Seasonal Allergies

Ah-choo! When the flowers are blooming and the pollen count is rising, we get a flood of sick visits—kids who are suffering with seasonal allergy symptoms.

Allergies can present at a young age, although usually not before 6 months. Why they don’t start earlier is interesting, but perhaps it’s because it often takes repeated exposure to an allergen before you see a reaction. Also, the mechanisms of inflammation in the body are not fully developed in a newborn.

Allergies often run in the family, and sometimes they are signs of a “sensitive” or atopic child in general. Quite often a child with allergies may have sensitive skin, eczema, and/or asthma as well.

Symptoms and Signs

The severity of allergies can vary. The eyes are usually itchy and mildly red, but there should not be any yellow or green discharge. The nose is running constantly, but it should be a clear, water-like discharge. And the throat can be itchy and dry. Kids have that nervous, throat-clearing cough for many reasons, but during the spring, don’t forget about allergies as a possible cause of mild cough or itchy throat.

The first few days of an upper respiratory infection, or common cold, can seem a lot like allergies, but the mucous is often more yellow or green in infectious processes. Fever is also a great way to pick out a cold—allergies would never start with a fever. Swollen glands are another way to differentiate colds from allergies, as they are enlarged when fighting an infection, but normal-size with allergies.

The physical signs of allergies can be puffy eyes, an allergic crease on the nose (from all the rubbing), and, as a doctor will see upon examination of the nasal turbinates, inflamed mucosa. The throat may also show signs of allergy, as the classic cobblestoning of the posterior pharynx often indicates allergies. The lungs should be clear in pure allergies, so if there is a wheeze this may be mild asthma (possibly triggered by the allergies), which requires treatment.

When to Use Medicine

Fortunately, treatments for allergies are quite safe and usually very effective. If the main problem is the eyes, we can prescribe drops such as Patanol or Zaditor for use as needed every 12 hours. For a constantly runny nose, we prescribe a nasal spray, and there are many good choices—Nasonex, Flonase, Veramyst, and Rhinocort are the most common. These are inhaled steroids, but the steroids act locally and are not absorbed in any significant manner into the blood.

If the allergies are stronger or all over (not just in the eye or nose), we would recommend an oral medication such as Claritin, Zyrtec, or Allegra. These medicines are so safe that most of them are now offered over the counter, and the generic versions are just as good and a lot cheaper. For Claritin and Zyrtec, the dose is 2.5ml, or half a teaspoon, once a night if your child is 6 months to 2 years old; 5ml, or a full teaspoon, if they are 2 to 6 years old. After that, the normal dose is 10ml, or 2 teaspoons. Good old-fashioned Benadryl will work (click here for dosages), but it is sedating, so I recommend it only when nothing else works, and not every night. Singulair is a nice, safe medicine (and not a steroid at all) that is mainly used for mild, persistent asthma, but has been proven to help with allergies as well. I wouldn’t use at as a first-line allergy treatment unless there was mild asthma as well.

Once we see that the Claritin or Zyrtec is working, we would continue that for a good month or so, and then try weaning off of it and watching for the return of symptoms. The other medications (for the eyes and nose) can be used on an as-needed basis. Some people have allergy symptoms all year round, and for those the medicines are safe and necessary all the time. But the vast majority of allergies will fade by the end of the summer.

When to See a Specialist

There are amazing doctors who specialize in pediatric allergies—so when should you meet them? When I see a young child who has hives, or any chance of a severe anaphylactic reaction (throat swelling, low blood pressure, etc.), I refer them to the specialist. These reactions are almost always the result of a food allergy, not a seasonal allergy.

Allergy testing is sometimes important, but if you know your child is allergic to the pollen, I don’t think skin or blood tests are necessary; they won’t change our management. And although allergen avoidance is an excellent treatment, I wouldn’t stop taking your little one to the park—activities like going to the park is important for their overall health.

On the other hand, there are certain kids whose allergies are so severe that they fail to respond to the typical medications. For those kids, referral to an allergist is crucial, as they will go over the risks and benefits of allergy shots. These shots, which are not at all related to the vaccine shots, are given weekly in most cases and involve a true commitment to follow up with the doctor. But they can really make a difference, allowing a child to function normally.

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