Itchy Nose, Sneezing Every Day, Rubbing Eyes? 

“Why does my child sneeze every morning?”
“My child keeps rubbing their nose and eyes—is it just a cold?”
“The runny nose has been going on for months. Why isn't it getting better?”

If these sound familiar, your child may have allergic rhinitis (AR).

Allergic rhinitis is a common condition in children caused by an allergic response in the nose. It can cause persistent or recurrent nasal symptoms and may affect sleep, concentration, school performance and quality of life.

What Does Allergic Rhinitis Look Like?

Parents often notice a combination of:

• Frequent sneezing, often in bouts
• Itchy nose
• Clear, watery runny nose
• Nasal congestion or blocked nose
• Itchy, watery or red eyes
• Frequent nose rubbing
• Poor sleep or mouth breathing
• Post-nasal drip or throat clearing

A child may also develop the classic “allergic salute”—repeatedly pushing or rubbing the nose upwards because it feels itchy.

Unlike many viral respiratory infections, allergic rhinitis typically causes itching, sneezing and clear nasal discharge without fever.

The “Atopic March” — Why This Matters

Allergic rhinitis is part of a group of allergic (atopic) conditions. Many children follow a pattern known as the atopic march, where different allergic conditions may appear at different ages.

A typical pattern is:

• Infancy: eczema (atopic dermatitis)
• Early childhood: food allergies may appear in some children
• Preschool and school age: allergic rhinitis becomes more noticeable
• Later childhood: some children may develop asthma

Not every child will go through all these stages, and having allergic rhinitis does not mean that a child will definitely develop asthma. However, children with allergic rhinitis are more likely to have other atopic conditions such as eczema, food allergy or asthma.

“What Triggers Allergic Rhinitis?”

Allergic rhinitis occurs when the immune system reacts to normally harmless substances in the environment.

Common triggers include:

• House dust mites
• Pet dander
• Mould
• Pollen
• Certain environmental allergens

Symptoms may become more noticeable in particular environments or after exposure to specific triggers.

However, not every child with rhinitis has an identifiable single trigger, and not every runny nose is caused by allergy.

“Does Allergic Rhinitis Cause Cough?”

It can.

Nasal inflammation and mucus draining towards the throat can cause:

• Throat clearing
• A sensation of mucus in the throat
• Dry cough
• Cough that is worse at night

However, persistent cough should not automatically be attributed to allergic rhinitis.

If your child has recurrent wheezing, breathlessness, exercise-related symptoms or persistent cough, asthma should also be considered.

Allergic rhinitis and asthma can occur together, so the child's overall respiratory history is important.

“Does My Child Need an Allergy Test?”

Not necessarily.

Allergic rhinitis is often diagnosed based on the history and clinical examination.

Allergy testing may be considered when:

• The diagnosis is uncertain
• Symptoms are persistent or difficult to control
• Identifying specific triggers would change management
• There is a need to guide allergen avoidance or consider allergen immunotherapy

Testing should therefore be clinically indicated rather than performed routinely for every child with a runny nose.

“What Can We Do About It?”

Treatment depends on the child's symptoms, severity, age and likely triggers.

1. Reduce Exposure to Relevant Triggers

Where a specific trigger is identified or strongly suspected, reducing exposure may help.

For example, measures may be considered for house dust mite, mould or pet exposure, depending on the child's individual situation.

However, it is usually not practical—or necessary—to try to eliminate every possible allergen from the child's environment.

2. Saline Nasal Rinsing

Saline nasal spray or nasal irrigation can help clear mucus and improve nasal symptoms.

It can be particularly useful when the nose is congested.

3. Medicines When Needed

Depending on the child's symptoms, treatment may include:

• Intranasal corticosteroids (INCS)
• Antihistamines
• Other medications in selected situations

“Are Nasal Steroids Safe for Children?”

This is a very common parental concern.

When appropriately prescribed and used correctly, modern intranasal corticosteroids have a good safety profile.

They act mainly within the nose, with relatively low systemic exposure. Evidence and guideline recommendations support their use in children when clinically indicated.

Parents should use the correct product, dose and technique recommended for their child's age.

“When Should I Bring My Child to See a Doctor?”

Consider a medical assessment if:

• Symptoms are persistent or frequently recurring
• Nasal congestion is affecting sleep
• Your child is frequently mouth-breathing
• Symptoms are affecting school, concentration or daily activities
• There is persistent cough or throat clearing
• There is recurrent wheezing or breathing difficulty
• Symptoms are significantly affecting quality of life
• You are unsure whether it is allergy, infection or another condition
• Symptoms are not improving despite appropriate treatment

Persistent nasal obstruction may also warrant assessment for other causes, such as adenoid enlargement, chronic sinus disease or structural nasal problems, rather than assuming everything is due to allergy.

What to Expect During the Consultation

1. Paediatric Consultation — Find the Cause First

We assess your child's symptoms, duration, triggers, nose and throat, eyes, breathing and overall condition to determine whether allergic rhinitis is likely.

2. Further Assessment When Indicated

If needed, we can arrange appropriate investigations, including allergy testing, depending on the clinical assessment.

3. Individualised Treatment

We provide advice on allergen avoidance, saline nasal care and appropriate medications based on your child's age and symptoms.

4. Referral When Needed

If your child requires further specialist assessment, we can arrange a referral to an ENT Specialist/ the appropriate paediatric subspecialist, allergy/respiratory service or hospital.

Assess → Identify the cause → Control the symptoms → Monitor → Refer when needed