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Jordan Smallwood, MD, is the Section Chief, Division of Allergy/Immunology, Nemours Children's Hospital; and an Assistant Professor, University of Central Florida College of Medicine. Julie L. Wei, MD, is the Division Chief, Division of Otolaryngology, Nemours Children's Hospital; and a Professor, Otolaryngology Head and Neck Surgery, University of Central Florida College of Medicine.
Disclosure: The authors have no relevant financial relationships to disclose.
One of the more common and potentially frustrating patients for any pediatrician or specialist to see is the child with acute or chronic symptoms of runny nose and nasal congestion. The challenge in treating these children comes from the physician knowing, even before going into the examination room, that in the majority of young children symptoms may reflect either allergic rhinitis or acute viral upper respiratory infection rather than bacterial infection; however, distinguishing between these diagnoses can be difficult. Despite the fact that most nasal symptoms in children are not due to malignancy or other serious medical conditions, parents are often concerned and distressed about their child's chronic nasal congestion, runny nose, or both. Parental concerns focus on the chronic nature of their child's symptoms-persistent daily congestion for months on end, repeated courses of antibiotics for treatment of presumed acute sinus infections, and quality-of-life issues such as absence from school and sleep disturbance. Parents and caretakers of these patients expect a diagnosis and a treatment plan that typically includes prescriptions for antibiotics, antihistamines, steroids, or decongestants. In their minds, physicians should make diagnoses and provide treatments; to parents, failure to do so either suggests incompetence or insensitivity. Herein lies the problem, because often the empirically prescribed medications provide minimal benefit or do not work at all, despite the clinician's best intentions.
Rhinitis
Rhinitis is defined as inflammation of the nasal mucosa, and it is often identified by the presence of some or all of the following: nasal discharge, nasal congestion, nasal or ocular itching, and sneezing. 1 Acute rhinitis is a global health problem in both pediatric and adult populations, affecting approximately 25% of the population of westernized countries. 1 Patient questionnaires, such as the Rhinoconjunctivitis Quality of Life Questionnaire and the Medical Outcomes Study Short-Form, can reveal significant impairment in daily quality of life in patients suffering from rhinitis. Rhinitis also...