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Rhinitis in Young Children

Rhinitis in Young Children. Hugo Van Bever Singapore. Cambodia, February 20, 2010. Cumulative prevalence of rhinitis in Singaporean children. 1 - 2 yrs-old 2002 -2003 . 4 - 6 yrs-old 2000 . 6 – 7 yrs-old

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Rhinitis in Young Children

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  1. Rhinitis in Young Children Hugo Van Bever Singapore Cambodia, February 20, 2010.

  2. Cumulative prevalence of rhinitis in Singaporean children 1 - 2 yrs-old 2002 -2003 4 - 6 yrs-old 2000 6 – 7 yrs-old 2001 12 – 15 yr-old 2001

  3. Chronic rhinitis in preschool children - NO DEFINITION (ARIA?) : not for preschool children = > 1 - 2 months at least 1/2 hr per day (?) - A SYNDROME  a combination of - rhinitis - sinusitis – rhino-sinusitis - adenoidal hypertrophy - dysfunction of Eustachian tube

  4. Chronic rhinitis in asthmatic children 1. INFANTS > 90 % 2. PRESCHOOL CHILDREN 70 % 3. SCHOOL CHILDREN 50 %

  5. Symptoms - nasal congestion (blocked nose) - nasal discharge (runny nose) - sneezing - itch (‘ salutallergique ‘) conjunctivitis

  6. Chronic rhinitis in preschool children ETIOLOGY 1. Hyperreactivity (intrinsic - postviral) (> 60 %) 2. Allergy ( 30 %) 3. Specific diseases (< 1 %) - CF - ciliar dyskinesia - immune deficiency

  7. Allergy in childhood asthma-rhinitis

  8. Allergens 1. House dust mites 2. Cockroaches 3. Pets (dog – cat) 4. Pollen 5. Moulds 6. Food

  9. SPT in young children ( < 3 yrs old) suffering from rhinitis

  10. Chronic rhinitis in preschool children Adenoidal hypertrophia Otitis (acute - chronic) Sinusitis (acute - chronic) OSAS Chronic rhinitis Bronchial hyperreactivity = ASTHMA

  11. Acute sinusitis Chronic sinusitis

  12. Psycho-social impact of allergic rhinitis in children. • sleep problems (OSAS) • learning problems • social problems

  13. Treatment of chronic rhinitis in preschool children 1. Causal treatment (allergic rhinitis) - avoidance of allergens - immunotherapy (SLIT) 2. Symptomatic treatment - nasal washes (saline) - intranasal medication - antihistamines (1st choice) 3. Chirurgical treatment

  14. Chronic rhinitis in preschool children INTRANASAL MEDICATION 1. saline 2. decongestants 3. cromoglycate 4. levocabastine 5. corticosteroids 1. Limited data in young children (few studies) 2. Young children hate them !

  15. Intranasal medication in young children … a daily fight !!! Low compliance

  16. Treating chronic rhinitis in young children 1. a sweet syrup 2. once daily

  17. The role of SUNC ???

  18. Singaporean University of Nose Cleaning (SUNC)

  19. Intranasal corticosteroids

  20. Intranasal and intrabronchial corticosteroids in preschool children ASTHMARHINITIS beclomethasone diprop. ++++ budesonide +++- fluticasone prop. ++

  21. Intranasal corticosteroids in preschool children INDICATIONS 1. Chronic rhinitis 2. Chronic sinusitis 3. Hypertrophia of adenoids 4. OSAS

  22. Antihistamines= 1st choice in preschoolers 1. easy to administer (better compliance) 2. effective (studies in preschool children) 3. good safety data (  ETAC, EPAAC)

  23. The 3 generations of antihistamines - 1st chlorpheniramine, clemastine, promethazine, hydroxyzine, oxatomide, azatadine, ketotifen, etc… - 2nd terfenadine, cetirizine, loratidine, astemizole, etc… - 3rd levocetirizine, fexofenadine, desloratidine

  24. Antihistamines - indications 1. Allergic rhinitis 2. Urticaria 3. Anaphylactic reactions 4. Eczema (?) 5. Asthma (?) level of evidence

  25. Side effects of 2nd generation antihistamines 1. Less central nervous system toxicity 2. Terfenadine and astemizole can cause cardiac toxicity in children. - Ventricular arrhythmias - torsades de pointes

  26. 3rd generation antihistamines LEVOCETIRIZINE - FEXOFENADINE - DESLORATIDINE 1. Metabolites 2. 24-hour effectiveness + fast onset 3. Non-sedating 4. No cardiac effects 5. No hepatic metabolism

  27. Antihistamines in children < 3 years 1. Limited number of studies ! 2. No safety studies on 1st generation antihistamines 3. Association with SIDS ? 4. Safety studies in young children cetirizine - levocetirizine > ketotifen > loratidine 5. Cetirizine has an extensive safety file (ETAC  n = 399) (EPAAC  n = 255)

  28. ConclusionManagement of allergic rhinitis in young children 1. Allergen avoidance  impossible 2. Immunotherapy (SLIT)  earlier in life (?) 3. Medication  antihistamines 4. Intranasal corticosteroids = daily fight !

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