Allergic rhinitis versus viral rhinitis in toddlers: a practicalevidence-based guide for South African healthcare professionals

Rhinorrhoea is a frequent presentation in toddlers and may result from viral or allergic rhinitis. Although these conditions share symptoms such as rhinorrhoea, sneezing and nasal obstruction, they differ in pathophysiology, clinical course and pharmacological management. This narrative review examines the differentiation and evidence-based management of viral and allergic rhinitis in toddlers, with particular relevance to South African pharmacy practice. Viral rhinitis is generally an acute, self-limiting illness, with most symptoms improving within 7–14 days, although some symptoms may persist longer in young children. Management is primarily supportive and includes saline nasal preparations, adequate hydration and age- and weight-appropriate analgesia for fever or discomfort. Antibiotics have no role in uncomplicated viral rhinitis, and evidence does not support antihistamines for reducing rhinorrhoea or sneezing in children with the common cold. Oral antihistamine-decongestant combinations should be avoided in toddlers because of limited evidence of benefit and the potential for adverse effects. Allergic rhinitis is more likely when symptoms are persistent or recurrent and accompanied by nasal itching, repetitive sneezing, ocular symptoms or an atopic history. Management includes allergen avoidance and age-appropriate pharmacotherapy, with intranasal corticosteroids preferred for persistent symptoms and second-generation H1-antihistamines appropriate in selected cases. Pharmacists have an important role in structured triage, distinguishing likely viral from allergic disease, counselling caregivers on appropriate medication use, promoting antimicrobial stewardship and identifying patients requiring referral. Persistent, severe, unilateral or atypical symptoms warrant further medical assessment. Accurate differentiation can reduce inappropriate medication use while improving symptom control and safety in this vulnerable age group.