Allergies ("Hay Fever")

Hilliard Pediatrics, Inc. - Dr. Tim Teller, MD


Introduction


Allergies are a common health problem. At least 1 out of 5 people have allergic rhinitis sometime in their life. Allergies run in families (are genetic) and often occur in children with asthma, eczema, and food allergies. Allergies take some time to develop. Although you might be “born to have allergies” because of a history of them in your family, they often take 2 years or more to develop. For the rest of this information sheet, when I say “allergies” I am referring to what is technically called allergic rhinitis and allergic conjunctivitis. See below.


Symptoms of Allergies


Allergies cause a number of different symptoms. Allergies never directly cause a fever. Not everyone with allergies have the same symptoms, but there a number of common signs to look for:

  • Runny nose
  • Itchy nose
  • Congested nose
  • Clear nasal mucous
  • Itchy eyes
  • Watery eyes

Common Allergy Seasons


Some allergies have a regular season, based on when the plant is releasing pollen into the air. These dates are based on Central Ohio seasons. Specific pollen counts are available at the AAAAI website: http://pollen.aaaai.org/nab/index.cfm?p=allergenreport&stationid=21

Ragweed: From early to mid-August until late October (it takes 2 good over-night frosts to stop the ragweed from pollinating).

Trees: From March thru May. Remember that the fluffy stuff you see floating down from the trees is not the pollen itself, even if that is when the pollen is being released by the trees. Grasses: From April thru early July.

Dust mites: From Fall until Spring, when we have our homes closed up and we are running the furnace. Dust mites live on fabrics such as clothes, bedding, carpets, and furniture.

Molds: There are two categories of molds that cause allergic reactions. One type is worse when it is damp and will worsen when it rains or moisture is trapped under fallen leaves (in the Fall). This type of mold is what often is in damp basements. Another type of mold likes dry conditions and can act up even when it has not rained recently. Molds often cause symptoms around Christmas time from live trees that are brought into the house. 


Allergies that Do Not Have a Season


Pets: Exposures to pets happen at all times of the year. We expect the symptoms to be whenever someone is around the pet. Although any pet with fur (hair) can cause an allergy, cats are the most likely to cause allergies, followed by dogs. The hair, skin, and saliva cause the symptoms. A cat that sleeps on your bed or favorite chair will leave behind enough hair and dander that you will have allergy symptoms even when the pet is now somewhere else in the house.

Dust mites and Molds: If they are in your house and you are sensitive enough to them, you may have allergy symptoms to dust mites and molds year round. They will be expected to be worse when the house is closed up when the air conditioner or furnace is running.


Treatment for Allergies


The most effective treatment for allergies is avoiding the thing your child that causes your child’s allergies. In real life, this is not very practical. Your child wants to play outside, go to grandma’s house where the cat causes them to sneeze, and roll in the fallen leaves.

The second most effective treatment is immunotherapy, also called allergy shots. Allergy shots work by desensitizing you to those things that cause your allergy symptoms. You are given shots on a regular schedule (usually weekly to start and then spaced out to 2-4 weeks) of tiny amounts of the proteins that trigger your allergies. Over time, you become less and less allergic. Depending on your symptoms, sometimes the shots are given for a few years and sometimes much longer.

The most common treatment for allergies is medication. They can help many children and adults with allergies, but they do not “cure” the allergies. Some of the medications are available over-the-counter without a prescription, while some of them require a doctor’s prescription. The medications that help with sneezing, itchy eyes or nose, and runny nose are antihistamines. These include Benadryl® (diphenhydramine), Claritin® (loratadine), Zyrtec® (cetirizine), and Allegra® (fexofenadine). For the stuffy nose and congestion, many children will try decongestants, such as pseudoephedrine and phenylephrine. There is a prescription strength medicine that can help for chronic congestion called Singulair® (montelukast). For eye itching that does not respond to antihistamines by mouth, we recommend allergy eye drops. These include Zaditor® (ketotifen) and Patanol® and Pataday® (olopatadine). For nasal allergy symptoms (runny nose, congestion, sneezing, itchy nose) that do not improve with the above medicines, we recommend a nasal steroid spray. These include Rhinocort® Aqua (budesonide), Flonase® (fluticasone), Nasacort Allergy 24-Hour® (triamcinolone), and Nasonex® (mometasone). These steroid sprays are only available by prescription, except Nasacort which went over-the-counter in 2014.


