The catarrhal child - a cause of recurrent colds, ear infections, tonsillitis etc

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This is a very common problem and easily recognised. There is a history of recurrent colds, snotty nose with green candles, blocked nose, poor sensations of taste and smell, and mouth breathing. Often there are recurrent attacks of tonsillitis, ear infections, sore throat and perhaps sinusitis. Untreated these children go on to get glue ear and deafness, failure to progress at school and may need grommets inserting.

Excessive catarrh is the body's way of trying to wash out something it does not want. For viral or bacterial infection this is entirely appropriate. However when the cause is an allergy, excessive catarrh is a real nuisance. Broadly speaking the child with thick secretions and blockage is allergic to foods. The child with thin watery secretions, sneezing and nasal itch (they often have a horizontal crease where the nasal bone ends as a result of rubbing the nose upwards with a flat hand the "allergic salute") is most often allergic to inhalants such as house dust mite, pollen or animal furs.

Other signs of allergy include dark rings (allergic shiners) under the eyes ("he always looks tired") and facial pallor (a slightly "marbled" appearance).

Diagnosing an allergy

Skin tests for inhalants can be useful, but can also be misleading - some children will react in the nose but not the skin, and vice versa. If the child is much better in a dry climate (hot dry or cold dry such as ski-ing holiday) or on the coast then this might also point to inhalant sensitivity.

The foods which most commonly causes catarrh are the dairy products. And really the best diagnosis of this is to the child on a dairy free diet for at least one month. Dairy is a frequent offender in these cases, and I remember hearing a paediatrician say that he considered it medical negligence to operate on a child for glue ears and grommets without first trying a dairy free diet. See Dairy free diet

The next suspect in line would be grains, yeast and sugar (think fermenting gut). However any food can cause catarrh. The offender is looked for by elimination dieting with a Stone Age Diet. If there are allergies to many foods, then I would consider desensitisation with Enzyme Potentiated Desensitisation (EPD) - how it works.

Chemical sensitivity can also cause rhinitis and catarrh. See Do A Good Chemical Clean-Up: chemicals make you fat and fatigued!

Allergy to gut flora (bacteria and/or yeasts) may also present with rhinitis. See Yeast problems and candida

Decongestants

Don't be tempted to use them! The problem is that in the short term they work! However when you stop using them there is a rebound hyper-secretion, ie the problem gets even worse. So the normal reaction is to use even more decongestant and this leads to a rhinitis medicamentosa (see Wikipedia article - rhinitis medicamentosa ) So save the decongestants for the occasional use when you have to perform and don't use them too frequently.

Guaifenesin 400mgs-2,000mgs daily is useful to thin secretions but this does not address the cause.

Nasal polyps

If there is on-going unremitting catarrh and post nasal drip it is worth getting an ENT surgeon to look at the back of the nose to see if there is a polyp. These are folds of mucous membrane which have developed as a result of some sort of chronic irritant such as allergy or irritant dusts (eg smoking). Once developed they are unlikely to shrink back and an operation may be needed to get rid of them. One must then think about the cause or they will recur.

Sinusitis

Sinuses evolved in mammals standing on all four legs so that they were naturally drained by gravity. When humans stood up on two legs this brought many problems including poor drainage of sinuses - the angles for drainage are all wrong when we stand rather than crawl!. They are cavities in the bones of the face with only one entry and exit hole which is easily blocked by catarrh or swollen mucous membranes. When this occurs, infection may follow on and cause sinusitis. The characteristic feature of sinusitis is pain in the face or headache when one bends down - this is due to increased pressure in the sinuses. The acute form is often treated with antibiotics such as doxycycline. But they may also get infected with yeasts and some people need anti-fungals to clear symptoms. Sinus washouts are sometimes helpful and one can get home DIY kits that work well.

Interventions and medications for catarrh and rhinitis

A neti pot is often very helpful - see WebMD article on neti pots. This is a low pressure device to wash out the sinuses with whatever - warm salt water 1% solution would be a starting point. It is of proven benefit whether the sinusitis is due to infection or allergy. All inhaled antigens (grass, pollen, animal dander, house dust mite etc) are water soluble. One could easily add in topical antimicrobials such as neem, nystatin powder or colloidal silver but any such solution must be kept weak (less than 1% ) or you risk irritating the delicate lining of the nasal passages.

A 1% solution of salt is made with 9 grams of salt in a litre of water.

Medications are usually aimed at blocking allergic reactions (antihistamines, steroids, cromoglycate) or suppressing inflammation (steroids). They work symptomatically but have to be taken all the time, may have side effects and by not addressing the root cause of the problem, may not prevent problems in other areas.

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