Living with Springtime Allergies

24th Mar 2016

Springtime brings warm weather, flowers, and, for many children, seasonal allergies. Symptoms of seasonal allergies include itchy and runny nose, nasal congestion, and sneezing. In addition to these symptoms, children can have a chronic cough, bad breath, scratchy throat, fatigue, and decreased appetite.

Some of the most important steps in alleviating your child’s allergy symptoms begin with prevention.

Allergy Prevention

The first line of treatment is to minimize or eliminate exposure to the allergy causing substances, or allergens. In addition to pollens, other common allergens are molds, dust mites, cockroaches, and animals. To determine which allergens a child is allergic to, he may undergo skin or blood testing; however, a good history of symptoms can often identify the offending agents.

To minimize exposure to seasonal allergens, like pollen:

  • Try to stay inside on high pollen count days. Newspapers and weather reports often include pollen counts.
  • When the pollen count is high, close windows and use air conditioners when possible.
  • If your child has spent time outside on a high pollen day, give him a bath before bed to remove pollens from his skin.Here are some suggestions for decreasing household allergens:
  • Use a HEPA filter or electrostatic air purifier to help reduce pet dander and pollens.
  • Use a vacuum cleaner with a double filtration system to decrease dust and dust mites.
  • Keep the humidity less than 50 percent with an air conditioner and dehumidifier to decrease mold and dust mites.
  • Encase mattresses and pillows in allergen-proof covers and eliminate carpeting to help decrease dust-mite exposure.
  • Wash bedding in the hottest water possible every two weeks kills dust mites.

Springtime Allergies & Medical Treatments

About one in five children develops seasonal allergy symptoms by age 3. Here in New England, tree pollen begins affecting susceptible individuals in April. In May, grass pollen causes most of the symptoms. Late in the summer, weed pollen is the most common culprit. During any of these times, untreated nasal allergies can trigger a variety of other problems, like conjunctivitis (pink eye), sinus infections, asthma, eczema, ear infections, snoring, sleep disturbances, and reduced quality of life.

Children with a history of seasonal allergic rhinitis should start medication BEFORE their symptoms develop. That usually means starting medicines at the end of March or in early April for spring allergies. It is much easier to prevent allergy symptoms than to relieve them once they’ve appeared.

Nasal Sprays

Nasal Steroids, which are now available without a prescription, are the most effective medicines for allergic rhinitis. We recommend Fluticasone propionate (Flonase) or Mometasone furoate monohydrate (Nasonex), because very little is absorbed into the body, greatly reducing side effects. The dose is one to two sprays in each nostril once daily. They are highly effective, but take several days to start working. Nasal spray steroids treat almost all of the symptoms of allergic rhinitis. For maximum effect, these medicines must be used every day during allergy season.

Medicines Taken by Mouth

Antihistamines are the main class of medicines used for allergies and are the first choice of medicine for children under 4 years old. They are absorbed by the entire body and can have side effects like dry mouth, drowsiness, or hyperactivity. Oral antihistamines can provide quick relief, but many are sedating, causing drowsiness. Sedating antihistamines include benadryl and brompheniramine. Non-sedating antihistamines include Claritin, Allegra, and Zyrtec. These don’t always work as well as sedating antihistamines, but are preferred for daytime use when children need to go to school.

Diphenhydramine (Benadryl) Dose Table

 

Child’s Weight (pounds) 20-24 25-37 38-49 50-99 100+ lbs
Liquid 12.5 mg ¾​ 1 1 ½ 2 tsp
Liquid 12.5 mg/5 milliliters (mL) 4 5 7.5 10 mL
Chewable/Fastmelts 12.5 mg​​ 1 1 ½ 2 4 tablets
Tablets 25 mg ½​ ½ 1 2 tablets
Capsules 25 mg 1 2 Caps

Notes:

  • Age Limits: Avoid diphenhydramine under 6 years of age unless instructed by a healthcare provider. Non-sedating alternatives (eg, loratadine, cetirizine, fexofenadine) are available over-the-counter and are safer for young children.
  • Dosage: Determine by finding child’s weight in the top row of the dosage table
  • Measuring the Dosage: Syringes and droppers are more accurate than teaspoons. If possible, use the syringe or dropper that comes with the medication. If you use a teaspoon, it should be a measuring spoon. Regular spoons are not reliable. Also, remember that 1 level teaspoon equals 5 mL and that ½ a teaspoon equals 2.5 mL.
  • Frequency: Repeat every 6 hours as needed
  • Adult Dosage: 50 mg
  • Risk Of Side Effects: May cause drowsiness and paradoxical hyperactivity. Use caution when driving or operating heavy machinery after dosing due to potential for sedation and decreased alertness. This is especially relevant for teen drivers.

