat allergic rhinitis. Atrovent nasal spray is a decongestant that targets the nasal mucosa, and Cromolyn sodium nasal spray is a mast cell stabilizer with anti-inflammatory properties.
Depending on age and severity of allergic rhinitis, choosing one or two of the allergic rhinitis treatments described above can be highly effective.
Recent research has shown that sublingual allergen therapy (Myeongyeok therapy) is effective. – 2014.
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Q.
When I have a cold, especially at night when I sleep, my breathing becomes so labored that I often feel out of breath along with the rhythm.
A.
As explained above, these symptoms seem to be caused by a combination of a cold, allergic rhinitis, adenoid hypertrophy, and/or asthma.
It’s generally true that asthma can develop in almost all children with a history of atopic dermatitis and allergic rhinitis.
Consult a pediatrician and treat asthma with a bronchodilator like albuterol or an anti-inflammatory medication like prednisone for a few days. Shortness of breath and other symptoms will significantly improve.
Also, treating allergic rhinitis with a corticosteroid nasal spray and oral antihistamines will significantly improve the treatment effect.
There is no specific treatment for colds.
Please also consider preventative measures to prevent allergic diseases. Q.
The doctor said my adenoids are enlarged and I might need to have them surgically removed. The pediatrician said they might shrink as I grow, so I should just wait and see. I’m afraid of the seasonal changes (fall and winter).
A.
Many children in the US suffer from similar health issues. This is especially true during the seasonal changes, when respiratory illnesses like colds and asthma become more common.
Cromolyn nasal spray is a long-term treatment for allergic rhinitis, administered intranasally (for several weeks or months). Cromolyn nasal spray is a mast cell stabilizer. It has few side effects and is effective in preventing allergic rhinitis.
In the US, it’s available over-the-counter, but it’s definitely worth a try to prevent allergic rhinitis. There are also corticosteroid nasal sprays that can be sprayed into the nasal passages to treat allergic rhinitis, and oral second-generation antihistamines like Claritin can also treat allergic rhinitis.
Q.
You mention occasional motion sickness, so I think you also have severe headaches. When you go to an ENT clinic, they say your nose keeps going back, and you also have sinusitis.
A.
Children with atopic dermatitis and allergic rhinitis, like their children, may have an adenoid facial structure, malocclusion, or other uneven teeth. They may also exhibit symptoms like allergic shiners. They are prone to motion sickness for various reasons, and their five senses are more sensitive to everything.
Allergic rhinitis causes swelling in the nasal mucosa, which can easily block the natural passages connecting the paranasal sinuses and nasal passages. This makes them prone to sinusitis. Sinusitis doesn’t occur when nasal secretions in the nasal cavity easily flow into the pharynx.
Q.
He only weighs 19 kg now. Seeing him having difficulty breathing makes me want to have surgery right away.
A.
He’s in the 50th percentile.
If the upper airway is blocked by enlarged adenoids, for example, he may have difficulty breathing and sleep at night. This can lead to increased fatigue and some children may complain of daytime sleepiness. Sometimes, he may not eat well. He may also experience hyperactivity and/or lack of concentration.
The bottom line is this:
He appears to have allergic rhinitis, sinusitis, enlarged adenoids, enlarged tonsils, or bronchial asthma. This phenomenon is also called “allergy marching.” Approximately 7-15% of children have this type of allergy.
The severity of symptoms varies greatly. Don’t worry. Consult with an allergist, pediatrician, or otolaryngologist and receive treatment from them. Then, you can raise your child healthily.
[Parents Should Be Half-Doctors Too – Pediatric Family Nursing Encyclopedia] – Volume 8: Respiratory Diseases in Children and Adolescents – Colds, Asthma, Allergic Rhinitis, Food Allergies. Please refer to Volume 17: Skin Diseases in Children and Adolescents – Atopic Dermatitis. Volume 18: ENT Diseases in Children and Adolescents – Sinusitis, Adenoids and Tonsil Hypertrophy, Adenoids and Excision Surgery, etc. Please visit the pediatrics department for further examination, diagnosis, treatment, and consultation. If you have any further questions, please contact us again. Thank you.
■ Guidelines for the Treatment of Obstructive Sleep Apnea in Children (American Academy of Pediatrics)
AAP Guidelines for Sleep Apnea in Children
Guidelines for the Diagnosis and Treatment of Sleep Apnea in Children and Adolescents without Complications
• All children and adolescents are advised to be screened for snoring by their primary care physician.
• Children with sleep apnea should undergo appropriate testing, such as polysomnography or nocturnal oximetry.
• If adenoid enlargement is present, a tonsillectomy is recommended.
• Positive airway pressure therapy, nasal decongestion, and intranasal corticosteroids are recommended.
