Dr.Irene Melinda Louis Fellow,

Paediatric Pulmonary and Sleep Service University Children’s Medical Institute

National University Hospital. Singapore

AR is frequently associated with other childhood atopic diseases such as eczema and asthma. In one study, it was found that 59% of children with asthma also had AR; health service utilization and costs for asthma are greater for asthmatic children with associated AR; Asthma may also be exacerbated by AR and treatment of the rhinitis can improve outcomes for asthma.

Classification

Rhinitis may be classified into non-allergic and allergic; AR is further divided into seasonal (“hay fever”) and perennial (all year round). While this classification is useful as it indicates the possibilities for specific management steps such as allergen avoidance and immunotherapy, in practice, non-allergic and allergic rhinitis often co-exist.

story continued inside...

Allergic rhinitis (AR) affects both adolescents

and younger children. AR is not infrequently

regarded by parents as an irritation rather

than as a significant disease, and is often

under-diagnosed and under-treated. As

AR is not life-threatening, many patients

or parents do not seek medical treatment

or may choose to medicate with over-the-

counter preparations. However, AR can have

a significant impact on the child’s quality

of life and influencing sleep, cognition and

psychomotor function.

“

“

july

201

0

The Children’s Asthma and Allergy Network@University Children’s Medical Institute

newsletter

MICA (P) 079/11/2009

NUH 25th AnniversaryChildren’s Drawing Contest

5

www.ican.com.sg

Details of the events are correct at the time of print. Please look out for more information through this channel or www.ican.com.sg nearer the event date.

For more details or registration: Call : 6772 5566 Fax : 6772 4453 Email : enquiry@ican.com.sg

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Aim for ACT score of 20 and above!1

References: 1. Ministry of Health Clinical Practice Guidelines for Asthma, 2008 2. GINA 6-point is referenced from GINA Report 2008

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Evidence supports use of montelukast as an initial controller therapy for mild asthma in children. 1

PRACTALL Pediatric Consensus ReportJanuary 2008

Copyright © 2009 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA. All rights reserved. 01 Feb 2011 SGA-2010-SG-4480-DA

Reference: 1. Bacharier LB, Boner A, Carlsen K-H, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy. 2008;63:5–34.

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and Allergic rhinitis

its treatment

1to 3allergic rhinitis and nasal spray >>

2“I CAN !” golf >>

discover your child’s allergy risk >> 4calendar of events >> 5

of this issuehighlights

Venue : NUHS Tower Block Auditorium

04 dec 2010

“I CAN !” 8thAnniversary

editorial teamEditorDr Genevieve V Llanora

Editorial TeamA/Prof Lynette Shek A/Prof Daniel GohProf Hugo Van Bever

Dr Chan Poh Chong Dr Irene Melinda LouisDr Eugene Han

Ms Christine Loh Mr Jerome CruzMs Michelle Tan Ms Sharmaine PohMs Siti Dahlia Ms Cai Xue TingMs Rafiah Omar

Design & PrintingDream Innovate Communication

This educational publication is printed with the kind sponsorship of:

!

!

calendar of events

Shawn Lee“I CAN !” member1st prize winner of NUH 25th Anniversary Children’s Drawing Contest

“The fond memories of “I CAN !” sport events have inspired Shawn to draw the winning piece!”

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Congratulations to all the winners!

Venue : TBA

“I CAN !” Sportsnov/dec school holidays

Cover Story continuation....

Treatment

Evidence suggests that parent or patient education improves treatment effectiveness and quality of life; The use of anti-histamines and intranasal steroids are the treatment of choice. Immunotherapy (“desensitization”) recommended in selected patients whose condition is not adequately controlled despite optimal medical therapy and allergen avoidance.

The chronic or recurrent nature of many cases of AR and the importance of self-management emphasizes the need for parent and patient education. This should cover the practical interpretation and implications of test results, in particular the relevance of allergen avoidance measures, benefits, risks and side effects of treatments, and techniques for administering topical medications.

Intranasal steroids

Intranasal steroids are the treatment of choice for persistent moderate-severe AR and may also improve non-allergic rhinitis. Intranasal steroids are safe for long-term use although it is prudent to use the lowest dose that will control symptoms. As stated above, nasal steroids are particularly effective at relieving nasal obstruction. Interestingly, ocular symptoms (eg itchy eyes) which commonly co-exist with AR may also be improved following the use of nasal steroid.

Many of the newer nasal steroid sprays do not have significant distribution to the rest of the body and hence have less potential for side effects. Concerns of effects of these medications on growth and adrenal function suppression have not been supported in studies with the two most commonly used compounds, fluticasone or mometasone.

The most common reason for treatment failure is non-adherence. Proper technique in nasal spray use will reduce the often reported discomfort associated with these medications.

Antihistamines

Oral antihistamines are effective in AR, particularly for symptoms such as itching, runny nose and sneezing. Antihistamines have little effect on nasal blockage. Because of the sedative effect of older antihistamines, there have been concerns about side-effects such as learning impairment and poor concentration. More often, the “non-sedating” antihistamines are preferred as they are longer acting (can be given only once a day)

2 3

Discover your child’s allergy risk.The number of children with allergies has increased in most Asian countries over the last decade. In fact,

in Singapore today nearly one in every four two-year-olds has had symptoms of allergy.1

™

Breastfeeding for at least six

months can help prevent allergies

If breastfeeding is not possible, or if you stop

breastfeeding after your baby reaches

six or more months of age, there are hypoallergenic

formulas with gentle proteins specially designed

to help prevent allergies.

