Should Your Child See a Doctor?
Nose Allergy (Hay Fever)
This Care Guide Covers
- An allergic reaction of the nose (called allergic rhinitis)
- An itchy nose, clear discharge and sneezing is common
See Other Care Guide If
- Does not look like hay fever. See COLDS.
Triggers of Nasal Allergies
- Cause. An allergic reaction of the nose and sinuses to an inhaled substance. The medical name for this is allergic rhinitis. The allergic substance is called an allergen.
- Most allergens float in the air. That's how they get in the nose. Here are the common ones:
- Pollens. Trees, grass, weeds and molds are the most common pollens. Tree pollens come in the spring. Grass pollens come in the summer. Weed pollens come in the fall. Pollens cause seasonal allergies. You can't avoid pollens because they are in the air. Most nasal allergies continue through the pollen season. They can last 4 to 8 weeks. Pollens cause seasonal allergic rhinitis.
- Pets. Allergens can also be from cats, dogs, horses, rabbits and other animals. Most people don't keep a pet that they are allergic to. They only have sporadic allergy symptoms when they are exposed to a pet. These symptoms usually last a few hours. If you own the pet, your child will have symptoms all the time.
- House Dust. House dust contains many allergens. It always contains dust mites. If your humidity is high, it will contain mold. If someone with a cat visits you, they will bring cat dander with them. House dust causes year round, daily symptoms. The medical name for this is perennial allergic rhinitis.
Symptoms of Nasal Allergies
- Clear nasal discharge with sneezing, sniffing, and itching of nose (100%)
- Eye allergies (itchy, red, watery and puffy) also can occur (70%)
- Ear and sinus congestion or fullness can occur
- Throat can also feel scratchy or have a tickly feeling at times
- Itchy ear canals, itchy skin or hoarse voice sometimes also occur
- Symptoms happen during pollen season
- Same symptoms during the same month of the last year
- Past diagnosis by a doctor is helpful
- No fever
How to Tell Seasonal Nasal Allergies from the Common Cold
- Symptoms happen during pollen season
- Had the same symptoms during the same month last year
- Hay fever symptoms last 6-8 weeks for each pollen. (Colds last 1-3 weeks).
- No fever with allergies
Nose and Eye Allergies: Age of Onset
- Seasonal pollen allergies usually begin at age 2 to 5 years.
- The symptoms peak in school age children, teens and young adults.
- Pollen symptoms are rare in children under age 2. They require at least 2 seasons of exposure to the pollen.
- Children under age 2 who have chronic nasal symptoms have other causes. Examples are recurrent colds, large adenoids or cow's milk allergy.
- Food allergies can start during the first year of life, but not pollen allergies.
When To Call Your Doctor
Call Your Doctor Within 24 Hours If
- You think your child needs to be seen
- Lots of coughing
- Sinus pain (not just congestion) does not go away with allergy medicines. (Note: Sinus pain is around the cheekbone or eyes.)
Call Your Doctor During Weekday Office Hours If
- Hay fever symptoms make it hard to go to school or do normal activities. (Note: Taking allergy medicine for 2 days has not helped.)
- Diagnosis of hay fever has never been made by a doctor
- Year-round symptoms of nasal allergies
- Snoring is a frequent problem
- You have other questions or concerns
Parent Care at Home If
Care Advice for Hay Fever
- What You Should Know About Nose Allergies (Hay Fever):
- Hay fever is very common. It happens in about 15% of children.
- Nose and eye symptoms can be controlled by giving allergy medicines.
- Pollens are in the air every day during pollen season. So, allergy meds must be given daily. They need to be used for 2 months or longer during pollen season.
- Here is some care advice that should help.
Long-Acting Allergy Medicines:
- Allergy medicines are called antihistamines. They are the drug of choice for nasal allergies.
- They will help control the symptoms. These include a runny nose, nasal itching and sneezing.
- You can give a short-acting allergy medicine (such as Benadryl). No prescription is needed. It needs to be given every 6 to 8 hours. See Dose Table.
- The bedtime dosage is especially important for healing the lining of the nose.
- The key to control is to give allergy meds every day during pollen season.
Nasal Washes to Wash Out Pollen:
- You can also use a long-acting allergy medicine (such as Zyrtec). No prescription is needed.
- Advantage: Causes less sedation than older allergy meds such as Benadryl. It is long-acting and last up to 24 hours.
