Does your child seem to have a constant runny nose? Are they frequently rubbing their eyes or nose? Do you feel like they have a never-ending cold? All of these things could point to seasonal allergies or allergic rhinitis.
Check out the PedsDocTalk YouTube Video: Seasonal Allergies in Kids for more details and recommendations about seasonal allergies in children, including causes, common ages, risk factors, management strategies, and when to seek an allergist evaluation.
Changes in weather introduce new allergens into the air, triggering people to seasonal allergies who are sensitive to those allergens causing them to respond with itchy, watery, or puffy eyes, sneezing, and post-nasal drip.
Common environmental allergens by season include:
Spring: tree/grass pollen and flowering plants (oak, birch, maple trees)
Summer: Weed pollen (ragweed, Bermuda grass, rye grass)
Fall: Ragweed pollen (ragweed, sagebrush)
Winter: mold, dust, pet dander (although this can be year round)
Symptoms of seasonal allergies:
The most common symptoms of seasonal allergies are a runny nose, sneezing, nasal itching, postnasal drip, throat itching or scratchiness, and cough. The runny nose is clear and almost watery and drippy. Children experiencing allergic rhinitis may also experience allergic conjunctivitis, where the allergies affect the eyes. This can result in red, watery, itchy eyes.
Many times, children can have viruses WITH allergy symptoms; but with allergies there is typically a longer persistent runny nose with symptoms described.
Children who are too young to blow their nose, or prefer not to, may snort, sniff or clear their throats frequently in attempts to clear their congestion. Some kids will do the “allergic salute”, a term for constantly rubbing the nose in an upward fashion which can sometimes result in a crease on the nose. Some kids may also develop allergic shiners Allergic shiners,which are dark circles that appear under the eyes due to sinus blockage caused by allergies
For those with significant allergies, congestion may block their nose resulting in mouth breathing, snoring, or sleep disturbances at night. Symptoms can be disruptive and bothersome to children and result in fatigue or trouble focusing at school.
What ages are typically affected?
10-30% of children are affected by seasonal allergies which is a pretty large portion of the population! It is important to note that it typically takes a few years of allergen exposure for an allergy to develop. Remember, in allergies the body gets exposed to a potential allergen, realizes they don’t like it, and creates an immune response for the next time – this can take 1-2 allergy seasons to see seasonal allergies.
Therefore, it’s VERY VERY rare for children under the age of 2 to have environmental allergens. Most commonly allergies start to develop around age 3-6 but they can present in older children as well, especially if they’re exposed to new allergens. This is commonly seen when a child moves to a new area that has different trees, grasses, or plants in bloom, or with exposure to a new pet. Sometimes kids will outgrow allergies as they get older but they can persist into adulthood.
You can listen to this podcast episode for more information on babies and seasonal allergies.
Once you have confirmed your child has seasonal allergies, it’s time to discuss management.
If your child is not very bothered by the symptoms, you don’t HAVE to treat it. If they’re sniffling, but sleeping well, not constantly scratching their eyes or complaining, you can leave it be. BUT, if they are itching or irritable, then consider OTC meds.
Most allergy symptoms can be managed with OTC meds. So many people have allergies that these medications are readily available without a prescription.
Check out this PedsDocTalk YouTube Video about seasonal allergies for more specific management recommendations and OTC medications.
First-line: Non-medicated measures
- If symptoms are VERY severe, I will discuss these measures and add meds.
- If you’re looking for an approach with less medicine, start by using nasal saline sprays to moisten the nose/clear it of allergens, closing windows on very windy days, and changing clothes and an evening bath to decrease the amount of allergen around your child.
- Eliminate smoking as this is a known airway irritant that doesn’t make allergy symptoms better.
Now what about the medications for seasonal allergies?
In terms of medication, the first line recommendation for seasonal allergies is a nasal steroid spray during the allergy season. Medicines like Flonase, Nasacort, or Rhinocort can be given to kids 2 years and over.
The second way to manage allergies with medications is by adding on antihistamines. Antihistamines are the mainstay treatment for allergies. They work by blocking histamine receptors on cells, preventing inflammation and allergy symptoms. I usually recommend nasal steroids sprays first for one week and if there is no improvement, adding on a daily antihistamine (usually in evening). If you know your child gets seasonal allergies every March, starting the nasal spray 10-14 days prior of the typical season can also help to reduce flares when the season begins.
Always discuss medication management with your child’s pediatrician.
When to see an allergist or do allergy testing?
Parents often want testing at the first sign of seasonal allergies, however this is not recommended. We KNOW your child has allergies based on symptoms, so the testing at this stage isn’t necessary. You can’t completely avoid the allergens, so we focus on management to get your child through the season.
I personally do recommend allergy testing if:
- A child is asthmatic and is constantly triggered by allergy symptoms. In this situation, it can be useful to know triggers and work with an allergist on the best management with medications and trigger avoidance.
- A child has year-round allergies, the management listed above is not helping, and it’s affecting their well-being/comfort. Allergy testing and seeing an allergist are useful to determine if other therapies are recommended.