Professional Documents
Culture Documents
morbidities in children
Meenu Singh. MD, FCCP, FCIAAI
Professor of Pediatrics, Advanced Pediatrics
Centre, PGIMER, Chandigarh 160012.
Allergy can affect different children in
different ways
Food Allergy
Atopic Dermatitis
Intermittent Persistent
• < 4 days per week • > 4 days per week
• or < 4 weeks • and > 4 weeks
Mild Moderate-Severe
• Normal sleep one or more items
Subacute/chronic
Rapid Phase Late Phase
inflammatory phase
Neutrophils
Chemotactic Factors
Mast Cell
Allergic Rhinitis in children
Cough Conjunctivitis
Sneezing Pharyngitis
Nasal pruritus Sinusitis
Nasal congestion Asthma
Sore throats – recurrent infections Eczema
Halitosis Otitis media
Respiratory distress – infant Lymphoid
hypertrophy/obstructive sleep
Hypernasality apnea
Behavioral problems Speech impairment
Failure to thrive
Reduced quality of life
“The nose is the part of the lung which can be accessed by the finger”
Allergic Rhinitis and Co-morbidities
How Common are the co-morbidities?
80
70 67.5
60
50
40
30
21.3 20.8
20
10
2.2
0
Chronic Sinusitis Asthma OM with effusion Recurrent nasal
polyposis
80
70 65.7
60
50
50
37.5
40
28
30 23
20
10
0
Asthma Chronic sinusitis OM with effusion Recurrent nasal
polyposis
Mucosal swelling
Chronic
Impedes normal movement of air and secretions
Sinusitis
Accumulation of thickened secretions &
impaired ciliary movements
Noctural cough in poorly controlled asthma Cough esp. nocturnal and post nasal drip
No history of wheezing Responsive to allergen avoidance; non-
Responsive to brochodilator therapy sedating long acting antihistamines; and/or
intranasal steroids
Misdiagnosis may lead to overtreatment
inhaled steroids, 2 agonists and oral
steroides
Same triggers
• HDM, pollen, pet dander, moulds, fungi
Same drugs
Allergic • Anti IgE ?
Same cells Rhinitis • Steroids(ICS/ INS)
• Mast cells • Antihistamines ?
• Eosinophils • Antileukotrienes ?
Asthma Sinusitis
Mucosal swelling
Chronic
Increased negative pressure and impaired
OME ventilation in middle ear
Allergen avoidance
indicated when possible
Pharmacotherapy Immunotherapy
Safety, effectiveness
easy to be administered costs Specialist Rx, may alter the natural
course of the disease
Patient's education
always indicated
Therapeutic options for AR
Hadley JA. Med Clin North Am. 1999;83:13-25. 16. Busse WW. Clin Exp Allergy. 1996;26:868-879.
Step ladder treatment of AR: ARIA
moderate
severe
mild persistent
moderate persistent
severe
intermittent
mild
intermittent
Intra-nasal steroid
Local cromone
Urticaria Angioedema