Hay Fever (Nasal Allergies)

Definition

• An allergic reaction of the nose (allergic rhinitis)
• 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

When to Call Your Doctor for Hay Fever (Nasal Allergies)

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

• You think your child needs to be seen
• Lots of coughing
• Sinus pain around cheekbone or eyes (not just congestion) 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

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:
   • Antihistamines are the drug of choice for nasal allergies.
   • Antihistamines will reduce the runny nose, nasal itching and sneezing
   • Benadryl or Chlorpheniramine (e.g., chlortrimeton) products are effective and over-the-counter (OTC). They need to be given every 6 to 8 hours (see dosage table)
   • The bedtime dosage is especially important for healing the lining of the nose.
   • The key to hay fever control is to give antihistamines every day during pollen season.
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: 10 mg tablet once daily in morning (10 mg for weight greater than 66 pounds)
   • Indication: wt. 66 pounds 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 and dosing based by weight (Reason: costs less than Claritin or Zyrtec brand)
4. Nasal Washes to Wash Out Pollen:
   • Use saline nose drops or spray to wash out pollen or to loosen up dried mucus. If not available, can use warm tap water. Teens can just splash warm tap water in the nose and then blow.
   • STEP 1: Instill 3 drops per nostril.
   • STEP 2: Blow each nostril separately while closing off the other nostril. Then do other side.
   • STEP 3: Repeat nose drops and blowing until the discharge is clear.
   • Frequency: Do nasal washes whenever your child can't breathe through the nose or it's very itchy.
   • Saline nasal sprays can be purchased OTC
   • Saline nose drops can also be made: add 1/2 tsp (2.5ml) of table salt to 1 cup (8 oz or 240ml) of warm water
   • Another option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
5. Eye Allergies:
   • For eye symptoms, wash the pollen or other allergic substance off the face and eyelids.
   • Then apply cold compresses.
   • Usually an oral antihistamine will adequately control the eye allergy symptoms, but sometimes eyedrops are also needed.
   • Antihistamine Eyedrops -- Ketotifen (not part of CCN care advice) (1st choice):
   • Ketotifen eyedrops (OTC) are a safe and effective product (e.g., Zaditor or Alaway)
   • Dosage: 1 drop every 12 hours
   • For severe allergies, the continuous use of ketotifen eyedrops on a daily basis during pollen season will give the best control.
   • Antihistamine/Vasoconstrictive Eyedrops (2nd choice):
   • Dosage: 1 drop every 8 hours
   • 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 "When to Call Your Doctor" symptoms.

References

1. Mahr T, Sheth K. Update on allergic rhinitis. Pediatr Rev. 2005; 26(8):278-283.
2. Meltzer EO. Treatment options for the child with allergic rhinitis. Clin Pediatr. 1998; 37:1-10.
3. Naglerio RM. Allergic rhinitis. N Engl J Med.1991;325:860-869.
4. Nash DR. Allergic rhinitis. Pediatr Ann. 1998;27:799-808.
5. Rooklin AR and Gawchik SM. Allergic rhinitis - It's that time again. Contemp Pediatr. 1994;11(4):19-41.
6. Schoem S, Josephson GD, Mendelson LM, Wohl DL. Why won’t this child’s nose stop running? Contemp Pediatr. 2002;19(12):48-63.
7. Solomon WR. Nasal allergy: More than sneezing and a runny nose. Contemp Pediatr. 1999;16(8):115-137.
8. Wallace DV, Dykewicz MS, eds. The diagnosis and management of rhinitis. J Allergy Clin Immunol. 2008;122:S1-84.

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: 1/4/2010

Last Revised: 1/4/2010 1:06:57 PM

Copyright 1994-2010 Barton D. Schmitt, M.D.