With pollen blowing across the country and “the worst spring allergy season in 10 years” in the headlines I thought I would follow up with a second blog on treating seasonal allergic rhinitis (SAR).
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As discussed previously I typically begin seeing seasonal allergic symptoms of runny nose, sneezing, itchy eyes and cough in children after the age of 2, and more typically around 4 years of age. Prior to that most physicians think that recurrent viral respiratory infections account for many similar symptoms in the toddler age group.
Parents who are convinced that their 8 month old baby has allergies this spring are most likely facing their child’s first “cold” as allergic symptoms to pollens are brought on after repeated exposure, so we therefore see the symptoms later on. Allergies do seem to be hereditary so a child who has two allergic parents has between a 50-80 % chance of developing those seasonal allergies.
Seasonal allergies at this time of year are typically due to pollen from trees, and will then be followed by grass and weed allergies. By far the best way to prevent the misery associated with SAR is to begin a nasal steroid spray early in the spring in order to help prevent the histamine release that occurs when microscopic pollen particles enter the nasal passages. For children with known allergies I typically begin nasal steroids in mid March.
The histamine release in the body following exposure to the offending pollens will cause all of the seasonal allergic rhinitis (SAR) symptoms. On top of using a nasal steroid children who have classic allergic shiners (darkened areas beneath their lower eyelid), clear watery nasal discharge with frequent sniffing and/or blowing or throat clearing, cough and sneezing may benefit from taking a daily anti-histamine. (in other words to fight the histamine release that has already occurred). There are both 1st and 2nd generation anti-histamines.
The 1st generation antihistamines are the older drugs that often cause sedation or drowsiness but are still excellent antihistamines. Examples of these are Benadryl (see recall info for this product), Tavist, Dimetapp, and Triaminic products that are all available over the counter. I use Benadryl (see recall info for this product) most frequently as there are so many different choices as to dosing methods. Many allergists also feel that if one class of anti-histamine does not work to try another, so many people have their own favorite medication.
The newer 2nd generation antihistamines such as Claritin, and Zyrtec (se recall info for this product) are now available OTC also and come in both liquid and chewable preparations. There are also prescription products in this group such as Allegra, and Clarinex and Xyzal. These antihistamines are labeled non-sedating and are usually given once a day. Again, one child may prefer one brand over another and some do not have a chewable or liquid option so are used in older children and adolescents.
There are also other drugs that are used to combat allergy symptoms and these drugs may be used in combination with antihistamines and nasal steroid sprays. Decongestants help constrict blood vessels and shrink the nasal mucous membranes and may improve nasal congestion. The most common medications are Sudafed which is pseudoephedrine (now found behind the medicine counter) and Sudafed-PE which contains the decongestant phenylephrine. These decongestants may also be found in nasal sprays to use topically, but if used locally within the nose may cause actual rebound symptoms of more congestion so are not recommended for use as a nasal spray for more than 3-7 days. Therefore it is preferred to use systemically to avoid that problem. Decongestants may also cause hyperactivity and insomnia so I rarely recommend them for use in the evening in children.
Singulair which is a leukotriene inhibitor (anti –inflammatory) may help relieve nasal allergic symptoms as well as the allergic cough, especially in children who have frequent night time coughs during allergy season. It comes as both granules, chewables and pills and may be given to children down to 2 years of age, especially those that have asthma as well as nasal allergies.
Lastly, there are antihistamine nasal sprays now available but they have the problem of “really tasting badly” and I find most children will not use them. There are also several good eye drops for those that get seasonal allergic conjunctivitis (SAC) several of which, Zaditor and Patanol are now available OTC and older children find them quite helpful.
Despite this huge armamentarium of products, no one (or two or three) will totally prevent symptoms. So make sure that your child bathes or showers after playing outside, including washing their hair, to get the pollen off of their skin and hair. It is also helpful to wipe off the dog or outside cat with a dryer sheet to get some of the pollen off of the pets. While I love to sleep with the windows open and ceiling fans going, if your children suffer from SAR you are better off keeping windows closed and the AC on.
That's your daily dose for today. We'll chat again tomorrow.