Introduction.
Allergies are a common health problem. At least
1 out of 5 people have allergic rhinitis sometime in their life. Allergies run
in families (are genetic) and often occur in children with asthma, eczema, and
food allergies. Allergies take some time to develop. Although you might be
“born to have allergies” because of a history of them in your family, they
often take 2 years or more to develop. For the rest of this information sheet,
when I say “allergies” I am referring to what is technically called allergic rhinitis and allergic conjunctivitis. See below.
Symptoms of Allergies.
Allergies cause a number of different
symptoms. Allergies never directly cause a fever. Not everyone with allergies
have the same symptoms, but there a number of common signs to look for:
-- runny nose -- itchy nose -- congested nose
-- clear nasal mucous -- itchy eyes -- watery eyes
Common Allergy Seasons.
Some allergies have a regular season,
based on when the plant is releasing pollen into the air. These dates are based
on Central Ohio seasons. Specific pollen counts are available online.
Ragweed: From early to mid
August until late October (it takes 2 good over-night frosts to stop the
ragweed from pollinating).
Trees: From March thru May.
Remember that the fluffy stuff you see floating down from the trees is not the pollen itself, even if that is
when the pollen is being released by the trees.
Grasses: From April thru early
July.
Dust mites: From Fall until
Spring, when we have our homes closed up and we are running the furnace. Dust
mites live on fabrics such as clothes, bedding, carpets, and furniture.
Molds: There are two
categories of molds that cause allergic reactions. One type is worse when it is
damp and will worsen when it rains or moisture is trapped under fallen leaves
(in the Fall). This type of mold is what often is in damp basements. Another
type of mold likes dry conditions and can act up even when it has not rained
recently. Molds often cause symptoms around Christmas time from live trees that
are brought into the house.
Allergies that do not
have a Season.
Pets: Exposures to pets
happen at all times of the year. We expect the symptoms to be whenever someone
is around the pet. Although any pet with fur (hair) can cause an allergy, cats
are the most likely to cause allergies, followed by dogs. The hair, skin, and
saliva cause the symptoms. A cat that sleeps on your bed or favorite chair will
leave behind enough hair and dander that you will have allergy symptoms even
when the pet is now somewhere else in the house.
Dust
mites and Molds:
If they are in your house and you are sensitive enough to them, you may have
allergy symptoms to dust mites and molds year round. They will be expected to
be worse when the house is closed up when the air conditioner or furnace is
running.
Treatment for Allergies.
The most effective treatment for allergies is avoiding the thing your child that causes
your child’s allergies. In real life, this is not very practical. Your
child wants to play outside, go to grandma’s house where the cat causes them to
sneeze, and roll in the fallen leaves.
The second most effective treatment is immunotherapy, also called allergy shots. Allergy shots work by
desensitizing you to those things that cause your allergy symptoms. You are
given shots on a regular schedule (usually weekly to start and then spaced out
to 2-4 weeks) of tiny amounts of the proteins that trigger your allergies. Over
time, you become less and less allergic. Depending on your symptoms, sometimes
the shots are given for a few years and sometimes much longer.
The most common treatment for allergies is
medication. They can help many children and adults with allergies, but they do
not “cure” the allergies. Almost all of the medications are available
over-the-counter without a prescription, while a few of them require a doctor’s
prescription. The medications that help with sneezing, itchy eyes or nose, and
runny nose are antihistamines. These
include Claritin® (loratadine), Zyrtec® (cetirizine), and Allegra®
(fexofenadine). For the stuffy nose and congestion, many children will try decongestants, such as pseudoephedrine
and phenylephrine. There is a prescription strength medicine that can help for
chronic congestion called Singulair® (montelukast). For eye itching that does
not respond to antihistamines by mouth, we recommend allergy eye drops. These
include Zaditor® (ketotifen) and Patanol® and Pataday® (olopatadine). For nasal
allergy symptoms (runny nose, congestion, sneezing, itchy nose) that do not
improve with the above medicines, we recommend a nasal steroid spray. These
include Rhinocort® (budesonide), Flonase® (fluticasone), Nasacort
(triamcinolone), and Flonase Sensimist® (fluticasone). These steroid sprays are
available over-the-counter. Astepro® Allergy Nose Spray is an anti-histamine
nasal spray that is available without a prescription.
Specific ideas for
avoiding what causes your allergy symptoms.
Grass: During the grass
pollen season, playing in the fresh-cut grass will cause the most symptoms. If
after playing outside in the grass, someone’s symptoms are bad, try having them
take a shower and changing clothes to get the pollen off their hair, skin, and
clothes.
