Spring Time Seasonal Allergies and Children

By Vincent Iannelli, M.D., About.com

Allergic rhinitis, or hay fever, is a common problem in infants and children. The most common symptoms include a stuffy or runny nose with clear drainage, sneezing, itchy eyes and nose, sore throat, throat clearing and a cough that may be worse at night and in the morning. These symptoms usually occur during certain times of the year for people with seasonal allergies, corresponding to being exposed to outdoor allergens, such as tree pollens, grasses and weeds. Other people may have perennial allergies, with problems occurring year round from exposure to indoor allergens, such as dust mites, pets, second hand smoke and molds.

Other signs of having allergic rhinitis include the 'allergic salute,' a common habit of children which consists of rubbing their nose upward. This is usually because the nose is itchy and this practice can lead to a small crease in the skin of the lower part of the nose. Children with allergic rhinitis also commonly have 'allergic shiners,' which are dark circles under the eyes caused by nasal congestion.

Allergic rhinitis does run in certain families and are more common in children that have asthma or eczema. It is also more common in children that are exposed to second hand smoke, air pollution and pets.

Having uncontrolled allergies can put your child at risk for getting a secondary sinus infection, ear infections, and for having poor concentration at school. It can also make asthma symptoms worse.

The best treatment for allergic rhinitis is to avoid what your child is allergic to by following prevention and environmental controls. For seasonal allergies, this includes keeping windows closed in the car and at home to avoid exposure to pollens and limit outdoor activities when pollen counts are highest (early morning for tree pollen in the spring, afternoon and early evening for grasses in the summer, and midday for ragweed in the fall).

The medications that are used to control the symptoms of allergic rhinitis include decongestants, antihistamines and steroids. If symptoms are mild, you can use over the counter medications as needed. Avoid using topical decongestants (such as Afrin) for more than 3-5 days at a time or frequent use of over the counter allergy medicines with antihistamines, as they can cause drowsiness and poor performance in school.

Prescription allergy medications include the newer, non-sedating antihistamines, such as Claritin and Zyrtec (usual dose is 1-2 teaspoons or 1 pill once a day), and topical steroids, such as Nasonex, Flonase, and Nasacort Aqua (usual dose is 1-2 squirts in each nostril once each day). If your child's symptoms are well controlled, then you can decrease the dose of the nasal steroid that you are using for 1-2 weeks and then consider trying your child off of it and see how they do. Continue the antihistamine for 1-2 months or until your child's allergy season is over. Allegra is another antihistamine that is commonly used in older children because it is only available in a pill form.

To be effective, your child should be using these medications every day. They will not work as well if just used on an as needed basis. They are in general very safe with few side effects, but the nasal steroids have been associated with growth suppression when used in high doses. This is however rare, and your pediatrician will monitor your child's growth to make sure this does not happen.

If your child's symptoms are not improving with the combination of the antihistamine and steroid, then we may also use a decongestant, such as Sudafed, AH-CHEW D, or as a combination (Claritin D).

For seasonal allergies, it is best to start using these medications just before your child's season begins and then continue the medicines every day all through the season. For perennial allergies, your child may need to take these medicines year round.

Your child may also benefit from nasal irrigations using saline nose drops 1-3 times a day. This will help the sinuses drain.

If your child does not improve with these interventions, then we will consider having him see an allergy specialist for skin testing to figure out what he is allergic to and to possibly start immunotherapy injections (allergy shots).

See our guide to Allergies and Children for more information.