Source: Physician’s First Watch for August 28, 2012
Sangwon Lee
The following is an example of a Q&A from the online Pediatric Health Counseling service regarding “bronchial asthma and allergic rhinitis.”
99999999
Q. & A. Bronchial Asthma, Allergic Rhinitis
Q.
Hello. I stumbled upon your website and found a lot of helpful information. My child is a six-year-old boy. Two years ago, he was playing in the cold near the river when he suddenly started breathing strangely at night. He went to the hospital the next day, was diagnosed with asthma, and was prescribed an allergy medication called Zaditen. He received Zaditen and histobulin injections for about a year, but I discontinued them midway. My child seems to experience asthma-like symptoms three or four times a year, similar to a cold, during seasonal changes. During seasonal changes, he experiences allergic rhinitis, sneezing and a runny nose in the morning. My pediatrician said this is a mild allergy and can be treated as needed, and I agree. However, this time, despite taking the medication, the phlegm noises didn’t improve at night, so I went to the respiratory allergy department at a general hospital hoping to get better quickly. The doctor ordered an X-ray of my lungs and nose, told me I had sinusitis, pneumonia, and asthma symptoms, and that I would need to take antibiotics for about six weeks for the sinusitis. He prescribed eight different medications that day (even though I didn’t have a fever or any other symptoms of sinusitis).
The day before, the local pediatrician hadn’t commented on the severity of the problem, so this sudden diagnosis was devastating. I didn’t seem to have any symptoms of sinusitis, so I’m sorry to hear that, but it’s hard to believe. The ENT doctor I frequently see says that children with rhinitis (a cold) often show up on X-rays like sinusitis, and he advises against getting X-rays for children. My child has been going to the doctor so often that I have a negative view of medication.
I want to give him the minimum amount of medication, so I’d like your advice. Also, I think the X-ray was taken while he was exhaling. Will the results be the same? He has never had pneumonia.
A.
Hello. Thank you for your question. The more information I have about your child, including their age, gender, past medical history, family medical history, physical examination findings, and clinical tests, the more helpful it is for me to provide you with an answer. I will provide an answer based on the information you have provided.
I believe your child suffers from both allergic rhinitis and asthma. He may also have had sinusitis. I’d like to explain in more detail why I believe this.
Q.
The child I’m consulting with is a six-year-old boy. Two years ago, he was playing in the cold near the river when he suddenly began to breathe strangely at night. He went to the hospital the next day and was diagnosed with asthma and prescribed the allergy medication Jaditen.
A.
Children with asthma are born with a genetic predisposition to develop asthma.
In other words, asthma is a genetic disease. When such children breathe cold air, the cold air they inhale can trigger an asthma attack.
This type of asthma is also called cold-air-induced bronchial asthma (cold-air-induced asthma). Q.
I was taking Zaditen and Histobulin injections for about a year, but I stopped taking them on my own.
A.
I don’t know the names of Zaditen and Histobulin, so I can’t tell you about them. However, the medications I most commonly use to prevent asthma are Cromolyn (Cromolyn Sodium, Intal) intratracheal spray and Cromolyn inhaled HFA.
These days, corticosteroid sprays and inhaled corticosteroid HFA are commonly used to treat and prevent asthma.
Q.
My child seems to have asthma symptoms similar to a cold three or four times a year, especially during seasonal changes. During seasonal changes, he or she experiences allergic rhinitis, sneezing and a runny nose in the mornings.
A.
Bronchial asthma and allergic rhinitis can be easily triggered by changes in temperature or upper respiratory viral infections, such as colds. You can also use nasal Cromolyn spray to prevent allergic rhinitis.
Q.
My pediatrician says this is a mild allergy and can be treated as needed, and I agree.
A.
Asthma is classified into intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma.
It appears your child has intermittent asthma.
This type of asthma can be effectively controlled by preventing asthma attacks and appropriately treating them with medication.
However, if mild persistent asthma triggers a moderate or severe persistent asthma attack, you should treat the acute attack and prevent future attacks with inhaled Cromolyn (Intal) HFA or another medication. If an acute asthma attack occurs, oral albuterol syrup (5cc = 2mg albuterol) can be taken orally every six hours as needed. Prednisone or prednisolone syrup can be administered at a daily dose of 1-2mg per kg of body weight, divided into two or three doses, for three to seven days. For your reference, please refer to this information.
Q.
However, despite taking medication, my phlegm persisted nightly. Hoping for a quicker cure, I went to the respiratory allergy department at a general hospital. The doctor ordered an X-ray of my lungs and nose, told me I had sinusitis, pneumonia, and asthma symptoms, and advised me to take antibiotics for the sinusitis for about six weeks. He prescribed eight different medications that day (I had no fever or symptoms of sinusitis). A.
