Why does my child always have a blocked nose? When it could be allergic rhinitis.

By Associate Professor Alberto Pinzon Charry

Paediatric allergist and immunologist in Woolloongabba, Brisbane

It can sometimes feel as though children spend half their lives with a blocked or runny nose. One cold clears up, only for the sniffles to seemingly start all over again.

But what if your child’s ‘cold’ never quite goes away? Or the same symptoms keep appearing at particular times or in particular places?

Sometimes, an ongoing blocked nose isn’t caused by repeated infections at all. It could be allergic rhinitis.

What is allergic rhinitis?

Allergic rhinitis occurs when the immune system reacts to something in the environment that would normally be harmless.

These substances are known as allergens. When a child with allergic rhinitis breathes in an allergen, it can trigger inflammation inside the nose.

Common triggers include:

• house dust mites
• grass, tree and weed pollens (rather than the plants themselves)
• animal dander
• mould spores.

Some children experience symptoms at particular times of the year, especially during pollen seasons. Others have symptoms throughout the year because they’re regularly exposed to an allergen such as house dust mites.

It’s also important to understand that a ‘grass allergy’ usually means an allergy to grass pollen, not to the grass itself. Children don’t need to avoid touching grass or playing on sporting fields simply because they’re allergic to grass pollen. Instead, symptoms are more likely to be influenced by how much pollen is in the air, which can vary with the season and weather conditions.

Is it an allergy or just another cold?

This isn’t always easy to tell, particularly in younger children who pick up plenty of viral infections.

One of the biggest clues is the pattern.

A cold will usually run its course. Allergic rhinitis tends to persist or repeatedly return when your child encounters the allergen triggering their symptoms.

As well as a blocked or runny nose, children with allergic rhinitis may experience:

• frequent sneezing
• an itchy nose
• itchy, red or watery eyes
• clear nasal discharge
• throat clearing or coughing
• symptoms that repeatedly occur in particular environments or seasons.

Unlike a viral infection, allergic rhinitis doesn’t cause a fever.

Sometimes parents notice another clue: their child is constantly rubbing or pushing their nose upwards because it itches.

A blocked nose can affect more than breathing

It’s easy to dismiss allergic rhinitis as simply an annoying runny or blocked nose, but persistent symptoms can have a bigger impact on children.

A child who can’t breathe comfortably through their nose may sleep poorly, breathe through their mouth or snore. Poor-quality sleep can then affect how they feel and function during the day.

Persistent nasal symptoms can also interfere with concentration, school and sport.

For children who already have asthma, identifying and managing allergic rhinitis can be particularly important, as the two conditions commonly occur together.

How do you find out what’s triggering it?

Understanding when and where symptoms occur can provide useful clues.

Do symptoms become worse during particular seasons or with changes in the weather? When your child spends time around a particular animal? Are symptoms worse at home or when they’re in bed?

Keeping track of these patterns can help when you speak with your child’s doctor.

When appropriate, allergy testing may also be used to investigate possible triggers. This can include skin prick testing or blood tests for specific allergens.

Importantly, an allergy test needs to be interpreted alongside your child’s symptoms. A positive test shows sensitisation to an allergen, but that result only becomes meaningful when it fits with what actually happens to your child.

Can allergic rhinitis be treated?

Yes. The right approach depends on what is triggering your child’s symptoms and how much those symptoms are affecting them.

Management may include reducing exposure to known allergens where this is practical, as well as treatments such as saline nasal rinses, antihistamines or medicated nasal sprays.

For children with persistent or more significant allergies, other treatment options may sometimes be considered.

The aim isn’t necessarily to create an allergen-free world around your child – something that is often neither possible nor necessary. It’s to understand their triggers and find a manageable way to keep symptoms under control.

With appropriate management, allergic rhinitis shouldn’t stop children from participating in sport, spending time outdoors or enjoying their usual social activities. Rather than unnecessarily avoiding everyday experiences, the focus should be on managing symptoms so children can continue doing the things they enjoy.

Look for the pattern behind the sniffles

A blocked nose is incredibly common in childhood, and most episodes won’t be caused by an allergy.

But if your child’s symptoms seem to be always there, keep coming back, or reliably appear around particular triggers, it’s worth looking beyond the assumption that they’ve caught yet another cold.

Sometimes, the pattern behind all those sniffles is the most useful clue of all.