How do I know if my child has allergic rhinitis or just a cold?

A cold lasts 5 to 10 days, has a defined onset, and may include fever. Allergic rhinitis is persistent or recurrent, has no fever, involves intense itching in the nose and eyes, clusters of sneezes, and worsens with dust, cold, or weather changes. If symptoms last more than 2 weeks or recur in the same situations, it is likely allergic rhinitis.

Can childhood allergic rhinitis be cured?

Allergic rhinitis is a chronic condition that cannot be cured but can be excellently controlled. Many children improve with age. Treatment combines environmental control (reducing dust mites), nasal washing, and medications when needed. Immunotherapy (allergy shots) is the only option that can modify the disease course long-term.

Is nasal saline washing effective for children with rhinitis?

Yes, nasal saline washing is one of the most effective and safe measures. It removes allergens, mucus, and secretions, relieves nasal obstruction, and can be done daily. For younger children, use saline drops; for older children, a syringe or squeeze bottle. Do it before nasal sprays to improve medication absorption.

Can children use nasal corticosteroid sprays?

Yes. Nasal corticosteroids (such as mometasone and fluticasone) are the most effective treatment for moderate to severe allergic rhinitis. In spray form, systemic absorption is minimal and they are considered safe for long-term use in children when prescribed by a pediatrician.

What home care should I provide for a child with allergic rhinitis?

Key measures include: dust mite-proof covers on mattress and pillow, washing bedding weekly in hot water, avoiding stuffed animals and heavy curtains, keeping rooms ventilated, no smoking indoors, using HEPA-filter vacuum cleaners, and avoiding strong-smelling cleaning products.

When should I see a specialist for childhood rhinitis?

See a pediatrician or allergist if rhinitis disrupts your child's sleep, affects school performance, causes snoring or mouth breathing, does not improve with antihistamines, or if there are recurrent sinus infections. Children who breathe through their mouth chronically may develop facial changes.

Allergic Rhinitis in Children: Symptoms, Treatment, and Daily Care in Brazil

Allergic rhinitis is the most common allergic condition in childhood, affecting approximately 26% of childrenin Brazil. The constant sneezing, stuffy nose, and itching disrupt sleep, school concentration, and quality of life. For expat families in São Paulo, understanding how allergic rhinitis is managed in Brazil — and how the city's climate and pollution can affect symptoms — is essential. The good news is that with proper diagnosis and treatment, symptoms can be controlled and complications prevented.

What Is Allergic Rhinitis?

Allergic rhinitis is an inflammation of the nasal liningtriggered by substances that the child's immune system mistakenly identifies as harmful — called allergens. The most common allergens are dust mites, mold, pet dander, and pollen. When the child inhales these allergens, the body produces an antibody called IgE, which triggers an inflammatory response: the nasal lining swells, produces excess mucus, and local nerves are stimulated, causing itching and sneezing.

Allergic rhinitis is frequently associated with other allergic conditions like atopic dermatitis (eczema), asthma, and allergic conjunctivitis — what is known as the “atopic march.” Children with one allergic condition are at higher risk of developing the others.

Allergic Rhinitis in Brazil: Key Facts

26%

of Brazilian children are affected

80%

of cases begin before age 20

40%

also have asthma

Types of Allergic Rhinitis

Allergic rhinitis is classified by the duration and severity of symptoms:

Intermittent

Symptoms less than 4 days per week
Or lasting less than 4 consecutive weeks
Common with pollen allergy (seasonal)

Persistent

Symptoms 4 or more days per week
And lasting more than 4 consecutive weeks
Common with dust mite allergy (the most frequent type in Brazil)

Symptoms: How to Recognize Rhinitis in Your Child

Nasal Symptoms

Clusters of sneezes (several in a row, especially upon waking)
Clear, watery runny nose (transparent discharge)
Nasal congestion (stuffy nose, alternating sides)

Intense nose itching (child constantly rubs or pushes nose upward)
Mouth breathing (open mouth due to obstruction)
Nighttime snoring and restless sleep

Associated Signs

Allergic shiners — dark circles under the eyes from nasal venous congestion
Allergic salute — the gesture of pushing the nose upward with the palm of the hand
Transverse nasal crease — a horizontal line across the nose from constant rubbing
Itchy eyes, ears, and throat — frequently accompanies rhinitis

Pediatrician's Tip

If your child constantly rubs their nose, sneezes upon waking, or has a stuffy nose almost every day, observe: do these symptoms worsen when sweeping, changing bedding, or on cold days? If so, it is probably allergic rhinitis. Write down when symptoms worsen — this information greatly helps with diagnosis.

Allergic Rhinitis or Cold? How to Tell the Difference

One of the most common questions parents ask is whether their child has a cold or flu or allergic rhinitis. This table helps differentiate:

Feature	Allergic Rhinitis	Common Cold
Duration	Weeks to months (while exposure continues)	5 to 10 days
Fever	No	Common (low-grade)
Nasal discharge	Clear and watery (always)	Starts clear, turns yellowish/greenish
Itching	Intense (nose, eyes, throat)	Mild or absent
Sneezing	In clusters (5-10 in a row)	Occasional
Pattern	Worsens with triggers (dust, cold, animals)	Defined onset, peaks in 2-3 days and improves

Not sure if it's allergies or repeated colds?

Dr. Paula can evaluate your child and determine the cause of persistent nasal symptoms. Bilingual care in Itaim Bibi.

