How To Use Nose Sprays Correctly

Nasal sprays are the preferred treatment for allergies based on guidelines, but I hear many reasons why people don’t use them. Some simply think they don’t work well. Others have gotten nosebleeds. Some simply don’t like the bad taste they get from using them. If used incorrectly you’ll taste medicine or feel a drip down the back of your throat. Nose sprays won’t work as well if used incorrectly and they might even traumatize the nose, leading to nosebleeds – and that traumatizes some kids and many of their parents. Using them correctly can help alleviate symptoms of allergies and allow kids to enjoy the great outdoors!

Start by using the right nose spray – or sprays

There are many nose sprays out there, and you need to be sure you’re using the correct product for your needs.

First you’ll need to know that allergy symptoms are caused by histamines. In a person who is sensitive to pollen, dust mites, or animal dander, histamine is released in response to exposure. The histamine can cause swelling of the nose or eyes, watery eyes, runny nose, and itch. Allergy treatments either focus on limiting allergen exposure, preventing the histamine release, or blocking the histamine response.

All of the nose sprays used for allergy management (except saline) are listed on the American Academy of Allergy Asthma & Immunology ALLERGY & ASTHMA MEDICATION GUIDE.

Saline

Saline is great for the nose. I actually prefer saline washes over saline sprays, but the sprays are good too. See the 2nd video below for why I love saline washes.

Saline helps to remove the pollen from the nose to limit the exposure time. It also helps to shrink swollen nasal tissues, which makes it easier to breathe, and loosens mucus to help get it out.

Saline is just salt water, so if you want something natural, this is it!

Many parents ask how often to use saline sprays, and it really can be used whenever it’s needed. For prevention of allergies, use it after going outside and before bed during pollen seasons. If you’re using it because of a stuffy nose, you can use it several times a day.

Saline can be used even in babies. If you use saline spray or saline drops they can be followed with blowing the nose (or using an aspirator).

I love to use saline first followed by a good blow (or suction) to clear out the nose. After the nose is cleared, if that’s not sufficient to last the whole day, the other sprays are more effective. Saline doesn’t have medicine to last several hours, but can be used before medicated sprays to help them be more effective.

Mast Cell Inhibitor

Cromolyn sodium is a mast cell inhibitor that can be used for allergies. It prevents the release of histamine, which causes allergic symptoms.

Cromolyn sodium must be started 1-2 weeks before pollen season and continued daily to prevent seasonal allergy symptoms. It doesn’t work as well as corticosteroid nasal sprays, so I generally don’t recommend cromolyn.

These sprays can be used in children as young as 2 years of age.

The biggest drawback is that it is recommended every 4 hours, up to 4 times a day. This is really hard to keep up every day during allergy season.

Antihistamine

If you don’t want the dry mouth or sleepiness associated with an oral antihistamine, you can try a nose spray antihistamine. Both oral and nasal antihistamines block the histamine from causing the typical allergy symptoms.

Antihistamine nasal sprays are approved for use down to 5 years of age.

Corticosteroid sprays tend to work better in the long run, but antihistamines are effective more quickly, so are good for rapid relief.

Antihistamine nose sprays are only needed once or twice a day, but since most kids like oral medicines better than nose sprays and you shouldn’t duplicate with both, I generally recommend that antihistamines be given orally.

Decongestant

Decongestant sprays are popular because they work quickly, but I rarely recommend them. The most common time I use them is to help get things stuck in the nose out.

Oxymetazoline hydrochloride (Afrin, Dristan, Sinex) and phenylephrine hydrochloride (Neo-Synephrine) are some examples of nasal spray decongestants. They are available over the counter.

Decongestant sprays shrink swollen blood vessels and tissues in your nose that cause congestion.

They can be used temporarily in kids over 6 years old, but if you use them longer than 3 days they actually cause more congestion.

Steroid

Corticosteroid nasal sprays can be used in kids over 2 years of age and are the preferred treatment in allergy guidelines because they work well.

These can be used once or twice a day year-round or just as needed for allergy relief. It’s best to start them 2-3 weeks before allergy season starts because it does take time for them to be most effective. If you forget to use them until symptoms start, it may take several days to feel benefit.

Corticosteroid nasal sprays are available over the counter. There are many brands, including less expensive store brands. They have various steroid active ingredients, but all work pretty well.

I generally recommend the non-fluticasone brands for kids. This is not because of the effectiveness of fluticasone. It works. But it smells flowery and many kids will resist it due to the smell.

Nasal steroids are approved for use to help allergies, but they also decrease the amount of mucus from other causes, such as the common cold.

If you’re worried about the side effects of steroids, know that the risk is very low with nasal corticosteroids. The dose is extremely small and nasal corticosteroids are considered to be safe for prolonged use, even in kids.

Because they work so effectively and are well tolerated, nasal steroids are my preferred allergy medicine. They can be used with antihistamines if needed.