- Age 2- 6 years old, discuss with your child's doctor. If approved, give 2.5 mg (2.5 ml or 1/2 teaspoon) of liquid syrup. Use once daily in the morning.
- Age 6-12 years old, give 5 mg chewable tablet once daily in morning.
- Age: 12 years and older, give 10 mg tablet once daily in morning.
- Downside: Doesn't control hay fever symptoms as well as older allergy medicines. Also, sometimes will have breakthrough symptoms before 24 hours. If that happens, you can give a single dose of Benadryl.
- Cost: Ask the pharmacist for a store brand. Reason: Costs less than the brand name products.
Eye Allergy Treatment:
- Use saline nose drops or spray (such as store brand). This helps to wash out pollen or to loosen up dried mucus. If you don't have saline, you can use a few drops of tap water. Teens can just splash a little tap water in the nose and then blow.
- Step 1: Put 3 drops in each nostril.
- Step 2: Blow each nostril out while closing off the other nostril. Then, do the other side.
- Step 3: Repeat nose drops and blowing until the discharge is clear.
- How often: Do nasal washes when your child can't breathe through the nose. Also, do them if the nose is very itchy.
- Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
- Saline nose drops can also be made at home. Use 1/2 teaspoon (2 ml) of table salt. Stir the salt into 1 cup (8 ounces or 240 ml) of warm water. Use distilled water or boiled water to make saline nose drops.
- Other option: Use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
Wash Pollen Off Body:
- For eye symptoms, wash off the face and eyelids. This will remove pollen or any other allergic substances.
- Then put a cold wet washcloth on the eyes.
- Most often, an allergy medicine given by mouth will help the eye symptoms. Sometimes, eye drops are also needed.
- Antihistamine Eye Drops - Ketotifen (1st Choice):
- Ketotifen eye drops (such as Zaditor) are a safe and effective product. No prescription is needed.
- Dose: 1 drop every 12 hours.
- For severe allergies, use ketotifen eyedrops every day during pollen season. This will give the best control.
- Antihistamine/Vasoconstrictive Eye Drops (2nd Choice):
- Dose: 1 drop every 8 hours
- Ask your pharmacist to suggest a brand (such as Opcon A).
- Do not use for over 5 days. (Reason: Will cause red eyes from rebound effect).
- Downside: Doesn't work as well as Ketotifen eye drops.
What to Expect:
- Remove pollen from the hair and skin with shampoo and a shower. This is especially important before bedtime.
Pollen - How to Reduce the Pollen Your Child Breathes:
- Since pollen allergies recur each year, learn to control the symptoms.
Call Your Doctor If:
- Pollen is carried in the air.
- Keep windows closed in the home, at least in your child's bedroom.
- Keep windows closed in car. Turn the air conditioner on recirculate.
- Avoid window fans or attic fans. They pull in pollen.
- Try to stay indoors on windy days. Reason: The pollen count is much higher when it's dry and windy.
- Avoid playing with the outdoor dog. Reason: Pollen collects in the fur.
- Pollen Count: You can get your daily pollen count from www.pollen.com.
- Just type in your zip code.
- Symptoms are not better in 2 days after starting allergy medicine
- Your child becomes worse
Remember! Contact your doctor if your child develops any of the "When to Call" symptoms.
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- Meltzer EO. Treatment options for the child with allergic rhinitis. Clin Pediatr. 1998; 37:1-10.
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- Rooklin AR and Gawchik SM. Allergic rhinitis - It's that time again. Contemp Pediatr. 1994;11 (4):19-41.
- Schoem S, Josephson GD, Mendelson LM, Wohl DL. Why won't this child's nose stop running? Contemp Pediatr. 2002;19 (12):48-63.
- Solomon WR. Nasal allergy: More than sneezing and a runny nose. Contemp Pediatr. 1999;16 (8):115-137.
- Wallace DV, Dykewicz MS, eds. The diagnosis and management of rhinitis. J Allergy Clin Immunol. 2008;122:S1-84.
This information is not intended to 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: Barton D. Schmitt, M.D.
Last Reviewed: 1/2/2014
Last Revised: 4/4/2014 2:00:08 PM
Content Set: Child Symptom Checker
Version Year: 2014
Copyright 1994-2014 Barton D. Schmitt, M.D.