Allergic Rhinitis

Allergic Rhinitis, which is sometimes also called Hay Fever, is the most common chronic childhood disease/condition. 

Allergic rhinitis can be seasonal or all year round (Perennial), depending on the allergic trigger, but typically is most prominent in early Spring and when high levels of pollen from ragweed, grass, weeds, and trees are present.  

Perennial allergy symptoms are most often associated with indoor allergies such as pet dander (cats and dogs) and dust mites. 

Symptoms most often associated with allergic rhinitis include: 

• • Red, teary, or itchy eyes 
  • Puffiness or even dark circles around eyes 
  • Sneezing 
  • Runny nose and nasal swelling/congestion 
  • Itchy nose including frequent nose rubbing. 
  • Itchy ear canals, mouth, or throat 
  • Sometimes dry cough 

These symptoms can sometimes seem similar to viral upper respiratory infections or conjunctivitis from bacteria (Pink Eye) but there are some important differences that you can spot at home, or your pediatrician can spot when evaluating your child. 

Viral URI –  

• • Cough is more common and often more productive or “wet” sounding. 
  • Itching of eyes, nose, ears, mouth and throat are not usually seen with viral infections. 
  • Fever is often present with viral infections but NOT with allergic rhinitis. 

Pink eye (bacterial conjunctivitis) 

• • Most often there is purulent thick discharge and/or crusting, while allergies cause clear tearing and often more eye redness. 

Primary treatment –  

Fortunately, we have many safe and effective treatment options for children with allergic rhinitis.  However, when there are so many different treatments available it can sometimes be difficult to know what to choose.  Pediatricians typically recommend starting treatment with a long acting (24hr, once daily dosing) non-sedating antihistamine such as Cetirizine (Zyrtec) or Loratadine (Claritin).  These medicines differ from short acting more sedating antihistamines such as Benadryl (Diphenhydramine) which are not recommended as a primary treatment method for children with allergic rhinitis.  

In addition, depending on the age of your child, severity of symptoms and/or response to the above medications your pediatrician may also recommend: 

• • intranasal corticosteroid spray such as Fluticasone (Flonase) or Mometasone (Nasonex) 
  • antihistamine eye drops  

Medications that should NOT being used for treatment of allergic rhinitis only in children, without consulting with a doctor, as they may be ineffective, potentially harmful, or both 

• • Nasal decongestant oral medications or sprays 
  • Montelukast (Singular) – (although it may be recommended in patients with allergic asthma) 
  • Diphenhydramine (Benadryl) 
  • Combination cough/cold or allergy medications with more than 1 ingredient. 

General allergy avoidance/prevention techniques may decrease allergy symptoms, although identifying specific allergy triggers and avoidance is more beneficial.  Some techniques include. 

• • Changing clothing and bathing or showering after playing outside  
  • Vacuum regularly and use anti-dust mite covers for pillows/bedding. 
  • Avoid leaving open windows, especially in bedrooms where children sleep during peak allergy season or high pollen counts. 
  • Keep pets out of children’s rooms and, especially their bed, whenever possible. 
  • HEPA-filtration systems can decrease allergen particle burden in the air when used properly. 

If your child does not improve with treatment or if they also have symptoms consistent with other common allergy triggered conditions, such as eczema or asthma, your pediatrician may recommend allergy testing or evaluation by an Allergy Specialist to further guide allergy treatment and avoidance.