Anticholinergic

Ipratropium is the ingredient in anticholinergic nasal sprays. It helps to decrease a runny nose by stopping the production of mucus. One downside to ipratropium is that it doesn’t help congestion or sneezing very well.

Ipratropium nasal spray can be used over 5 years of age for up to 3 weeks at a time for runny noses from allergies and colds.

It is available by prescription only and I’ve never personally prescribed it. I personally think it has too many limitations and few benefits.

Allergen blocker

I have to admit that I’ve never even heard of this before, but I saw it on the American Academy of Allergy and Immunology site referenced above.

Alzair produces a protective gel-like barrier that evenly coats the nasal membranes and acts to block inhaled allergens within the nasal cavity. It’s available by prescription and looks like it’s approved for kids 8 and over.

One downside is that it needs to be used every time you blow your nose, so I don’t see it useful for school aged kids who have to go to the nurse for all treatments.

If anyone has used it, I’d love to hear your comments below about how it works!

Using nose sprays – it’s all about technique

Most people use nose sprays incorrectly, even if they pick the right one.

It’s not intuitive how to use them correctly. We tend to aim towards the center of the nose (which leads to nosebleeds) and inhale too much (which leads to icky drip down the throat).

Getting ready

Blow your nose. Or even better, rinse it with saline!

Take off the cap. You’d be surprised how many people skip this step.

Shake the bottle before each use. Think of Italian salad dressing. If you don’t shake it, you won’t get the good stuff.

You will need to be sure the tube inside the bottle has the liquid in it if it’s a new bottle or hasn’t been used in awhile. Much like when you get a new pump soap, you need to pump a few times to get results. Once you see the mist come out, you know the medicine’s ready to spray out.

Positioning

Be sure to keep the bottle fairly upright during the spraying. See the 1st video below for why this is important.

Many people tilt their head back when using nose sprays. Don’t. You’ll get more drip down your throat and less effective spray onto the nasal tissues.

Look slightly down.

Put the tip of the spray bottle into the nose and aim toward the back of the eye on the same side of the head. Don’t ever aim toward the center of the nose. This causes nosebleeds. Use the right hand to spray the left nostril and the left hand to spray the right nostril to help get the proper positioning.

Spraying

When the tip of the spray bottle is in your nose properly, squeeze the bottle.

Take the bottle out of your nose before releasing the squeeze. If it’s still in your nose, it will suck up whatever’s in there… including germs that can grow in the bottle.

Don’t feel like you need to inhale the stuff to your brain. The medicine works in the nose. Sniffing too much will make the medicine bypass your nasal tissue and go to the back of your throat. This misses the opportunity for the medicine to work where it’s supposed to work and it’s an icky feeling in the throat.

Sniff only enough after the spray to keep it from dripping out.

Finishing up

Wipe the top of the bottle clean before putting the lid back on.

Store the bottle out of reach of children and keep it out of the direct sunlight.

For more

I’ve always said that one day I’d make videos of how to use nose sprays and nose wash systems correctly. I know this post is about nose sprays, but if your nose is plugged with mucus, the sprays just won’t work.

Nasopure has a number of videos on how to use nose washes that I frequently recommend. I don’t get paid at all from Nasopure — I just love the bottle and their website resources. And they’re even made in Kansas City!

Until now I haven’t found a great video on how to use nose sprays. Thanks to Dr. Mark Helm, I’ve finally found a great video for how to use nasal sprays.

I’m off the hook for making videos!

I like this video from AbrahamThePharmacist. He gives great information with a fun style.

I’ve shared the video below many times because it shows just how well a good nose wash can work. I warn parents that most kids don’t love it as much as this girl does. It usually involves a lot of crying and fighting in my experience, but it is so worth it! I don’t know where she got the tip for the syringe, but I’d recommend the Nasopure bottle as shown above.

And finally, for those who think their child is too young to do a nose wash, check out this cutie! She’s in several of the Nasopure videos but she shows perfect technique here!

Spring is here and it brought the pollen! Control allergies and enjoy the outdoors.

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?

Learn to diagnose allergies, what to do when you have them and what you risk if you don't treat them.
Learn to diagnose allergies, what to do when you have them and what you risk if you don’t treat them.

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:  

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!

I am an Amazon Affiliate member, so if you buy from this Amazon link, I do get a small percentage.

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.

Medications

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

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.

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

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.

Montelukast

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

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

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.

Learn to diagnose allergies, what to do when you have them and what you risk if you don't treat them.
Learn to diagnose allergies, what to do when you have them and what you risk if you don’t treat them.



New Allergy Guidelines for People Over 12 Years Old

If you or your kids suffer from allergies, I’m sure you want to know how to best manage them. In addition to limiting exposure, medications can be a big benefit. Treatment of allergies can be directed by new guidelines. These guidelines cover the initial medical treatment of seasonal allergies in people 12 years and older.

