Allergic Irritability in Children
by Dr. Paul Carson
Nasal allergy makes people feel quite miserable. Of that, there is no argument. However, nasal allergy in children, if unrecognised (maybe it’s been misdiagnosed as a summer head cold) or badly managed, can have a significant toll on emotional as well as physical well-being.
For years I’ve been dealing with kids allergies, children troubled by multiple allergy problems and wondered how they get through a full school-day? What with their itchy eczematous skin, their snuffly and irritable noses and wheezy chests, they carry a significant burden of ill health. Adults know how to complain (and rarely hold back), whereas some children don’t know any better. They think everyone goes around with a bunged up nose, wheezy chest and an almost perpetual tiredness. If the nasal allergy is especially troublesome the child may get intermittent hearing loss. One day he’s bright and alert in class, inter-reacting and cooperating. Next day he seems distant and detached, ignoring questions or not fully grasping what’s going on. The teachers are at a loss to explain these variations in attentiveness and the boy’s parents can’t quite understand the situation either. It’s not uncommon for these children to be labelled ‘difficult’.
Nasal allergy also provokes intense fatigue. If an affected child is not treated he misses out on ordinary children’s activities and can be isolated and ignored. He’s not picked for the football team even though he loves the game. And if he’s picked he’s usually last choice and then put in goals, out of harm’s way. And secretly he’d love to be a striker, fast footed and skilful. He knows he’s well able to take the ball around defences. If only he could get the chance. If only he didn’t feel so tired all the time. If only he didn’t have to stop every five yards to blow his nose, if only he didn’t have to take a puff of his asthma inhaler in front of everyone. If only, if only……
I’ve been talking about this for years to the point of being considered a crank. Then an article appeared in a reputable medical journal that summarised my observations to a tee. (Making the allergic child happy: treating more than symptoms, H.P. van Bever & P.C. Potter, Clinical & Experimental Allergy Reviews, 6, 6-9). Suddenly I knew how right I’d been. Now I realised that I wasn’t the only one making these comments. The difference was that while my observations were no more than just that, observations, the authors of this piece had the scientific background to stand over their claims.
The term Allergic Irritability Syndrome has been coined to explain the many unpleasant symptoms and features children with untreated nasal allergy show. Allergic rhino-sinusitis (ARS) is the medical term for allergy driven nose and sinus problems.
So here goes. Children with un-recognised ARS have:
- A significantly impaired quality of life.
- Significant learning difficulties.
- A lower ability to achieve different types of knowledge (factual, conceptual and knowledge application) compared with healthy children.
- May suffer sleep apnoea, snoring and disturbed sleep pattern. This in turn leads to daytime drowsiness, grumpy mood and poor school performance.
- In severe cases it may cause or at least contribute to attention deficit hyper-activity disorder (ADHD).
- May cause impaired hearing if fluid collects in the inner ear (medical term: serous otitis media).
- May suffer repeated ‘head colds’ that go down to the chest (which is really an untreated nose and sinus allergy triggering early asthma).
- Nasal blockage and irritation (sneezing, rubbing at the nose to relieve itch); dark circles around the eyes with puffiness of the lower lids.
- Poor concentration; disruptive behaviour and unexplained mood swings.
I recall one six-year-old boy who told his parents that he felt angry all the time when unwell with his allergic sinusitis. This is sad and unnecessary as nasal allergy is easily managed, especially in children. The treatment strategies outlined in Chapter 4 apply to adults and children.
Below are the common effects of persisting nasal allergy in children.
Sometimes a child’s nose is congested (obstructed) to the point that he or she breathes through the mouth, especially while sleeping.
If the congestion is left untreated this forces air currents through the mouth. The strength of the air changes the way the soft bones of the face grow. The features may become abnormally elongated in a pattern called ‘adenoidal face’. This causes the teeth to come in at an improper angle as well as creating an overbite. Braces or other dental treatments may be necessary to correct these problems.
Nasal allergy and ear infections
Nasal allergy can lead to inflammation in the ear and may cause fluid accumulation which in turn can trigger ear infections and decreased hearing. If this happens when the child is learning to talk, poor speech development may result. Hay-fever can also cause earaches and ear itching, popping and fullness (‘stuffed up ears’).
Nasal allergy while at school
Nasal allergy can last throughout the school year. For some kids this means absences due to allergy flares. Here are some of the problems to look out for so that the condition can be properly diagnosed and treated, as well as several suggestions for helping the allergic child.
- Dust irritation: reducing dust in the home will be helpful to most allergic family members. At school, children with allergy problems should sit away from the blackboards to avoid irritation from chalk dust.
- School pets: furry animals in school may cause problems for allergic children. If your child has more problems while at school, it could be the class pet.
- Asthma and physical education: sports are a big part of the school day. Having asthma does not mean eliminating these activities. Often medication administered by using an inhaler is prescribed before exercise to control their symptoms. Children with asthma and other allergic diseases should be able to participate in any sport the child chooses – provided the doctor’s advice is followed.
