Me too. I love when the weather changes – but not the allergies that come with!
Spring and fall are my favorite seasons, but with the weather change and blooming trees/grass/plants comes with allergens galore.
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:
Constant runny nose that is also associated with bouts of sneezing, throat clearing, nose rubbing, sniffling, and/or itchy watery eyes.
Environmental allergies will not cause fevers like viral illnesses and unlike viral illnesses, the symptoms will seem constant. The symptoms will also be notably worse when outside or around the trigger.
One differentiator for me are allergies tend to be associated with some sort of constant irritation (like itching in the nose, bouts of sneezing, and/or eye irritation).
Viruses can also have runny noses, but the mucous tends to be thicker and waxes and wanes more.
Some kids can have BOTH allergies and colds at the same time—watch for itchiness, puffy eyes, or watery eyes in common allergy seasons to make that differentiation.
Does my one-year-old have seasonal allergies?
The youngest I have seen true seasonal allergies is 18 months, but usually we make the diagnosis after 2 years. Why? In order for a child to develop seasonal allergies, their body has had to be around that trigger once or twice to realize it’s something they don’t love. Hence, a 1-year-old would be too young for seasonal allergies due to lack of repetitive exposure. Now, if your 1-year-old has a constant cough, wheezing, etc; it’s important to bring this up with your child’s clinician to confirm there isn’t anything else that needs to be done or evaluated. Remember also that smoking in the home and mold in the home are environmental triggers of cough that are often thought about.
Once you have confirmed your child has seasonal allergies, it’s time to discuss management.
If you 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; consider the following 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.
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 medicines for seasonal allergies?
First-line medication: Nasal steroid sprays
Nasal steroid sprays contain a small amount of steroid in them and are safe and effective in children 2+. These sprays help reduce the irritation/inflammation in the nasal passages that is associated with stuffy/congested noses caused by allergens. This is my first-line medicine; however it can take two weeks to take effect.
So, starting it on a Monday and not seeing any change on a Friday doesn’t mean it’s not working; it just means it may need more time. These nasal steroid sprays are taken the entire allergy season and is best to be started 1-2 weeks before allergy season in a child known to have seasonal allergies. If your child is new to having seasonal allergies, you can start with this but do remember it takes two weeks to kick in.
Common nasal sprays include Flonase or Nasocort.
If the symptoms are severe OR the nasal steroids did not work, I like to add an oral antihistamine to help. Antihistamines block histamines (think: ANTI (against) histamines). Histamines are what cause the allergen response (itchy eyes, swelling, sneezing, and the misery associated with seasonal allergies).
These medicines will help the itchiness and irritation but won’t help the actual congestion like nasal steroids do.
My favorite antihistamine is Zyrtec: Of most of the antihistamines, it’s less likely to cause drowsiness and has a quicker onset of action (1 hour). You can give this in the morning before going out into the allergen-filled world.
My next favorite is Claritin: Claritin is also great but I find that it takes longer to set in than Zyrtec.
My next favorite is Allegra: It is the least sedating, but also shorter-acting. So, I prefer to use Zyrtec first above anything else.
What about Benadryl?
Benadryl is not recommended because it can be VERY sedating, can lead to upset stomach, and can leave children very drowsy. We also have other great antihistamines listed above.
What about Eye Drops for these allergies?
For eyedrops I tend to use antihistamine ones if there are eye symptoms (itchiness or feeling like constant grit or “sand” in their eyes). Depending on the severity, I will start with only the nasal steroid (which can sometimes help with all the nasal inflammation that can also cause eye irritation as well). If symptoms are severe OR the nasal steroid doesn’t work, I like to use an OTC antihistamine eye drop. Rewetting drops or Visine are not going to be useful because we have to help the itching component. Visine constricts blood vessels, but doesn’t do much for helping the underlying inflammation from allergens.
My favorite OTC eye drop is Zaditor, which can be used twice a day A prescription option is Pataday which I do prescribe if Zaditor doesn’t work; however it is not always covered by all insurance plans and can be pricey.
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 an asthmatic and is constantly being triggered by allergy symptoms. In this situation, it can be useful to know triggers and work with an allergist on best management of meds and trigger avoidance
- A child has year-round allergies and management listed above is just not helping and it’s affecting the child’s well-being/comfort. Allergy testing and seeing an allergist is useful to determine if other therapies are recommended
Final message on seasonal allergies for our kiddos 2+:
- Treat allergies only if your child is bothered by them
- If bothered, look at the symptoms.
- If congested, start a nasal steroid.
- If bothered by the itchiness, start an oral antihistamine.
- If eyes are involved, start an antihistamine eye drop
- If symptoms are not improving after one month or if lasting longer than the season: speak to pediatrician or allergist.
- The treatment strategy can be geared towards symptoms as not all children need all these medications.