Spring is a beautiful time of year. The flowers bloom, the birds chirp… it’s like we’re all awakening after a long, cold winter. But with the flowers (and birds) comes pollen. And with pollen comes allergies. I don’t want anyone to be afraid to enjoy the beautiful outdoors, so learn to control allergies.
Why treat allergies?
I often hear parents say that they don’t want to give their kids medicine to treat allergies because, well, it’s medicine. They prefer to be natural and the symptoms don’t seem “that bad”.
Before you decide if the symptoms require treatment or not, be sure to recognize all the potential consequences of allergies. It’s not just a runny nose and sneezing.
Allergies can impair sleep (leading to all the problems associated with not enough sleep) in addition to the annoying symptoms of itching, coughing, sneezing, runny nose, and watery eyes.
Some kids get a crease across their nose from wiping – AKA the “allergic salute”.
Others get purple circles under their eyes called allergic shiners.
For people with asthma, allergies are a known trigger. It’s especially important that people with wheezing tendencies keep up on allergy prevention and treatments.
Some will chronically mouth breathe, which can affect the growth and development of their jaw, lead to bad breath, and increase the risk of cavities. Dr. Deborah Burton, an ear, nose, and throat specialist, discusses these and other consequences of mouth breathing in one of her DrMommaSays blogs.
How do you know it’s allergies?
Allergies can cause runny nose, headache, congestion, sneezing, watery eyes, itching eyes, sore throat, itchy throat, and itchy skin. Not all symptoms need to be present.
An upper respiratory tract infection (AKA common cold) can also cause a runny nose, headache, congestion, sneezing, watery eyes, and sore throat. The difference is the cold symptoms tend to not last as long as allergies. There also could be a fever, body aches, and a general feeling of “not well” with viral infections.
Seasonal allergies tend to follow a seasonal pattern, so they can be easier to recognize than allergies to indoor allergens.
These days it’s easy to track pollen counts online. If you realize that every day the counts for one type of tree or grass is elevated you have symptoms, that’s strong support that you’re allergic to that plant.
Of course, it’s possible to get a cold on top of your allergies, which adds to the confusion sometimes.
Treatments to control allergies
It is best to treat before the symptoms get bad. Treatments include not only medicines, but also limiting exposure.
Use what you can to prevent and treat allergies, which most often means using more than one of the following treatments.
Limiting exposure can help decrease symptoms.
Avoid Bringing allergens into the Home
Remove clothing and shoes that have pollen on them when entering the house to keep pollen off the couch, beds, and carpet.
Keep the windows closed. Sorry to those who love the “fresh air” in the house. For those who suffer from allergies, this is just too much exposure!
Beloved pets cause unique issues
If someone’s allergic to animals or suffers from year long symptoms, learn if your family pet is a problem.
When you have pets that go outdoors and then into the home, bathe them regularly.
Don’t let pets on the couch or beds and keep them out of the bedrooms of allergic sufferers.
If you know a family member is allergic to an animal, don’t get a new pet of this type!
If you already have a loved pet someone in the home, consider allergy shots against this type of animal. Talk to your pediatrician and consider a trip to an allergist.
Wash and clean
Wash towels and sheets weekly in hot water.
Vacuum and dust weekly. Consider cleaning home vents. Consider hard flooring in bedrooms instead of carpeting.
Wash stuffed animals and other toys regularly and discourage allergic children from sleeping with them.
There are many types of air filters that have varying benefits and costs. For information on air filters see the Environmental Protection Agency’s interactive page on indoor air quality.
Smoke is a “no”
Keep smoke away. Smoke is an airway irritant and can exacerbate allergy symptoms.
Remember that the smoke dust remaining on hair, clothing, upholstery, and other surfaces can cause problems too, so kids can be affected even if you don’t smoke near them.
And for those of you who vape, it’s not better. We’re still learning the risks of e-cigarettes because vaping is relatively new, but early data supports staying away from e-cigs!
Wash it off of you!
Wash hair, eyelashes, and nose after exposures — especially before sleep. They all trap allergens and increase the time your body reacts to them.
Learning to rinse your nose
I have found the information and videos in Nasopure.com‘s library to be very helpful. You can teach kids as young as 2 years to wash their noses. Note: I have no financial ties to Nasopure… I just love the product and website!
If you wear contacts
If itchy eyes are a problem for contact lens wearers, a break from the contacts may help. Talk with your eye doctor if eye symptoms cause problems with your contacts.
I don’t want kids with outdoor allergies to be afraid to go outside, so taking medicines to keep the symptoms at bay while out can help.
Antihistamines work to block histamine in the body. Histamine causes the symptoms of allergies, so an antihistamine can help stop the symptoms.
Some people respond well to one antihistamine but not others, so sometimes you must use trial and error to find the right one.
In general I prefer the 12-24 hour antihistamines simply because it’s very difficult to cover well with a medicine that only lasts 4-6 hours, such as diphenhydramine (Benadryl) and they’re less sedating. Long acting antihistamines include loratadine -Claritin (24 hour), fexofenadine- Allegra (12 hour for kids, 24 hour for teens and adults), and cetirizine- Zyrtec (24 hour).
Different antihistamines work better for some than others. Personally loratadine does nothing for me, fexofenadine is okay, but cetirizine is best. I have seen many patients with opposite benefits. You will have to do a trial period of a medicine to see which works best.