Not all hypoallergenic formulas are the same. Expert groups, such as the European Academy

of Allergology and Clinical Immunology, emphasise that if a hypoallergenic

formula is used, it should be clearly proven in clinical

trials to protect babies from allergies.2

Most allergies develop early in life Once an allergy develops, it can be distressing for both the baby and his mother. Unfortunately, there is also a real chance allergies will continue to affect a baby into childhood and potentially through the adult years.

The most common allergies in early infancy include food allergy and atopic dermatitis (eczema), and babies that have these may also be affected by diarrhoea, fever or a rash.

Is your child at risk?It isn’t always easy to predict which child will develop allergy and which child won’t. Research shows, however, that there’s a greater risk a child will develop allergy if one of his parents or a close relative has allergies. There’s an even greater risk if both parents have a history of allergy. Even so, around 15% of children with allergies don’t have a history of allergy in their families.

In the following table, you can see your child’s approximate risk of allergy according to your family’s allergy history.

How can you reduce the risk? The good news is you can help minimise the risk of your child developing allergy.

One of the things your doctor will recommend if you have a baby is to breastfeed for at least the � rst six months and continue to do so for as long as possible. Breast milk is hypoallergenic and it also contains antibodies, probiotics and other things that make it the best protection against allergy.

Speak with your doctor about allergy prevention if you think your child may have an increased risk.

Important Notice: Breastmilk is the best for babies. The World Health Organisation (WHO) recommends exclusive breast-feeding for the � rst 6 months and should be continued as long as possible. Unnecessary introduction of bottle-feeding or other food and drinks should be discouraged since it will have a negative effect on breast-feeding. Consult your doctor for advice if you are unable to breastfeed.

References: 1. Tan TN, Lim DL, Lee BW, Van Bever HP. Pedietr Allergy Immunol 2005; 16 (2): 151-156. 2. Høst A, Halken S, Muraro A et al. Pediatr Allergy Immunol 2008; 19: 1-4.

*Compared with a child whose parents/relatives do not have allergies.

Infl uence of family history on a child’s risk of allergy

Family History

Low risk

No defined history of allergy

High risk*

One or more 1st degree family members with allergy

% in all newborns

Likelihood of child

developing allergy

15% 30 – 40% 50 – 80%

25%25%25% 5%5%5%70%

30 – 40% 50 – 80%

NAN HA_SG_ADV_A4_FA.indd 1 6/22/10 5:19 PM

Important Notice: Breastmilk is the best for babies. The World Health Organisation (WHO) recommends exclusive breast-feeding for the � rst 6 months and should be continued as long as possible. Unnecessary introduction of bottle-feeding or other food and drinks should be discouraged since it will have a negative effect on breast-feeding. Consult your doctor for advice if you are unable to breastfeed.

References: 1. Osborn DA, Sinn J. Cochrane Database of Systematic Reviews 2006, Issue 4; Art No CD003664. 2. Saavedra JM. Nutr Clin Pract 2007; 22: 351-365.

For children 6+ monthsFor children 10+ months

Clinically Proven Confidence™

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NAN HA_SG_STRIP AD_52.5w x 297hmm.indd 1 6/22/10 5:33 PM

4

Every year, the children’s asthma and allergy network (“I CAN !”), organizes sports events to encourage children with asthma and allergies to participate in sports, despite their condition. On June 12 this year, over 15 “I CAN !” members, together with their parents, trooped to Marina golf course on a very bright and sunny Saturday, to learn how to play golf.

For the many young maiden golfers, it was a great experience getting basic pointers from Mr. Vincent Gallus, a coach from the Star Golf Academy(a centre that teaches golf to adults and children). Mr Gallus is also a certified member of the Switzerland and European PGA, with a 12-year experience in golf, and special interests in teaching golf to children.

The children were very happy to be given a chance to play golf and learn from one of the best golf coaches in Singapore.

This has been another successful and unforgettable event. We know many kids are looking forward to the next “I CAN !” sports event. See you soon!

g lf

sports event

By Dr Genevieve V. Llanora

1 Gently blow your nose to clear nostrils.

2 Remove the cover from the nasal spray.

3 Shake the nasal spray.

4 Hold head in neutral upright position.

5 Direct spray to the side, away from the middle of the nose, either 10 o’clock or 2 o’clock direction. (Use the right hand to spray left nostril and left hand to spray right nostril)

6 Activate the device as recommended by the manufacturer and with the number of sprays recommended by the doctor.

7 Gently breath in during spraying.

8 Breath out through the nose.

9 Repeat steps 4 to 8 for the other nostril

ALWAYS ASK YOUR DOCTOR OR NURSE FOR A DEMONSTRATION

NoteIf the nasal spray is used for the first time, shake the canister and spray it several times into the air till the mist is uniform.

Repeat this process if the spray has not been used for 14 days or longer.

A B

C D

HOW TO USE THE NASAL SPRAY

and also are less likely to cause sedation and its attendant side effects. The most complete safety data on the use of antihistamines in young children is found with the antihistamine cetirizine (Zyrtec®). The safety of cetirizine when administered on a daily basis in an allergy prevention trial for a period of one to 2 years has been comprehensively evaluated in a multicentre study in infants and

toddlers. No significant increase in adverse effects, including sedation, were observed.

There is extensive evidence describing the benefits of using both nasal corticosteroids and oral antihistamines in the treatment of AR. In one study, antihistamine in combination with nasal steroid improved symptom scores significantly more than nasal steroid alone.