 

Non-Sedating Antihistamines:

Cetirizine (Zyrtec) Dose Table

 

Child’s AGE (years) 2-5 6-12 12+ years
Liquid 5 mg/ 5 mL 2.5 5 10 mL
Liquid 5 mg/ 1 teaspoon (tsp) ½ 1 2 tsp
Chewable 5 mg tablets 1 2 tablets
Tablets 10 mg 1 tablet

.

Notes:

  • Cetirizine is the most effective, but also the most sedating of the “non-sedating” antihistamines.
  • Age Limits: For 2 years of age and up. For colds, not advised at any age. Reason: no proven benefits.
  • Dosage. Find the child’s age in the top row of the dose table. Look below the correct age for the dose based on the product you have.
  • Measure the Dosage. Syringes and droppers are better to use than teaspoons. If possible, use the syringe or dropper that comes with the medicine. If not, you can get a med syringe at a drug store. If you use a teaspoon, it should be a measuring spoon. Reason: regular spoons are not reliable. Keep in mind 1 level teaspoon equals 5 mL and that ½ teaspoon equals 2.5 mL.
  • How Often. Give once a day in the morning.
  • Adult Dose. 10 mg

 

Loratadine (Claritin) Dosage Table

 

Child’s AGE (years) 2-5 6-12 12+ years
Liquid 5 mg/ 5 milliliters (mL) 2.5 5 10 mL
Liquid 5 mg/ 1 teaspoon (tsp) ½ 1 2 tsp
Chewable 5 mg tablets 1 2 tablets
Tablets 10 mg 1 tablet

 

Notes:

  • Loratidine is the least effective and least sedating of the “non-sedating” antihistamines.
  • Age Limits:  Age 2 years and up. Used for allergies. Does not help colds.
  • Dosag. Find the child’s age in the top row of the dose table. Look below the correct age for the dose based on the product you have.
  • Measure the Dosage. Syringes and droppers are better to use than teaspoons. If possible, use the syringe or dropper that comes with the medicine. If not, you can get a med syringe at a drug store. If you use a teaspoon, it should be a measuring spoon. Reason: regular spoons are not reliable. Keep in mind 1 level teaspoon equals 5 mL and that ½ teaspoon equals 2.5 mL.
  • How Often. Give once a day in the morning.
  • Adult Dose. 10 mg

 

Fexofenadine (Allegra) Dosage Table

 

Child’s AGE (years) 2-5 6-11 12+ years
Liquid 30 mg/ 5 milliliters (mL) 5 5 10 mL
Tablets 30 mg oral disintegrating 1 2 tablets

 

Notes:

  • Age Limits:  Age 2 years and up. Used for allergies. Does not help colds.
  • Dosage. Find the child’s age in the top row of the dose table. Look below the correct age for the dose based on the product you have.
  • Measure the Dosage. Syringes and droppers are better to use than teaspoons. If possible, use the syringe or dropper that comes with the medicine. If not, you can get a med syringe at a drug store. If you use a teaspoon, it should be a measuring spoon. Reason: regular spoons are not reliable. Keep in mind 1 level teaspoon equals 5 mL and that ½ teaspoon equals 2.5 mL.
  • How Often. Give twice a day.
  • Adult Dose. 60 mg twice a day
  • Do not give with fruit juice

 

Medicine for Eye Symptoms

Topical antihistamines relieve red, itching, burning and watery eyes caused by seasonal allergies. They are nonprescription.

Zaditor (Ketotifen) Eye drops

 

Child’s AGE (years) 2-5 6-11 12+ years
All ages 1-2 drops in each eye twice a day

 

Other Medications

Leukotriene inhibitors such as montelukast (Singulair) and omalizumab (Xolair), are prescription medicines that help with allergy symptoms and asthma symptoms. They are very expensive and are used primarily for patients with asthma.

 

Allergen Immunotherapy (also known as allergy shots) is generally reserved for patients who have failed all medications. It involves a series of weekly injections. As the dose of the shots gets stronger, the body develops tolerance to the allergens. Subsequently, patients undergoing this type of therapy require monthly maintenance shots for years. .

 

About Us

Welcome to Hyde Park Pediatrics, recognized by Massachusetts Health Quality Partners (MHQP) as one of the top pediatric practices in the region. Our entire team, from our doctors to our nurses to our care coordinators to our administrative staff, are highly accomplished and compassionate professionals who are firmly committed to our patients and their families.

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Hyde Park MA, 02136
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Milton, MA 02186
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Phone: 617-361-1470

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