If they make your child sleepy, giving antihistamines at bedtime instead of the morning might help.
Prescription antihistamines are available, but usually an over the counter type works just as well and is less expensive. Insurance companies rarely cover the cost of antihistamines these days.
Antihistamine and decongestant combinations
Antihistamine and decongestant combinations are available but are not usually recommended. Decongestants can cause dizziness, heart flutters, dry mouth, and sleep problems, so use them sparingly and only in children over 4 years of age.
Once control of the mucus is achieved, a decongestant isn’t needed. Giving a medicine that isn’t needed just increases the risk without increasing the benefit.
If you need a decongestant initially, you can use one with your usual antihistamine.
Most decongestants on the shelves are ineffective. If you ask the pharmacist for pseudoephedrine, it is available behind the counter. It was replaced by phenylephrine years ago due to concerns of methamphetamine production, but works a little better than phenylephrine.
Decongestants do NOT fix a cold, they only dry up some of the mucus.
Nasal spray steroids and antihistamines
Nasal spray steroids and antihistamines are available over the counter or as a prescription. An office visit to discuss the value of these for your child and proper use is recommended.
Nasal steroids are often the preferred treatment based on effectiveness and tolerability.
See How to Use Nose Sprays Correctly – many people use them improperly and complain they either cause problems or don’t work. Proper use solves many problems.
If your child resists nose sprays
You can help your kids get used to nasal sprays with saline sprays. Saline is simply salt water, so it is okay to let your kids practice with these without risking any overdose of medication.
Eye drops can help alleviate eye symptoms.
They are available both as over the counter allergy drops and as prescription allergy eye drops. If over the counter drops fail, make an appointment to discuss if a prescription might help better. Most insurance companies don’t cover prescription allergy eye drops well, so you might want to check your formulary before asking for a prescription. This is usually available on your insurance website after you log in.
If your child resists eye drops
Tips to administer eye drops include washing hands before using eye drops, put the drop on the corner of the closed eye (nose side) and then have the child open his eyes to allow the drop to enter the eye.
Singulair (Montelukast) works to stop histamine from being released into the body.
It helps control both allergies and asthma and is best taken in the evening.
Once a person has been on montelukast for a couple of weeks, they usually don’t need an antihistamine any longer.
Montelukast is available only by prescription, so make an appointment to discuss this if your child might benefit.
Steroids decrease allergic inflammation well. These include both oral steroids for severe reactions (such as poison ivy on the face or an asthma attack) and inhaled corticosteroids for the nose (or lungs in asthma).
The nasal steroids are discussed above and are highly recommended for kids and adults who tolerate putting a spray in their nose.
Other steroids require a prescription, so a visit to your provider is recommended to discuss proper use.
What if all of the above isn’t helping to control allergies?
Maybe it’s really not allergies.
There are many things that can seem to be allergies but aren’t. If proper treatment is not working, reconsider the diagnosis.
It’s possible that the allergy treatment is working, but you caught a cold on top of the allergies. Both are common, so they can occur together.
Allergies to things other than foods are rare before 2 years of age. If you’re treating allergies in an infant or toddler, be sure to keep your pediatrician in the loop.
I’ve known people who are treated for years by an allergist for allergies, but when they’re tested due to a poor response, they have no allergies. They might have frequent infections or other irritants like smoke exposure. Learn to control these issues too, starting with good hand washing, avoid touching your face, and avoiding smoke.
Allergy testing is possible by blood or skin prick testing, but can be costly. Not to mention the fact that kids tend to not like needles, which are used with most testing.
Allergy testing isn’t recommended for most allergy sufferers. It can be used to guide allergy immunotherapy, which involves routine allergy shots. Most suffers don’t need allergy shots, but if you think your child would benefit (and allow them), talk to your doctor.
In most cases I don’t find test results very helpful for environmental allergens because you can’t avoid them entirely. You can limit exposures as discussed above, regardless of test results.
Tracking patterns and symptoms to identify allergies
By tracking seasonal patterns over a few years can identify many of the allergens. You can still treat as needed during this time. Reports of pollen and mold counts are found on Pollen.com.
Rather than testing, note animal exposures and household conditions and any symptoms seen with exposures.
Write symptoms and exposures weekly (or daily). It often doesn’t take long to see patterns. Testing is important if allergy shots are being considered.
Need help tracking allergy symptoms? There’s an app for that! Here’s one review I found of allergy apps. I don’t have any personal experience of any, so please put your favorite in the comments below to help others!
Wrong medicine or wrong dose.
Some people have more severe allergies and need more than one treatment. I personally use eye drops, nasal spray, and an oral antihistamine in addition to nasal washes and daily (sometimes twice daily) showers when my allergies flare.
Switching types of medication or adding another type of medicine might help. If you need help deciding which medicines are best for your child, schedule an office visit with your PCP for an exam and discussion of symptoms.
Some kids outgrow a dose and simply need a higher dose of medicine as they grow. Talk to your pharmacist or physician to decide if a higher dose is indicated.
Is Nothing working?
Consider allergy shots (immunotherapy) to desensitize against allergens if symptoms persist despite your best efforts as above.
Schedule an appointment with your pediatrician to discuss if this is an option for your allergy sufferer.