By Julia Gaines MD, FAAP
I’m sure I don’t have to tell anyone this, but the spring pollen season has arrived in Atlanta! In addition to the yellow dust all over the place, the parade of miserable kids with itchy, runny eyes and noses has made that clear over the past few weeks. A lot of parents have been asking me a lot of allergy questions recently so I thought I’d address some of the more common ones:
What are the symptoms of seasonal allergies?
The symptoms are pretty much what you would expect – clear runny nose, itchy nose, sneezing, itchy runny eyes, and coughing. Some kids may complain of headache or fatigue, especially if the allergies are disrupting their sleep. Fever is not a symptom of allergies. Of course, seasonal allergies happen seasonally – right now the trees and grasses are the main culprits.
What causes an allergy?
Basically, an allergy occurs when your immune system views an innocent piece of pollen or dog dander or mold spore as a fearsome invader and makes an antibody called IgE to help combat it. That’s all well and good but, unfortunately, one of the results of this is the release of a chemical called histamine from certain cells in your bloodstream. Histamine then causes an increased production of thin watery mucous from your eyes and nose to flush out the invader and an increase in sneezing to blow the enemy out. The higher the pollen count, the more mucous and sneezing and the more miserable the person becomes.
Are seasonal allergies dangerous?
Seasonal allergies are not, in and of themselves, dangerous. As opposed to a food allergy or bee sting allergy, there is no danger of anaphylaxis with these types of allergies. However, all the congestion can increase the risk of sinus infections and ear infections and increase the need for antibiotics, which isn’t great. More concerning is that many kids with allergies also have asthma and the allergies can certainly exacerbate the asthma. Treating the asthma effectively necessitates treating the allergies as well.
Can my 6 month old be suffering from pollen allergies?
Nope, it’s one of the few things we don’t worry about with babies! While kids under 3 years are more likely to have food allergies than older kids, they almost never suffer from seasonal allergies at that age. It requires several years of exposure to develop these seasonal allergies so we don’t really even think about it in infants. People with allergies who move to a different part of the country often get a temporary relief from the allergies until they’ve had enough exposure to the different pollens to mount an allergic response.
How do I make it stop?
There are several layers of treatment for seasonal allergies. Generally, we will start with one of the long acting over-the-counter antihistamines – Claritin (loratadine), Zyrtec (cetirizine), or Allegra (fexofenadine). The medications last 12 hours (Allegra liquid) to 24 hours and have very few side effects, especially compared to the older antihistamines like Benadryl. They are fairly effective for both allergic rhinitis and allergic conjunctivitis but I do tend to find that they are often not enough in the face of a 9000 pollen count. They work by blocking histamine (remember that critter?) release into the bloodstream.
If the antihistamine alone does not provide enough relief, we will generally add a nasal steroid like Nasonex or Flonase. There are a number of different nasal steroids and many are in the process of going over the counter. They all work well so definitely go whichever version costs the least. The nasal steroids work by decreasing inflammation in the nose and therefore decreasing the sneezing and other nasal symptoms. They work very well but do need to be used daily and can be a bit of a hard sell with some kids who may not appreciate things in their nose.
If your child suffers from eye symptoms, there are a number of eye drops available over the counter. Some work quite well while others are not worth the money and aggravation. I prefer products with the active ingredient ketotifen. One brand name is called Zaditor but any product with that ingredient should work well.
Some children with allergies will be prescribed a product called Singulair, or monteleukast. This is an oral medication that works on a different part of the inflammatory pathway than steroids, and also can have some benefit with asthma. This medication requires a prescription, is fairly expensive, and can have some significant side effects so it is not used as much as the previous medications.
And just a note – local honey does not treat or prevent allergies. The pollens that contribute to allergies are very small and therefore can be absorbed into the nose and eyes. The plants that produce these pollens depend on wind to spread the pollen. Plants that use bees as pollinators produce much larger pollen grains – if you look at a honeybee in your flowers, you will see the pollen collecting on their hind legs. These pollens, as well as the stuff on your car, are too large to be absorbed through the nose. So buy local honey to support local beekeepers, but go to the pharmacy for your allergy treatment!
Does my child need allergy shots?
Allergy shots, officially known as subcutaneous immunotherapy, or SCIT, have generally been considered the “cure” for allergies. It involves injecting very small amounts of the allergen and increasing the dose over time until tolerance is achieved. It requires a substantial time investment as the regimen generally starts with shots 2-3 times a week and can take several years to complete. Due to the risk of serious reactions, the shots must be administered in an allergist’s office. Plus, you know, the kid has to get shots. However, if all goes as planned, by the end of it, you have a kid who no longer has allergies. We encourage SCIT for kids when their allergies/asthma substantially impact on their life despite maximum medical treatment. Please talk with your provider if you think your child would benefit from SCIT.
The newest treatment on the block is sublingual immunotherapy, or SLIT. In this case, the allergist administers the immune serum as drops under the child’s tongue. It still needs to be done in the allergist’s office but obviously eliminates the whole needle thing. At this time, SLIT is not FDA approved and is generally not covered by insurance, but stay tuned!
What else can I do?
There are definitely some non-medical things that can help. You could just lock your child in the house for the duration of the allergy season but that probably isn’t a great idea. It’s spring – the weather is beautiful and kids need to play outside! However, it’s worth encouraging them to play outside in the afternoon when the pollen count is lower rather than in the morning. Ideally, kids should bathe and change their clothes when they come inside so they can rinse all the pollen off (even if they don’t wash their hair every day, they should at least rinse it out). If that isn’t possible, at least have them wash their hands before they rub the pollen in their nose and eyes. Keep the windows and doors closed in the house and car and keep the pollen out! And the kid with grass allergies really shouldn’t be mowing the grass.
As I keep reminding myself each time I have to clean my car’s windshield, the spring pollen season is the price we have to pay to live in Atlanta with all its beautiful trees. For those with allergies, the price is definitely higher but there is treatment out there! Please speak with your provider about seasonal allergies if you have any further questions or concerns.