Health Education

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Spring in Cleveland is one of the most enjoyable times of the year. But with spring comes spring time allergies. For those of us who suffer from the runny nose, congestion, eye drainage and coughing spells, spring is no time to picnic. Fortunately, the treatment of springtime allergies has improved drastically over the past few years. There is no need to suffer and many of the medications are now more easily available over the counter.

What causes allergy symptoms?

The basic mechanism which accounts for the aforementioned allergy symptoms is histamine release. Allergens like tree, weed and plant pollens attach to receptors in the eyes, nose and lungs, causing the release of histamine. With histamine release, blood vessels become leakier which explains the runny nose and eye drainage as well as the nose congestion. Histamine also causes airways to become more irritated and this accounts for the cough and the wheezing (allergic people are much more likely to wheeze than the general population). There are two basic approaches to dealing with histamine release. 1) Antihistamines are like mitts. They catch the histamine molecules and prevent them from doing their dirty work. They are inexpensive and easily available over the counter. But they are not foolproof. When there is an overwhelming allergy attack, even the most effective antihistamine is overwhelmed. 2) Medications like Singulair prevent the release of histamine. They take longer to take effect and are only available by prescription but can be a helpful addition in the treatment of seasonal allergies.

What are non-pharmacologic approaches to allergies?

The most effective treatment is always prevention. Many allergic responses are immediate. The child plays outdoors on the day that the grass was cut and immediately suffers from runny nose, watery eyes, nasal congestion and a cough. But there is also a delayed response coming 6-8 hours after the irritation. Since we cannot keep our children in a bubble, it is helpful to keep windows closed at night and use air conditioning whenever possible. This protects the child from night time exposure and allows recovery from the effects of histamine release. Washing hair at night prevents allergens in the hair from becoming embedded in the pillows and again, protects the child from 24/7 exposure. Similarly, children with significant seasonal allergies who play baseball or soccer, benefit greatly from a shower immediately after the game.  Additionally for older children and teens, use of a neti-pot or other nasal saline rinse before bed to wash out the pollen and secretions that are in the sinuses can also help.

How do I treat mild allergy symptoms?

For treatment of runny nose, eye discharge and nasal congestion, start with the oral antihistamine cetirizine (Zyrtec) because it works effectively without making your child sleepy. There is no reason to spend extra money on brand name antihistamine medications. Cetirizine is designed as a 24 hour medication but our experience has been that it often helps to give a dose of Diphenhydramine (Benadryl) at bedtime to enhance the antihistamine effect. Only about 10-20% of people who use diphenhydramine will suffer from sleepiness. Fexofenadine (Allegra) is another great anti-histamine and is designed to be given once daily or twice daily but should not be used in conjunction with another oral antihistamine.

Cetirizine (Zyrtec) Dosing: 6 months to 2 years old - 2.5ml daily (there is only one liquid strength), 2 to 6 years old - 5mls or one 5mg chewable tablet daily, 6 years old and older - 10mg tablet daily

Diphenhydramine (Benadryl) Dosing:  5ml for 20 pound children (there is only one liquid strength), 10mls or chewables (25 mg) for 40 pound children, 15mls or chewables (37.5 mg) for 60 pound children, 20mls (50 mg) or 2 tablets for children over 85 pounds

Fexofenadine (Allegra) Dosing: 6 months to 2 years old - 2.5ml twice daily (there is only one liquid strength), 2 to 11 years old - 5ml twice daily, 12 years old and older - one 60mg table twice daily or one 180mg table once daily

How do I treat moderate to severe allergies?

When antihistamines are not effective, the next step is to consider nasal steroids.  Two products are now over the counter: Nasacort and Flonase.

Nasacort and Flonase Dosing: 2 to 11 years old - 1 spray each nostril daily, 12 years old and older - 2 sprays each nostril daily at one time.

There additional treatments such as Singulair which has been shown to prevent the release of histamine. When used in combination, Singulair and antihistamines can really reduce the symptoms of moderate to severe allergies. If your child is experiencing these more intense symptoms and over the counter products are unsuccessful, please schedule an appointment to see us.

What about itchy or watery eyes?

Antihistamine drops such as ketotifen (Zatidor) are available without prescription and has become the treatment of choice. Ketotifen dosing (for children 3 years and older) is 1-2 drops to each eye twice a day for as long as symptoms persist.

What about treatment of cough?

When OTC products are ineffective, often it means that the allergies are more significant and may be causing mild wheezing. When your child is coughing, especially at night, the treatment can be a combination of bronchodilators that open up the airways (albuterol and brand names) and inhaled steroids (Flovent, Azmacort and others) which are available only by prescription. Please schedule an appointment for us to evaluate the best combination of medications to help your child.

What about treatment of allergy symptoms in infants and young children?

We believe that even infants can manifest the symptoms of allergies. If the parents are suffering in April and May and the child is congested, it is certainly possible that the child is suffering from the same seasonal allergies. Unfortunately, there is no medication that is safe for use under 6 months. In the 6-24 month age child, however, please schedule an appointment to see us if you suspect that your child is suffering from seasonal allergies.