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Pediatrics in Review is the official journal of the American Academy of Pediatrics. A monthlypublication, it has been published continuously since 1979. Pediatrics in Review is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2010 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0191-9601. Online ISSN: 1526-3347.
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Article ear, nose, throat
Katherine A. Gargiulo, MD,* Nancy D. Spector, MD†
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Author Disclosure Drs Gargiulo and Spector have disclosed no ﬁnancial relationships relevant to this article. This commentary does not contain a discussion of anunapproved/ investigative use of a commercial product/ device.
List the broad variety of causes of nasal congestion in the pediatric population. List the differential diagnosis of chronic rhinitis. Distinguish between allergic and nonallergic rhinitis. Discuss the impact of nasal congestion on pediatric patients. Describe the various treatments for stuffy nose, including topical and oralcorticosteroids, antihistamines, and decongestants.
Nasal congestion—“stuffy nose”—is one of the most common ailments brought to the attention of a pediatrician. Nasal congestion is such a frequent and familiar condition that both parents and medical professionals often overlook the need for intervention. Children who have congestion, however, can suffer signiﬁcant quality-of-life detrimentsbecause of sleep disturbance, learning impairment, and fatigue. Furthermore, there are multiple organic consequences of untreated nasal congestion.
Chronic rhinitis is one of the most common causes of nasal congestion in pediatrics. In 1998, the Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology deﬁned rhinitis as “Inﬂammation of the membrane lining thenose, characterized by nasal congestion, rhinorrhea, sneezing, itching of the nose and/or postnasal drainage.” By deﬁnition, symptoms last at least 30 minutes daily and for 2 or more months’ duration. The cause of chronic rhinitis can be allergic or nonallergic. Although the presentation may vary, the basic pathophysiology essentially is the same. Stimuli such as allergens, medications, orhormones cause mast cells and basophils within the nasal mucosal epithelium to degranulate, releasing various chemical mediators. These mediators include leukotrienes, cytokines, and prostaglandins that cause rhinorrhea and nasal congestion, as well as histamine, whose release causes sneezing and itching.
Allergic rhinitis (AR) is the most common chronic disease in children, with aprevalence of up to 40%. Despite its high prevalence, AR often is overlooked, undiagnosed, and undertreated due to both the inability of children to verbalize their symptoms and AR often being mistaken for recurrent episodes of the common cold. Although AR is not considered to be a life-threatening disease, it is one of the major reasons for visits to pediatricians and is associated with a numberof signiﬁcant comorbidities. AR is a hypersensitivity reaction to speciﬁc allergens that occur in sensitized patients. It is mediated by immunoglobulin E (IgE) antibodies and results in inﬂammation. AR is classiﬁed as either intermittent or persistent, depending on the duration of the condition and the allergen involved. Intermittent disease involves symptoms for fewer than 4 days per week or...