Specific Ideas for Avoiding Your Child's Allergies


Grass: During the grass pollen season, playing in the fresh-cut grass will cause the most symptoms. If after playing outside in the grass, someone’s symptoms are bad, try having them take a shower and changing clothes to get the pollen off their hair, skin, and clothes.

Molds: Bringing live plants and trees from outside to inside your home will dramatically raise the mold count in your home. Changing from a live to an artificial Christmas tree will help. Also, avoid raking leaves when the leaves have gotten damp (it is better to wait when they are dry). The dampness makes the mold count greatly increase.

Dust mites: Dust mites live on carpets, rugs, bed clothes, clothing, couches, and chairs that have a fabric covering. They are often worst when the house is closed up and the furnace circulates them through the house. Since the bedroom can be a likely place to get exposed to dust mites, placing dust mite covers on the mattress and bed pillows can be very helpful. Wash the sheets and blankets at least once a week in warm to hot water to remove the dust mites. Remove carpets from living areas and clean rugs and carpets frequently to remove dust mites. An air filter (“HEPA filter”) also can help remove the dust mites.

Pets with fur: If you have a cat or dog that causes your child’s symptoms, do not let the pet in their bedroom (especially their bed), try to avoid having the pet lick your child, vacuum frequently to remove the pet hair, and consider having your dog live outside rather than inside.

Ragweed, other weeds, and trees: keeping the windows closed and running the air conditioner helps decrease how much of the air-borne pollen your child will be exposed to.  


What to Do for Your Child's Allergy Symptoms


If you see seasonal and year-round allergy symptoms and your child is at least 2 years of age: try one of the over-the-counter antihistamines. These medicines can safely be given every day or as needed.

If your child’s symptoms do not improve with the over-the-counter medications, contact our office during regular office hours. Your child may benefit from an appointment to discuss other options.

When it is time to see an allergist for allergic rhinitis:

  1. If even prescription medications do not help your child’s allergy symptoms.
  2. If the allergies now cause your child to wheeze.
  3. If you want to know if your child is allergic to a pet (especially if you plan on getting rid of one).

If your child’s allergies improve with the medication and they need the medicine during certain seasons, just keep using the medication as needed. If it seems to stop working, we can discuss other possibilities. 

Medication Dosing:
  • Claritin® Syrup 2-5 years of age: 5 ml. once a day. 6 years of age and above: 10 ml. once a day.
  • Claritin® Reditabs 24-Hour 6 years of age and above: 1 dissolvable tablet once a day.
  • Claritin® Reditabs 12-Hour 6 years of age and above: 1 dissolvable tablet twice a day.
  • Claritin® Children’s Chewables 5 mg 2-5 years of age: 1 once a day. 6 years of age and above: 2 chewables once a day.
  • Claritin® 10mg Tablets 6 years of age and above: 1 tablet once a day.
  • Zyrtec® 10mg Tablets 6 years of age and above: 1 tablet once a day.
  • Zyrtec® 5mg Chewable Tablets 2-5 years of age: 1 tablet once a day.
  • Zyrtec® 10mg Chewable Tablets 6 years of age and above: 1 tablet once a day.
  • Zyrtec® Children’s Allergy Syrup 2-5 years of age: 2.5 ml. once a day. 6 years of age and above: 5 ml. once a day.
  • Benadryl® Children’s Allergy Liquid 25-49 pounds: 5 ml.; 50-74 pounds: 7.5 ml.; and more than 74 pounds: 10 ml. by mouth every 6 hours.
  • Allegra® Oral Suspension 2-11 years old: 5 ml. twice a day.
  • Allegra® ODT Orally Disintegrating Tabs 6-11 years old: 1 tablet twice a day. It dissolves on the tongue.
  • Allegra® 60mg Tablets 12 years of age and above: 1 tablet twice a day.
  • Allegra® 180mg Tablets 12 years of age and above: 1 tablet once a day.
  • Zaditor® Ophthalmic Solution 3 years of age and above: 1drop twice a day, every 8-12 hours.
  • Patanol® Ophthalmic Solution 3 years of age and above: 1 drop twice a day, every 8-12 hours.
  • Pataday® Ophthalmic Solution 3 years of age and above: 1 drop once a day, every 24 hours.
  • Nasacort® Allergy 24-Hour 12 years of age and above: 1-2 sprays per nostril once a day. 

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