- Dry air: with the onset of cold weather using a humidifier to accompany forced air heating systems may be helpful in some regions of the country. Adding a small amount of moisture to dry air makes breathing easier for most people. However, care should be taken not to allow the humidity above 40%, which promotes the growth of dust mites and mould.
- Change in behaviour: children cannot always vocalise their annoying or painful symptoms. Their discomfort may manifest as behaviour problems. Be on the alert for possible allergies if your child has bouts of irritability, temper tantrums or decreased ability to concentrate in school. These may be signs of ‘allergic irritability syndrome’ caused by nose and ear symptoms in allergic children. Sometimes allergic children are badly behaved and have short attention spans. Needless to say their schoolwork suffers. When a child’s allergies are properly treated, his symptoms, behaviour and school performance can improve dramatically.
Case history: Jack, aged eight years, is a problematic child at home and at school. He seems constantly agitated, ill-at-ease with himself and disruptive. His teachers complain that he’s troublesome, irritable, cranky and hard to handle. When they mention this to his parents they hear their own concerns echoed by Jack’s mum and dad. They too find the boy difficult.
In case there’s a physical cause for his behaviour Jack is brought to the family doctfooor for a check-up. Within the first few minutes of the consultation the doctor notices how much Jack is agitated by his nose. He’s constantly rubbing at it, dragging his sleeve along the nostril openings, snorting and snuffling. When the doctor inspects the inside lining of Jack’s nose he realises immediately that the boy has an aggressive nasal allergy. He arranges for a battery of tests, including an allergy screen. Surprisingly the only abnormal reaction to show up is that Jack has a strong horse hair allergy. “That makes no sense,” complain both parents. “We’re miles away from any horses and Jack doesn’t even like going near them.” But the family doctor, wise man that he is, recognises that something has to be irritating Jack’s nose and sinuses. He advises the boy’s parents to check their house carefully for horse hair.
Two days later he gets a delighted telephone call. Jack sleeps in a room on his own. But there is a spare bed in that room for the occasional visitor. The bed was inherited from an elderly uncle and the mattress is stuffed with horse hair. Jack uses the bed as a trampoline. Every time he jumps up and down on it he disturbs the horse hair which in turn enters his nose and sinuses which in turn causes havoc with their delicate membranes. And this is the background allergic challenge to Jack’s ill-health.
Out go the horse hair bed and mattress. Jack’s room is steam cleaned to remove any residual traces of horse hair. Then Jack’s troublesome nasal allergy is successfully treated with medicine.
The boy improves dramatically. His mood, personality, temperament and behaviour recover to normal limits within a week. Jack’s parents are astonished. Jack’s teachers are delighted. Jack’s doctor is pleased as punch at his diagnostic skills. And Jack is a much more contented child. Jack has been suffering from ‘allergic irritability syndrome’.
However not every doctor has the insight to check for this condition and the skill to know how to manage it correctly. There are a lot of unhappy Jacks in the world who don’t know what it’s like to have a normal functioning and not-irritated nose. And there are many Jacks with hay-fever being treated for summer ‘head colds’ and who suffer misery each year because of this ignorance.
Allergic Diseases and Cognitive Impairment
Sneezing, wheezing, watery eyes and runny nose aren’t the only symptoms of allergic diseases. Many people with nasal allergy also report feeling ‘slower’ and drowsy. When their allergies act up they have trouble concentrating and remembering.
For instance, nasal allergy can be associated with:
- Decreased ability to concentrate and function
- Activity limitation
- Decreased decision-making capacity
- Impaired hand-eye coordination
- Problems remembering things
- Sleep disorders
- Missed days at work or school
Experts believe the main factors contributing to cognitive impairment of people with nasal allergies are sleep interruptions and over the counter (OTC) medications.
Secondary factors, such as blockage of the Eustachian tube (ear canal), also can cause hearing problems that have a negative impact on learning and comprehension. Constant nose blowing and coughing can interrupt concentration and the learning process. Allergy related absences impact on education and can make it difficult for children to keep up.
Chronic (on-going) nasal congestion can cause difficulty in breathing, especially at night. If your child has a significant nose allergy he may awaken a dozen times a night. Falling back asleep can be difficult, cutting short the total number of sleep hours. Losing just a few hours of sleep can lead to a significant decrease in your child’s ability to function. Prolonged loss of sleep can cause difficulty in concentration, inability to remember things, and can contribute to accidents. Night after night of interrupted sleep can cause serious decreases in learning ability and performance in school.
Many over-the-counter sinus therapies (especially antihistamines) adversely affect mental functioning. Indeed some allergy therapies may even cause cognitive or mental impairment.
Children often cannot speak for themselves when trying to explain their sense of ill-health. Persisting nasal allergy can trigger often dramatic problems for children. With allergy on the rise worldwide the plight of the untreated allergic child is not a happy one.