With such a mild winter, you may have noticed butterflies in December and spring wildlife emerging already. We have already found children struggling with hay fever for the past month; earlier than in many years! Is your child having increasing sneezing, congestion, rubbing eyes and nose? Why so?
Hay fever can start as early as two years, however is more common from when children start school. The constant blocked noses and sneezing of toddlers may evolve into seasonal rhinitis, or even dust-driven congestion resulting in symptoms throughout the year. Look out for these telltale signs;
- Itchy eyes/ throat
- Sneezing, blocked/runny nose
- Watering, red eyes (allergic conjunctivitis)
- Headaches, blocked sinuses
- Shortness of breath
- Tiredness
- The sensation of mucus running down the back of the throat, which can also be a symptom, is called ‘post-nasal drip
More information from AllergyUK on hay fever can be found here.
Why is spring starting in January?
Our mild winters are related to climate change, and the greater the warming, the earlier the pollen season. This American study found a 20% increase in pollen levels across the whole of USA by measuring 821 site-years of data across the last 30 years. The data shows that the pollen season starts 20 days earlier, and this is strongly associated with the increasing temperature of the climate crisis – see the projected model in the picture.
Are UK Children Particularly at Risk of Pollen Related Symptoms?
Interestingly, the UK has always had a high rate of hay fever (medically, ‘allergic rhinitis’). The earliest global trend survey showed the UK to have high prevalence among children as young as 6 years which were similar to Australia, although in later years the increase has been leap-frogged by crowded areas such as Taiwan and Hong Kong.
This points to the urban-rural gradient driving allergic disease. Unfortunately despite lesser exposure to diversity of pollen, there are lots of children in urban centres trying to get on with troubling rhinitis. This is likely due to increased eczema in urban populations, a well-established phenomena, in combination with air-borne urban exposures. Furthermore, the fashion for silver-birch elegance in landscaping with paved areas resulting in pollen lasting for years increasing the local burden of trigger factors.
The Importance of Coughing
Coughing is commonly caused by viral illnesses, however also asthma as well as rhinitis. If your child has regular evening cough as well as tendency for any congestion or breathlessness, an allergy review may help distinguish the driving causes. Simply borrowing a blue inhaler is not adequate or safe for managing episodes of worsened coughing, and any persistent breathlessness or lethargy needs an urgent medical review from acute services.
Asthma and rhinitis often develop hand in hand, again with higher rates of prevalence in urban areas. This is particularly relevant to the UK where the rates of untreated asthma are still the highest in Europe.
Take Home, and Watchful-Eye
There is no substitute for having an open-mind for regular behaviors that develop with children.
Many parents are resigned to ‘habits’ which actually present underlying problems that can be treated, and may impact upon their development. Trying a few over-the-counter medicines from the pharmacy may be a sound first step, however often results in sedating antihistamines and saline sprays that are ineffective, and can even make children more drowsy through the worst of the season. This may contribute to the deteriorating exam marks in summer GCSEs across the UK, which is an unfair limitation on their life prospects. This has led some to ask whether it is fair for those children with hay fever to submit exams during the summer?
The best approach is to notice whether nasal congestion, sneezing and sniffing is associated with itchiness of the eyes, airways, nose or skin rashes, which are telltale signs of an allergy cause. Sniffing is often associated with viral illnesses and therefore temperature, sore throat and poor appetite, however seasonal changes or environmental exposures may drive persistent congestion.
Coughing deserves particular care in management, because most professionals ‘follow the guidelines’ blindly when often testing, detailed history taking and monitoring for treatment response is a fundamental approach to management.