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Hay Fever (Nasal Allergies)  
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Does this describe your child's symptoms?

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

If not, see these topics
  • Doesn't look like hay fever, see COLDS

When to Call Your Doctor

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) 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:  
    • 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.

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.

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