Children with asthma are more likely to develop allergic rhinitis, and children with allergic rhinitis are more likely to develop asthma. They are also more likely to develop sinusitis and otitis media. Unfortunately, it’s almost certain that they have all three underlying conditions. Additionally, adenoids may be abnormally enlarged. The tonsils may also be enlarged. Furthermore, nasal and paranasal sinuses may be affected.
For these reasons, doctors sometimes perform X-rays of the nose, paranasal sinuses, and upper respiratory tract.
For some reason, a facial X-ray can incidentally reveal pre-existing sinus abnormalities. Sometimes, even in the absence of any symptoms or signs of sinusitis, sinus abnormalities can be found on such X-rays, leading to a diagnosis of sinusitis.
It’s possible for a person with symptoms or signs of sinusitis to have a normal sinus X-ray. This statement is somewhat contradictory and inconsistent.
These days, sinusitis is more often diagnosed with a CT scan than with a sinus X-ray. A child with a clinically obstructed nose, allergic rhinitis, a runny nose, and a cough may have thick, yellow nasal discharge when examined with a nasal speculum or nasal endoscope.
If these symptoms persist for more than 10 days, sinusitis may be diagnosed clinically and treatment may begin.
Acute sinusitis is usually treated with antibiotics such as Amoxicillin or Augmentin for 2-6 weeks. This is a very common treatment. Don’t worry. Nasal sprays containing Cromolyn or a corticosteroid can be used for one or two months to effectively treat the condition.
Q.
Also, the chest X-ray appears to have been taken while exhaling. Will the results be the same? I’ve never had pneumonia.
00000000
A
When pneumonia is mild, it may not show up on an X-ray. Conversely, in some cases, pneumonia may be visible on an X-ray but there are no symptoms or signs.
This type of pneumonia is called walking pneumonia.
Pneumonia is often diagnosed clinically, based on symptoms, signs, and physical examinations, without an X-ray.
Please continue to receive diagnosis and treatment at a pediatric clinic.
Please be sure to read the Q&A on allergic rhinitis, asthma, and asthma several times. Please refer to [Parents Should Become Half-Doctors – Pediatric Family Nursing Encyclopedia] – Volume 18, Pediatric and Adolescent Otorhinolaryngological Diseases – Sinusitis, etc.
Please contact us again if you have any further questions. Thank you. Sincerely, Sangwon Lee
The following is an example of an online Q&A on “Snoring and Mouth Breathing” from the Pediatric and Adolescent Health Counseling Service.
Q & A. Snoring and Mouth Breathing
Q.
Hello. My name is Jin-kyung Kim and I live in Melbourne, Australia.
My 8-year-old son, Dong-min, has been snoring while sleeping for the past couple of months.
I found it pitiful to see him sleeping, so I wanted to ask him this. I don’t know why he suddenly started snoring, but I would appreciate it if you could give me some detailed advice on how to break this habit. For your information, Dong-min often has a stuffy nose due to allergies, and we sometimes use nasal spray to relieve the symptoms. As a result, he developed a habit of sleeping with his mouth open. I wonder if this has anything to do with his snoring.
I know you’re busy, but I would appreciate your reply.
Have a nice day… from Melbourne.
A.
Kim Sook-ja
Hello. Thank you for your question.
It’s a good question. The more information we have about your child’s age, gender, past medical history, family medical history, physical findings, and clinical tests, the more helpful it is for us to provide you with an answer.
I will provide an answer based on the information you provided. It appears that allergic rhinitis causes swelling and congestion of the nasal mucosa, leading to nasal congestion and mouth breathing.
This phenomenon of mouth breathing is called “gaping” or mouth breathing in English.
If allergic rhinitis is chronic, the adenoids and tonsils will also swell and enlarge.
This causes anatomical changes in the nasal cavity, adenoids, tonsils, and soft palate, narrowing the upper airway and causing snoring. Treatment for snoring should focus on treating both the allergic rhinitis and restoring the structural changes in the upper airway caused by chronic allergic rhinitis. Please refer to the following information to learn more about snoring.
A surprising number of children and adults experience loud snoring while sleeping. Some children snore every night while sleeping, while others snore only occasionally.
Snoring varies greatly in severity. In some cases, the cause of snoring is clearly identifiable, while in others, it’s not. To better understand the causes and treatments, it’s important to understand the anatomy of the upper airway.
The upper airway is the airway extending from the nostrils to the larynx. This includes the nasal cavity, paranasal sinuses, adenoids, tonsils, and pharynx.
The airway extending from the larynx to the lower airway is called the lower airway. When a portion of the upper airway becomes partially obstructed, breathing difficulties can occur, leading to snoring.
There are several causes of partial upper airway obstruction. Congenital anomalies of the upper airway, such as hypertrophy of the adenoids, or anatomical problems that develop later in life can temporarily obstruct a portion of the upper airway. Snoring is more often caused by temporary upper airway obstruction due to acquired conditions such as tonsillar hypertrophy or adenoid hypertrophy, rather than congenital malformations.