The American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology (AAAAI and ACAAI) have published new guidelines in the Annals of Internal Medicine for the initial medical treatment of seasonal allergies in people 12 years and older.

The guidelines for treatment of allergies essentially state:
  • Use steroid nasal sprays first without an oral or nasal antihistamine. Many intranasal steroids are available over the counter without a prescription. A great list is included on the AAAAI website. (Be careful to not to confuse them with the nasal antihistamines, which are in the same chart but identified in the column titled “Class”.)
  • In those over 15 years, the nasal steroid is preferred over a leukotriene receptor antagonist (ie Singulair or montelukast). For those with asthma, the leukotriene receptor antagonist might offer an additional benefit for asthma, but it is not the preferred treatment in either allergies or asthma. (I think the age change is simply due to the ages studied but it was not specified.)
  • In moderate to severe allergic conditions, a combination of nasal steroid and nasal antihistamine can be considered.

These recommendations are based on a review of many studies to show what treatments worked and what didn’t.

They also took into consideration the fact that oral antihistamines can cause sedation and the nasal antihistamines do not.

In general the nasal steroids worked better than other treatments. They did note that for people who do not tolerate nasal sprays, alternates would be oral antihistamines or leukotriene receptor agonists.

UPDATE 3.27.18

I have a new blog on the general identification and treatment of allergies. Check out Spring is Here!

 

Itchy, sneezy, puffy… what can you do about allergies?

It’s allergy season! Prevention and treatment is important if you have seasonal allergies so you can enjoy the great outdoors. This is an update to a previous blog I wrote on the subject, since there are many more medicines now available over the counter.

Symptoms of Allergies: 

allergies

Allergies are more than just sneezing.

They can impair sleep (leading to all the problems associated with not enough sleep) and can lead to the annoying symptoms of itching, coughing, sneezing, runny nose, and watery eyes.

Some kids get a crease across their nose from wiping.

Others get purple circles under their eyes called allergic shiners.

These symptoms last longer than the typical cold, which usually resolves after 1-3 weeks. Fever is a sign of infection, not allergies. Other than fever, it is very difficult sometimes to decide if it is a virus or allergies until a seasonal pattern really develops. Even then it is possible to get colds during allergy season some years!

Treatments: 

It is best to treat before the symptoms get bad. It is easy to monitor pollen counts online to know what’s out there and start treatment before symptoms make you (or your child) miserable. Treatments include medicines and limiting exposure.

Medications:

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

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.

In general I prefer the 24 hour antihistamines simply because it is impossible to cover the full day with a medicine that only lasts 4-6 hours. 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 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 by me. Once control of the mucus is achieved, a decongestant isn’t needed.

If you need a decongestant initially, you can use one with your usual antihistamine. Most decongestants on the market 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. Decongestants can cause dizziness, heart flutters, dry mouth, and sleep problems, so use them sparingly and only in children over 4 years of age.

Nasal Spray steroid and antihistamine

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.

Eye drops

Eye drops can help alleviate eye symptoms. They are available both as over the counter allergy drops and 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.

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.

Montelukast

Montelukast (commonly known as Singulair) 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. It is available only by prescription, so make an appointment to discuss this if your child might benefit.

Steroids

Steroids decrease allergic inflammation well. These can 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). These require a prescription, so a visit to your provider is recommended to discuss proper use.

Limiting Exposure:  

The longer your airway is exposed to the allergen (pollen, grass, mold, etc) the more inflammation you will have.

Wash off pollen

Wash hair, eyelashes, and nose after exposures — especially before sleep. They all trap allergens and increase the time your body reacts to them.

I have found the information and videos on Nasopure.com very helpful to teach kids as young as 2 years to wash their noses.

keep pollen out of the house

Remove clothing and shoes that have pollen on them when entering the house to keep pollen off the couch, beds, and carpet.

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 this pdf from the Environmental Protection Agency: Aircleaners.

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!

Think about pets

Keep pets out of bedrooms. 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 is allergic to, consider allergy shots against this type of animal.

Contact lens wearers

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.

Smoke is an added irritant

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.

What if all of the above isn’t helping?

Maybe it’s really not allergies.

Allergies to things other than foods are rare before 2 years of age.

Viruses can cause very similar symptoms to allergies.

Allergy testing is possible by blood or skin prick testing, but can be costly. In most cases I don’t find it very helpful for environmental allergens because you can’t avoid them entirely and you can always limit exposures as above. I think that 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. Note also animal exposures and household conditions. 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. Allergies tend to worsen as kids get older. Switching types of medication or adding another type of medicine might help. If you need help deciding which medicine(s) are best for your child, an office visit for an exam and discussion of symptoms is advised.

Some kids outgrow a dose and simply need a higher dose of medicine as they grow.

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.