Pediatric Associates of Richmond

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Seasonal Allergies (Allergic Rhinitis)

Seasonal allergies, also known as allergic rhinitis, affect many families during the spring and early summer season.  Runny nose, itchy or watery eyes, sneezing, stuffy nose and mouth breathing that last 2 weeks or longer and occur at around the same time each year are common indicators of intermittent allergic rhinitis.  Seasonal allergies are common in children, affecting approximately 40% of the pediatric population, by some estimates.   We commonly think of these allergies as ‘outdoor’ allergies, triggered by increases in the pollen or mold count in the local environment.  Some patients, however, experience allergy symptoms year round.  These allergies, sometimes thought of as ‘indoor allergies’ may be exacerbated by dust, animal dander, second hand smoke or indoor mold.  These allergies are classified as ‘persistent allergies.’

Allergies can have a significant impact on children and families.  Behavior, sleep and appetite can all be affected by allergy symptoms.   In addition, the incidence of allergic rhinitis has been noted to be on the rise in the US.  Many factors may contribute to the increase, with studies suggesting associations between allergies and environmental pollution, early-life exposure to tobacco smoke, as well as genetic predispositions.  Recent studies have also noted an association between diet/nutrition and allergies, noting that a diet high in fat and low in fresh fruits and vegetables correlate with asthma and allergies.

Fortunately, there are many ways to help manage allergic rhinitis and ease the burden and frustration that allergies may cause.  Treatments include many simple steps you can take at home, over-the-counter medications, prescription medications and sometimes help from a pediatric allergist.

Managing Allergies

Avoidance is the first step in allergy management.  This is far easier to do, in theory, with allergies to foods than with allergies to tree or grass pollens.  During the months when air borne allergens are most prevalent, keep windows closed and use air conditioners.  Be sure to keep filters clean and regularly changed. Encourage your children to wash hands and faces when coming in from outdoor play.  Spraying the nose with saline spray is a gentle and effective way of washing allergens from the nose.   If possible, have your child change clothes and deposit them in a laundry basket outside of your child’s sleeping space.  Have your child bathe or shower nightly, washing hair as well.  This will prevent spread of pollens to your child’s bedding.  Avoid allowing your child to play in freshly mowed grass, piles of leaves or dry grass.  If possible, avoid outdoor activities during days when the pollen count is high.  For more tips on controlling allergens inside and outside your home, click here.

Many patients will respond to simple environmental control measures.  However, many will still need medications for relief of symptoms.  The shelves at the pharmacy are crowded with medicines and it may be difficult to know where to start.  For specific guidance, please consult our providers for appropriate medications and dosages for your child.

Oral antihistamines are an excellent first line treatment.  These include over the counter medications such as certirizine (Zyrtec™), fexofenadine (Allegra™) and loratidine (Claritin™) .  These are available in liquid or dissolvable tablets, which most children find easy to take.  They are generally given in the morning, though they may be used at bedtime if they make your child sleepy.  These medicines are helpful to control itchiness and runny nose.  Avoid taking fexofenadine (Allegra™) with fruit juices, as this may make the medicine less effective. For itching and watery eyes, antihistamines are also available as an over the counter eye drop, ketotifen (Zaditor™) or olopatidine and azelastine, available by prescription.  Dry eyes are sometimes a side effect of these medicines.

The second medicines that may be considered for allergy symptom relief are intranasal corticosteroids.  These medicines are sprayed into the nose once or twice daily and help to alleviate the swelling and congestion as well as the itchiness and runny nose.   Commonly used medications include mometasone, beclomethasone, and ciclesonide and are available by prescription.  Fluticasone proprionate (Flonase™) is now available over the counter, as is triamcinolone (Nasacort AQ™).   Adding in or changing to these medications may be helpful if oral antihistamines aren’t providing relief after using them for 2 weeks.  Patients will sometimes complain of brief stinging in the nose or some taste of medicine once dosed.  These medicines typically help within a few hours, but may need a week or more to see full effect.   When administering these medicines, be sure to direct the spray away from the nasal septum to avoid nosebleeds.  A good trick is to think about putting the applicator in the nose and then ‘aiming it toward the ear’.

Of note, nasal decongestant sprays, which are available over the counter are NOT recommended.  These products such as phenylephrine or oxymetazoline (Afrin™) work in ways that may temporarily relieve congestion but shut down receptors in the nose after a few days resulting in increased “rebound” congestion and possibly dependency.

If these measures do not provide improvement in allergy symptoms, other prescription medicines may be needed.  Montelukast (Singulair™) is a medication of a class known as ‘mast cell stabilizers’.  These medicines may be combined with over-the-counter treatments or used alone.  They may also be useful in the management of asthma.  Occasionally, courses of oral steroids may be needed.   Sinusitis and ear infections are sometimes complications of allergic rhinitis, for which antibiotics may be prescribed.  Some allergies are very persistent and severe or may have complications such that they need to be treated by an allergy specialist with treatments such as immunotherapy (‘allergy shots’).

Hopefully, your family will now be better prepared to enjoy the spring and summer season without the aggravation of the runny noses and the sneezes.  Please call our office for more help or guidance in management of your child’s allergy symptoms.