Hay Fever (Nasal Allergies)

Pediatric HouseCalls Online

DEFINITION 

• An allergic reaction of the nose
• An itchy nose and clear discharge is common

Symptoms

• Clear nasal discharge with sneezing, sniffing, and nasal itching.
• Eye allergies (itchy, red, watery and puffy) are commonly associated.
• Ear and sinus congestion may also be associated.
• A tickling, scratchy sensation in the back of the throat can be associated.
• Itchy ear canals, itchy skin, and hoarse voice are also seen.
• Symptoms occur during pollen season.
• Similar symptoms during the same month of the previous year.
• No fever.

Causes

• Hay fever is an allergic reaction of the nose and sinuses to an inhaled substance, usually a pollen.
• Grass, tree and ragweed are the most common pollens
• Allergens from cats, dogs, horses, rabbits and other animals

See More Appropriate Topic (instead of this one) If

• Doesn't look like hay fever, see COLDS.

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WHEN TO CALL YOUR DOCTOR

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

• You think your child needs to be seen.
• Lots of coughing.
• Sinus pain (around cheekbone or eyes) and not relieved by antihistamines

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns.
• Hay fever symptoms interfere with school or normal activities after taking antihistamines for 2 days.
• Diagnosis of hay fever has never been confirmed by your doctor.
• Year-round symptoms of nasal allergies.

Parent Care at Home If

• Hay fever and you don't think your child needs to be seen.

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HOME CARE ADVICE FOR HAY FEVER

1. Reassurance:

   • Hay fever is very common, occurring in 15% of children.
   • Nose and eye symptoms can be brought under control by giving antihistamines.
   • Because pollens are in the air every day during pollen season, antihistamines must be given daily for 2 months or longer.
2. Antihistamines:  
   • Give antihistamines continuously during pollen season (continuously is the key to control).
   • Chlorpheniramine (e.g., chlortrimeton) products are effective and don't need a prescription. Any antihistamine you have will do, but some may cause more drowsiness.
   • See dosage charts for chlorpheniramine or benadryl.
   • The bedtime dosage is especially important for healing the lining of the nose. (Benadryl is a good choice for bedtime)
   • Benadryl: If the runny nose and itchy eyes are out of control and your child is taking long-acting antihistamines, it's safe to give an occasional dose of Benadryl (see dosage table) to stabilize your child.
3. Loratadine (Claritin) or Cetrizine (Zyrtec):
   • Loratadine became OTC in 2003 and Cetirizine become OTC in 2008.
   • Advantage: causes less sedation than older antihistamines (Benadryl and chlorpheniramine) AND is long-acting ( lasts up to 24 hours).
   • Dosage: For 6-12 year old, give 5 mg chewable tablet once daily in morning
   • For over 12 years old, give 10 mg tablet once daily in morning
   • Indication: Age 6 (FDA approved) AND drowsiness from older antihistamines interferes with function
   • Limitation: doesn't control hay fever symptoms as well as older antihistamines. Also, occasionally will have breakthrough symptoms before 24 hours.
   • Cost: ask pharmacist for store brand (Reason: costs less than Claritin or Zyrtec brand)
4. Nasal Washes:
   • Use warm water (or saline) nosedrops to wash pollen or other allergic substances out of the nose.
   • Instill 2 or 3 drops in each nostril followed by blowing the nose. Repeat until open.
   • Teens can just splash warm water in the nose and then blow.
   • To make saline nosedrops: 1/2 teaspoon salt to 1 cup (8 oz) of warm water.
   • Do nasal washes at least 4 times/day or whenever your child's nose is blocked is blocked or itch.
5. Eye Allergies:  
   • For eye symptoms, wash the pollen or other allergic substance off the face and eyelids.
   • Then apply cold compresses.
   • Antihistamine-vasoconstrictor eye drops (no prescription needed) are sometimes needed, but oral antihistamines usually control eye symptoms.
   • Dosage: 1 drop every 8 hours as necessary.
   • Ask your pharmacist to recommend a brand. (e.g. Naphcon A, Opcon A, Visine A)
6. Wash Pollen Off Body:
   • Remove pollen from the hair and skin with hair washing and a shower, especially before bedtime.
7. Expected Course: Since pollen allergies recur each year, learn to control the symptoms.
8. Pollen Avoidance:
   • Pollen is carried in the air
   • Keep windows closed in the home, at least in child's bedroom
   • Keep windows closed in car, turn AC on recirculate
   • Avoid window fans or attic fans
   • Try to stay indoors on windy days (Reason: the pollen count is much higher when it's dry and windy)
   • Avoid playing with outdoor dog (Reason: pollen collects in the fur)
9. Call Your Doctor If:
   • Symptoms aren't controlled in 2 days with continuous antihistamines
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 6/18/2008

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.