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 the prevention and environmental controls described below.
Although food allergies as a trigger for a runny nose is not common, if you notice that your child’s allergy symptoms always get worse after being exposed to certain foods, then you should avoid those foods. The most common foods that can cause problems include: milk, eggs (especially egg yolks), peanuts, soybeans, tree nuts, seafood, and wheat.
These steps help to control common allergens, including dust mites, mold, animal dander and pollens.
- Get rid of dust collectors, including heavy drapes, upholstered furniture, & stuffed animals.
- Use an airtight, allergy-proof plastic cover on all mattresses, pillows and boxsprings.
- Wash all bedding and stuffed animals in hot water every 7-14 days.
- If you must keep pets in the house, at least keep them out of your child’s bedroom and wash your pet each week to remove surface allergens.
- Avoid exposing your child to molds by keeping him away from damp basements or water-damaged areas of your home (check under carpets).
- Remove carpeting if possible.
- Vacuum frequently (when your child is not in the room, since many of the things that cause allergies are small enough to go back out of the vacuum cleaner bag).
- Cover air vents with filters.
- Avoid the use of ceiling fans.
- For seasonal allergies, keep windows closed in the car and home to avoid exposure to pollens and limit outdoor activities when pollen counts are highest (early morning for spring time tree pollens, afternoon and early evening for summer grasses, and in the middle of the day for ragweed in the fall)
- Consider using a HEPA filter to control airborne allergens (these only work if what you are allergic to is airborne, which doesn’t include dust mites and mold).
- Keep indoor humidity low, since dust mites and mold increase in high humidity.
- Provide a smoke-free environment for your child (it is not enough to simply smoke outside).
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 Allergra, Claritin, Clarinex and Zyrtec (usual dose is 1-2 teaspoons or 1 pill once a day), and topical steroids, such as Nasonex, Flonase, and Nasacort (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.
Keep in mind that Claritin is now over-the-counter and it is also available in the generic forms Alavert and loratadine.
Singulair is another medicine for kids with allergies. Although previously just used as a preventative medication for kids with asthma, it is now also approved to treat allergies. It is available as a chewable tablet and is approved for kids over age 1.
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.
- Call your pediatrician if you need a refill on your medications for allergic rhinitis, if your child is not improving in 1-2 weeks, or if he is showing signs of a secondary sinus infection, with a green runny nose lasting more than 10 days.
- If your child does not improve with these interventions, then we will consider having him see an allergy specialist for allergy testing to figure out what he is allergic to and to possibly start immunotherapy injections.