Luke Voytas is a pediatrician and author in Portland, Oregon. His posts combine research and common sense to help parents be calm and confident in raising their kids.

Pummeled by Pollen

Pummeled by Pollen

Figuring out when your kid has seasonal allergies can be tough – kids get a lot of colds and the virus season overlaps pretty heavily with the allergy season. But by mid-May it starts to become obvious. Your kid’s been oozy for weeks but without any fevers, sore throats, or feeling crummy. His nose and eyes are more watery than snotty, he sniffs a lot, and all these symptoms are magnified when he’s been running around outside.

This is hay fever, or seasonal allergies due to pollens and grasses, and it’s probably your fault (it’s super hereditary). It’s really rare before age two, but can appear at any age after that. While allergies aren’t usually as intense as an illness, they can simmer for months and take a toll on kids’ sleep, energy, and even school performance. Fortunately we can do plenty to control allergies. Here are some treatments to consider for your child:

1. Non-medicine stuff – for me, avoidance isn’t an option. Your kid needs to be outside running around even if he does have allergies. But when he comes in, you can quickly wipe his face with a wet cloth and have him wash his hands to physically get the pollen off his body. Saline nasal spray (or a Neti-pot if he’s old enough) and a shower make a great bedtime routine to clear his nose and eyes.

2. Cetirizine (Zyrtec) or Loratadine (Claritin) – this is where medical treatment starts for most kids. These are long-acting antihistamines that make your kid less watery and itchy for most of the day when taken in the morning. They come in syrups and chewables and dosing is easy – it’s 5 mg from age two until six, and then 10 mg from age six on (the adult dose).

3. Nasal Steroids (Flonse, Nasonex, etc.) – this is the big gun, and it works AMAZINGLY when used the right way. You should think about a nasal steroid when your kid still has significant congestion, drainage at night, or cough despite cetirizine or loratadine. For kids with bad allergies, the lining of their nose and sinuses is inflamed and oozes fluid. These medicines shrink that tissue to stop the oozing. A large review of 300 articles found nasal steroids to be very effective at treating symptoms of allergic rhinitis. (1) Another study from Japan looking at kids between the ages of two and fifteen years old found that one nasal spray of fluticasone (name brand Flonase) daily significantly helped nasal and eye allergy symptoms. (2) They also found that most of the kids had no measurable amount of the steroid in their blood – a common concern for parents.

            Nasal steroids are safe down to age two and are now over-the-counter. Start with one spray to each nostril (preferably at night so the spray can “settle in”) daily, and increase to twice a day after a few weeks if your child is still struggling. Your kid won’t like it at first, but he’ll get used to it. One very important note is that nasal steroids take about a week to really start working, and you then have to give them every day to maintain the effect. They are not “as needed” medicines.

4. Eye Drops – kids seem to have less allergy eye symptoms than adults, but redness and eyelid swelling can be dramatic when they occur. Ketotifen fumarate (super fun to say, name-brand Zaditor) drops are a great over-the-counter option for use as needed. They are safe for ages three and up and can last for 12 hours.

Does your kid need allergy testing? Not usually. If he’s allergic to “springtime stuff” and does better with treatment, I don’t think it’s particularly helpful to pin down specific pollens and grasses. I think there are three situations in which testing can be helpful:

1. Your kid has asthma – the stakes are higher with these kids since allergies can be a trigger.

2. Your kid seems to get allergies at other times of the year – it can really be helpful to discover that your child has a dust, mold, cat, or dog allergy, because we can do a lot to avoid these.

3. You’re struggling to control symptoms even though you’re maxed out on over-the-counter meds.

Testing can be done with an allergist (skin-pricks) or sometimes through a blood test that your pediatrician can order.

1. Mometasone furoate nasal spray: a systematic review. Passali D et al. Multidiscip Respir Med. 2016 May 2;11:18. doi: 10.1186/s40248-016-0054-3. eCollection 2016.

2. Safety and efficacy of fluticasone furoate nasal spray in Japanese children 2 to <15 years of age with perennial allergic rhinitis: a multicentre, open-label trial. Okubo K et al. Allergology International. 2015 Jan;64(1):60-5. doi: 10.1016/j.alit.2014.07.002. Epub 2014 Nov 26.

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