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Child's nosebleeds may be caused by allergic rhinitis


Q: I have a 2-year-old daughter who scratches her nose a lot. She also wakes up with a bloody nose. Is it allergies? What should I do?

A: An itchy nose can be a sign of nasal allergy, or allergic rhinitis. A child who is bothered by such allergies frequently rubs her nose often enough and vigorously enough to create a crease a little way up from the tip at the place the bony part of the nose begins. Bloody noses are also common with allergies, because the lining of the nose, which has many, many blood vessels very close to the surface, is constantly irritated.

Most children with allergic rhinitis have other symptoms, too. They sneeze, and their noses run. Their nasal mucosa may be so swollen that their breathing sounds "stuffy," and they may choose to breathe through their mouths most of the time. They may snore when asleep. Often their eyes are red with dark circles.

If your daughter has many of these symptoms, your doctor may " decide to try a type of medication called an antihistamine that keeps cells from reacting so vigorously to the allergen (the external substance the body is trying to reject). Your doctor may also be able to help you determine just what the allergen is likely to be. although your daughter may be too young for you to notice a pattern.

In spring, allergic rhinitis is often caused by tree pollen, in summer by grass pollen and in fall by weed pollen. If symptoms continue all year long, the allergy may be to the dander of a pet, to the dust mite which thrives even in the cleanest of homes, or to molds. The problem might be an irritant, rather than an allergen, most often cigarette smoke. We recommend a trip to your child's doctor to try to sort this out.

Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

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