What is the differential diagnosis of rhinitis in child old 6 months?

Differential diagnosis in spite of the differential diagnosis of infective nose wide, tends doctors to take the causes of only a few into account فتعزى most cases للأرجية or some forms of infection, bacterial or viral. And when fail to address this diagnoses few, are usually recommendation clinical the following is a referral لأخصائي allergic and / or specialist ear and throat. Likely to see both التخصصين sub the same set of children healthy otherwise, with a view to access diagnosis most likely based on the history of patients, testing, and testing of appropriate, for example للأرجية inclusion or the exclusion of rhinitis allergic, seen him mostly as "a convicted to prove برائته". For لأخصائي allergic children, the story pathological common of the parents والقائمين care is something like "my child has congestion nose doctor says it's sensitivity (allergic)". Is usually this diagnosis bet a safe, because the 40% of patients with children are infected inflammation nose allergic (2). But, when taken into account the diagnosis rhinitis allergic, it is important that contains the history of patients the evidence on التأتب (ready-allergic) atopy, such as the itch nasal, itching eye, or contraindication seasonal symptoms related pills vaccine in the environment in the open air. Less likely to be the patient is infected inflammation nose allergic in the absence of redness eye, itching nose and eye, والعطاس occurring in the season, the right. For لأخصائي ear and throat, the story pathological repeated of the parents والقائمين care is the "my child has a blockage or congestion nose," and "always has infection sinus". Reveals the history of patients detailed that symptoms occur daily basis, which excludes the presence of infection sharp. There assumption is common to the presence of هالات dim under eyes ("هالات allergic") - with the presence or absence of the symptoms of nasal مصاحبة- sign of allergy allergic. Cause congestion blood vessels this Halos dark often accompany congestion nose والجيوب nasal. Enhances rubbing eyes later only from their appearance dark. Although the Halos black under eye may cause of rhinitis allergic, but must remember that sleep deprivation, in addition to any other case cause congestion nose like inflation الغدانيات adenoid hypertrophy blockage nose chronic, you may also cause Halos black. So no need to lead Halos black under eyes automatically to diagnose rhinitis الأرجى. Subject to more and more patients to test globulin immunoglobulin e qualitative (ige) by doctors primary care to diagnose, "allergic". Potentially useful for this test in the diagnosis and treatment of allergic, However, the quality of approximately 80% 90% with the sensitivity of 80% 85% (3), which means that there is great potential for error follows-diagnosis of the wrong. Increase the likelihood error in patients who brings they have a level ige overall increase significant, such as patients eczema severe, because the high ige contribute in the possibility of positive results of the wrong. (Always explain this concept parents / guardians this analogy: if you win contest withdrawing misfortune Red from the vase, it is very easy to win if the vessel is full بالبلي Red). Unfortunately, a small number of parents estimated the characteristics of assessment test allergic based ige. Must remember the physicians who seek to measure ige the course of history and clinical the patient. Can't explain test allergic based ige solo, because it will result in لفرط diagnosis fumbling allergic. Examples repeated on hyper diagnosis fumbling allergic based test ige النوعى when tells US parents that their child is no longer eat certain types of foods on the basis of the results of the test, although the child may enjoy these foods themselves before the test, did not subject to any of the symptoms of sensitivity. كأطباء, we must remind ourselves treat patients on the basis of the assets in the history of patients and testing, not just on the basis of the results laboratory. Vast majority of children with leaching frequent can be treated appropriately by the doctors of primary health care, and not require a test allergies or referral specialties sub. Based on instructions for the American Academy of ear and throat-surgery head and neck 2015 on clinical practice of infective nose allergic (2), should pediatricians disciplines children sub give children the injured inflammation nose allergic attempts of السترويد in the nose anti histamine mouth. No need to make a test allergies or referral لأخصائي allergic or the ear and throat or both, most of the children brah frequently. Must refer the child evaluation بالتخصصات sub-only when suffers from the symptoms of continuous, in spite of use and hard للسترويدات nasal and anti histamine oral.

DD

• Allergic

• Primary Cilial Dysfunction

• Infective

• Immune deficiency • Cystic Fibrosis • Idiopathic

• Cystic Fibrosis • Idiopathic

• Idiopathic

Most probably it is a case of Primary Ciliary Dyskinesia • 50% with situs inversus – high index of suspicion • Often presents in infancy with rhinitis but not diagnosed until 4 years (avge) • ? ↑ suspicion if a cough also presents check the heart.

Transient hypogammaglobulinemia of infancy, • IgG subclass deficiency, • impaired polysaccharide responsiveness (partial antibody deficiency) • IgA deficiency. All four illnesses are characterized by recurrent bacterial respiratory infections such as purulent rhinitis, sinusitis, otitis, and bronchitis.

Idiopathic neonatal rhinitis, Related to reflux.

 

In this age of child explanated conditions can most relate to primary cilliary dyskinesia. It is necessary to check microbiological examination of sputum and make a nasal brush biopsy and check nasal smear. Certainly, don't hurry with treatment because the child is in good condition. In the same time, would think about cystic fibrosis, unilateral choanal atresia, possible foreign body in the nose, check nursemaid's health, cracks on the meninges, selective IgA immunodeficiency, secretory brain tumors, craniosynostosis syndromes, CHARGE syndrome, etc.