Nasal Allergy in Children: What Every Parent Needs to Know
Your child is sneezing every morning. Their nose runs constantly. They rub their eyes, scratch their ears, and wake up tired. Their teacher says they seem distracted. You have taken them to multiple doctors and tried various syrups and drops, but nothing seems to hold. The problem is that you may be managing symptoms without diagnosing the condition — and in children, untreated allergic rhinitis has consequences that extend far beyond a runny nose.
How Common Is Allergy in Indian Children?
Allergic rhinitis affects an estimated 15–40% of children in urban India — with rates rising due to increasing indoor allergen exposure (dust mites, cockroach, mould), air pollution, dietary changes and the hygiene hypothesis. It is the most common chronic condition in childhood and yet remains substantially underdiagnosed and undertreated.
Symptoms to Recognise in Your Child
- Sneezing — especially in bursts, on waking, or on exposure to dust
- Clear, watery nasal discharge
- Nasal obstruction — mouth breathing, open mouth posture at rest
- Itching of the nose, eyes, ears or roof of the mouth
- Dark circles under the eyes (allergic shiners)
- A horizontal crease across the bridge of the nose from frequent upward rubbing (allergic salute)
- Frequent throat clearing or sniffing
- Snoring or noisy breathing during sleep
- Waking tired, hyperactivity or poor concentration
- Recurrent ear infections or ear fullness
Why It Affects School Performance
Multiple studies confirm that children with allergic rhinitis perform measurably worse in exams — particularly during high pollen or allergen seasons. The reasons are multiple: poor sleep from nasal obstruction, direct neuroinflammatory effects of cytokines on cognition, and the sedating effects of older generation antihistamines (chlorpheniramine, promethazine) that are unfortunately still widely prescribed to children in India.
Using non-sedating antihistamines and intranasal corticosteroids — which are both safe and effective in children — avoids this cognitive impairment while managing symptoms.
The Ear Connection: Recurrent Ear Infections
Allergic rhinitis is the most important risk factor for recurrent otitis media (middle ear infection) and glue ear in children. Nasal mucosal swelling obstructs the Eustachian tube, creating negative middle ear pressure and fluid accumulation. Children who present with repeated ear infections, hearing difficulty or speech delay need to be evaluated for nasal allergy — not just given repeated antibiotics.
Safe and Effective Treatment in Children
The good news: allergic rhinitis in children is very well treated. First-line treatment is intranasal corticosteroid spray — mometasone and fluticasone furoate are licensed from 2–3 years of age and are safe for long-term use. Second-generation antihistamines (cetirizine, loratadine, fexofenadine) are safe and non-sedating. Saline nasal rinses are safe from any age and significantly improve nasal clearance.
Allergen immunotherapy (allergy desensitisation) is appropriate for children from age 5 onwards in whom identified allergens are driving persistent moderate-severe disease. It is the only treatment that modifies the underlying immune response and can induce long-term remission.
Trigger Reduction at Home
- Use allergen-impermeable mattress and pillow covers
- Wash bedding weekly in hot water (60°C)
- Reduce indoor humidity to below 50% to inhibit dust mite growth
- Remove carpets and soft furnishings from the bedroom where possible
- Ensure good ventilation; clean AC filters monthly
- Keep pets out of the child’s bedroom
- Address cockroach infestations — a major allergen source in Indian urban homes
Dr Pranshu Mehta is an ENT Surgeon at Rog Nidan ENT & Dental Clinic, C-2/275 Janakpuri, New Delhi. For paediatric allergy evaluation: WhatsApp +91 98186 35660. Watch: @TheENTSurgeons on YouTube.