Talk to the Pediatrician

Causes and Risk Factors

Allergic rhinitis has two fundamental components: genetic predisposition (atopy) and allergen exposure. The main triggers are:

Main Allergens

•Dust mites — the #1 cause in Brazil (Dermatophagoides pteronyssinus)
•Mold (fungi) — thrives in humid environments
•Pet dander and saliva — cats are more allergenic than dogs
•Pollen — more relevant in southern Brazil
•Cockroach allergens — common in urban areas

Irritants (aggravate, do not cause)

•Cigarette smoke — potent airway irritant
•Strong-smelling cleaning products
•Perfumes and air fresheners
•Temperature changes (cold, dry air)
•Air pollution— aggravates symptoms in large cities like São Paulo

Treatment: Three Pillars

Treatment is based on three pillars: environmental control, nasal saline washing, and medications. The right combination depends on symptom severity.

1. Nasal Saline Washing

Nasal saline washing is the first step of treatment and one of the most effective measures. It removes allergens, secretions, and mucus, relieves congestion, and improves the absorption of nasal medications.

Nasal Washing by Age

Babies (0-1 year): Saline drops or 3ml syringe — 2-3 drops per nostril

Toddlers (1-5 years): 10-20ml syringe with saline — head tilted forward

Older children (5+ years): Squeeze bottle or neti pot — they can learn to do it themselves

Frequency: 2-3 times/day for maintenance; up to 6 times/day during flares

2. Medications

Oral Antihistamines

For: Mild to moderate rhinitis. Relieve itching, sneezing, and runny nose.

Prefer second-generation options (loratadine, desloratadine, cetirizine) — they cause less drowsiness than older ones. Available in drops for young children at any pharmacy in Brazil.

Nasal Corticosteroid Sprays

For: Moderate to severe rhinitis, especially when nasal congestion is significant.

These are the most effective treatment for allergic rhinitis. Mometasone and fluticasone can be used from age 2. In nasal spray form, systemic absorption is minimal — they are safe for long-term use when prescribed by a doctor. Your pediatrician can guide dosing and duration.

Immunotherapy (Allergy Shots/Drops)

For: Moderate to severe rhinitis that does not respond well to medications, or when the goal is to modify the disease course.

The only treatment that can change the natural course of the disease. It involves gradually increasing doses of the allergen (sublingual or injectable) over 3-5 years. Recommended from age 5.

Warning: Nasal Decongestant Sprays

Never use nasal decongestant sprays (naphazoline, oxymetazoline) in children without medical guidance. These sprays provide quick relief but cause rebound effect — the nose becomes even more blocked than before. Use for more than 3-5 days can cause medication-induced rhinitis (spray dependency). In young children, they can cause serious cardiovascular side effects.

3. Environmental Control

Child's Bedroom Checklist

Dust mite-proof covers on mattress and pillow

Wash bedding weekly in hot water (60°C / 140°F)

Remove stuffed animals or wash them weekly

Replace heavy curtains with washable blinds

Vacuum with HEPA filter (do not sweep)

Keep room ventilated (prevent mold)

Avoid strong-smelling cleaning products

No smoking inside the home or car

Complications of Untreated Rhinitis

Recurrent sinusitis — chronic nasal inflammation blocks sinus drainage

Ear infections (otitis media) — Eustachian tube obstruction can cause recurrent ear infections

Asthma — 40% of children with rhinitis develop asthma

Facial changes — chronic mouth breathing can cause elongated face, high palate, and dental misalignment

Sleep disorders — blocked nose disrupts deep sleep, which can affect growth and learning

Warning Signs — See the Pediatrician

Nasal congestion that disrupts sleep, eating, or speech

Intense snoring or breathing pauses during sleep

Constant mouth breathing (even when awake)

Yellow/green nasal discharge with fever (may indicate sinusitis)

Symptoms do not improve with antihistamines after 2 weeks

Rhinitis in São Paulo: Seasonal Tips

In São Paulo, the autumn and winter months (March to August) are the most challenging for children with allergic rhinitis. The cold, dry airirritates the nasal lining, and people spend more time indoors, increasing exposure to dust mites and mold. São Paulo's air pollution compounds the problem.

Tips for Autumn/Winter

Increase nasal washing — at least 3 times/day during cold months
Wash blankets and comforters before use (they accumulated dust mites while stored)
Humidify the room — use a humidifier or damp towel in the bedroom
Dress your child before going outside — temperature shock worsens sneezing
Get the flu vaccine — respiratory infections worsen rhinitis

Flu vs Cold in Children

Learn when symptoms indicate flu, cold, or allergy

Baby Eczema Treatment Guide

The atopic march: rhinitis and eczema frequently go together

Childhood Asthma Guide

40% of children with rhinitis develop asthma

First Pediatric Appointment Guide

What to expect and how to prepare for your first visit

Scientific References

ASBAI. IV Brazilian Guidelines for the Management of Allergic Rhinitis. Arq Asma Alerg Imunol. 2018.
Bousquet J, et al. ARIA 2016: Care pathways for allergen immunotherapy. Allergy. 2019;74(7):1249-1259.
Solé D, et al. Prevalence of symptoms of asthma, rhinitis, and atopic eczema among Brazilian children (ISAAC Phase 3). J Pediatr (Rio J). 2006;82(5):341-346.
Sociedade Brasileira de Pediatria. Allergic Rhinitis in Childhood — Practical Update Guide. 2021.
Global Initiative for Asthma (GINA) and Allergic Rhinitis and its Impact on Asthma (ARIA). 2023 Update.