There are various causes of tonsillar hypertrophy and adenoid hypertrophy.
The most common causes are infectious diseases or allergic diseases affecting the upper respiratory tract.
Children with atopic dermatitis or a history of allergic diseases such as bronchial asthma or atopic dermatitis may develop tonsillar or adenoid hypertrophy due to allergies, which can lead to snoring.
Snoring can occur when tonsillar or adenoid hypertrophy narrows the upper airway, causing abnormal vibrations in the posterior nostrils, soft palate, posterior pharynx, and tongue with each breath. When a child snores, if the position of the head or neck changes, the partial obstruction in the upper airway can temporarily decrease or increase. This can result in less snoring, louder snoring, or even the elimination of snoring.
The first step is to consult a pediatrician to determine the cause of snoring. If the tonsils or adenoids are abnormally enlarged and causing snoring, it’s important to determine whether the enlargement is caused by an infection, allergies, or another cause. If the enlargement is due to an infection, the cause should be identified and treated accordingly.
The upper airway extends from the nostrils to the larynx. This includes the nasal cavity, paranasal sinuses, adenoids, tonsils, soft palate, uvula, pharynx, tongue root, and the back of the pharynx.
The lower airway is the airway below the larynx, including the trachea and bronchi. When part of the upper airway becomes partially obstructed, breathing difficulties can occur, which can lead to snoring. Upper airway obstruction can occur for a variety of reasons. Congenital anomalies, enlarged tonsils, or abnormally enlarged adenoids, which are present at birth, can temporarily obstruct a portion of the upper airway, causing snoring. Most snoring is caused by the interaction of enlarged tonsils or adenoids with other abnormalities in the upper airway, rather than congenital anomalies that block the upper airway. This creates a snoring sound, much like an orchestra playing together. Enlarged tonsils and adenoids can have various causes. The most common causes are infectious diseases or allergic diseases in the upper airway. Children with atopic dermatitis or a history of allergic diseases like asthma or atopic dermatitis may develop allergic rhinitis, enlarged tonsils, or enlarged adenoids, which can block a portion of the upper airway and cause snoring.
Snoring occurs when enlarged tonsils or adenoids narrow a portion of the upper airway and cause abnormal vibrations in the soft palate, posterior nostrils, posterior pharyngeal wall, and tongue with each breath.
In children who snore while sleeping, changes in head or neck position can widen or even further obstruct the previously blocked upper airway.
Therefore, changes in head or neck position can cause snoring to fluctuate, or it can become less intense, louder, more persistent, or even cease altogether.
If your child snores, the first step is to consult a pediatrician to determine the underlying cause. If your tonsils or adenoids are abnormally enlarged and causing snoring, you should determine the cause. Specifically, whether the enlargement is due to an infectious disease, an allergic disease, or another cause, you should determine the cause.
If the enlargement is due to an infectious disease, you should determine the pathogen causing the enlargement and treat it accordingly.
If the enlargement is due to an infectious disease, you should determine the pathogen causing the enlargement and treat it accordingly.
If the enlargement is due to an allergic disease, you should determine the allergen causing the enlargement and treat it appropriately by eliminating or avoiding the allergen, or by taking allergy medication or other treatments.
Severe upper airway obstruction can cause sudden awakenings and difficulty sleeping. If this condition persists for a long time, it can lead to growth and development delays, learning disabilities, high blood pressure, daytime sleepiness, hyperactivity or attention deficit disorder, and heart problems (cor pulmonale). Obstructive sleep apnea can occur. When adenoids or tonsils become enlarged, partially blocking the upper airway and causing snoring, an adenoidectomy or tonsillectomy may be performed. If you have any further questions, please contact us again. Thank you. Sincerely, Sangwon Lee
Guidelines for the Treatment of Obstructive Sleep Apnea in Children (American Academy of Pediatrics)
AAP Guidelines for Sleep Apnea in Children
Guidelines for the Diagnosis and Treatment of Sleep Apnea in Children and Adolescents
• All children and adolescents should be screened for snoring by their primary care physician.
• Children with sleep apnea should undergo appropriate testing, such as polysomnography or nocturnal oximetry.
• If adenoids are enlarged, a tonsillectomy is recommended.
• Positive pressure ventilation therapy, nasal decongestion, and intranasal corticosteroids are recommended. Source: Physician’s First Watch for August 28, 2012
■ Sources and References
Red Book 29th Edition, American Academy of Pediatrics
Harriet Lane Handbook, 19th ed.
Nelson Pediatric Textbook, 19th ed.
MMWR
CDC
Others
Parents Should Become Half-Doctors, Too
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