Is your child having paroxysmal bouts of sneezing? If he does, do you often see him attempting to wrinkle his nose because of itchiness? Or do you notice frequent clear watery discharges from his nose? Be advised! This is the classic presentation of rhinitis.

Rhinitis is an inflammation of the lining of the nose, characterized by nasal congestion, rhinorrhea or clear watery nasal discharge, sneezing and nose itching. If there is a strong family history of allergy in the family, allergic type of rhinitis should be strongly considered.  Seasonal allergic rhinitis, otherwise known as hay fever is commonly seen in children and adults who are sensitized to pollens of trees and grasses. Perennial allergic rhinitis has symptoms that occur throughout the year. It is caused by allergens which the patient is constantly exposed to such as house dust mites, animal danders, feathers and pets. Food allergens can also be the offending agent.

A child with allergic rhinitis has airway blockage due to boggy edema of his nasal mucus membranes. Symptoms include frequent sore throats, dryness of the mouth, snoring, and a nasal quality tot the voice. Interestingly, a child or even an adult with allergic rhinitis can be recognized based on their facial characteristics and mannerisms.

1.   Rabbit nose. This is a mannerism by the child attempting to wrinkle his nose due to itchiness.

2.   Allergic salute. A mannerism by the child referring to the upward or sideways thrust of the palm of the hand against the tip of his nose when watery rhinorrhea  and itchiness are significant

3.   Transverse crease. This refers to the horizontal ridges at the junction of the tip of the nose and the more rigid bridge. Frequent mannerisms of rabbit nose and allergic salute lead to the formation of the crease.

4.   Allergic shiners – These are dark circles under the eyes due to venous stasis resulting from blood flow obstruction caused by the edema of the nasal mucous membranes.

5.  Mouth breathing – Due to nasal obstruction, the child is obligated to breathe in the mouth. Most of the time then he  keeps his mouth slightly open, and this can cause mouth dryness.

Recognition of these facial features can help in the diagnosis of allergic rhinitis. Once suspected, the child should be brought to a physician for parent/child education regarding allergic rhinitis, allergen avoidance and pharmacotherapy.