Molds: Bringing live plants
and trees from outside to inside your home will dramatically raise the mold
count in your home. Changing from a live to an artificial Christmas tree will
help. Also, avoid raking leaves when the leaves have gotten damp (it is better
to wait when they are dry). The dampness makes the mold count greatly increase.
Dust mites: Dust mites live on
carpets, rugs, bed clothes, clothing, couches, and chairs that have a fabric
covering. They are often worst when the house is closed up and the furnace
circulates them through the house. Since the bedroom can be a likely place to
get exposed to dust mites, placing dust mite covers on the mattress and bed
pillows can be very helpful. Wash the sheets and blankets at least once a week
in warm to hot water to remove the dust mites. Remove carpets from living areas
and clean rugs and carpets frequently to remove dust mites. An air filter
(“HEPA filter”) also can help remove the dust mites.
Pets with fur: If you have a cat or
dog that causes your child’s symptoms, do not let the pet in their bedroom
(especially their bed), try to avoid having the pet lick your child, vacuum
frequently to remove the pet hair, and consider having your dog live outside
rather than inside.
Ragweed, other weeds,
and trees:
keeping the windows closed and running the air conditioner helps decrease how
much of the air-borne pollen your child will be exposed to.
What to do for your
children’s allergy symptoms.
If
you see seasonal and year-round allergy
symptoms and your child is at least 2 years of age: try one of the
over-the-counter antihistamines. These medicines can safely be given every day
or as needed. Consider adding a nose spray if the antihistamines do not help or
if they antihistamines cause side effects (especially drowsiness).
If
your child’s symptoms do not improve
with the over-the-counter medications, contact our office during regular office
hours. Your child may benefit from an appointment to discuss other options.
When
it is time to see an allergist for
allergic rhinitis: 1. If maximizing what we can with medications does not help
your child’s allergy symptoms. 2. If the allergies now cause your child to
wheeze. 3. If you want to know if your child is allergic to a pet (especially
if you plan on getting rid of one).
If
your child’s allergies improve with the
medication and they need the medicine during certain seasons, just keep
using the medication as needed. If it seems to stop working, we can discuss
other possibilities.
Note
that ongoing research into diphenhydramine (Benadryl®) shows that, although it
may help with allergy symptoms, the side effects (especially drowsiness) are
enough to not routinely recommend it for allergies at this time. We would
recommend Claritin®, Zyrtec®, or Allegra® instead.
If
one of the Claritin®, Zyrtec®, or Allegra® is not working well, try another
one. It is not unusual for one of these to work better than another in some
people.
If
the antihistamines are not working well on their own, add a nasal spray.
Astepro® works best for sneezing and runny nose (as it is an antihistamine),
while the inhaled steroid nose sprays (Flonase®, Nasacort®, etc.) work best
against congestion.
The
least volume of spray and the least scent of any nose spray for allergies is
Flonase® Sensimist.
Medication Dosing.
Claritin® Syrup 2-5 years of age: 5 ml.
once a day. 6 years of age and above: 10 ml. once a day.
Claritin® Reditabs
24-Hour 6
years of age and above: 1 dissolvable tablet once a day.
Claritin® Reditabs
12-Hour 6
years of age and above: 1 dissolvable tablet twice a day.
Claritin® Children’s
Chewables
5 mg. 2-5 years of age: 1 once a
day. 6 years of age and above: 2 chewables once a day.
Claritin® 10mg Tablets 6 years of age and
above: 1 tablet once a day.
Zyrtec® 10mg Tablets 6 years of age and
above: 1 tablet once a day.
Zyrtec® 5mg Chewable
Tablets 2-5
years of age: 1 tablet once a day.
Zyrtec® 10mg Chewable
Tablets
6 years of age and above: 1 tablet once a day.
Zyrtec® Children’s
Allergy Syrup 2-5
years of age: 2.5 ml. once a day. 6 years of age and above: 5 ml. once a day.
Allegra® Oral Suspension
2-11
years old: 5 ml. twice a day.
Allegra® ODT Orally
Disintegrating Tabs
6-11 years old: 1 tablet twice a day. It dissolves on the tongue.
Allegra® 60mg Tablets 12 years of age and
above: 1 tablet twice a day.
Allegra® 180mg Tablets 12 years of age and
above: 1 tablet once a day.
Zaditor® Ophthalmic
Solution
3 years of age and above: 1drop twice a day, every 8-12 hours.
Patanol® Ophthalmic
Solution
3 years of age and above: 1 drop twice a day, every 8-12 hours.
Pataday® Ophthalmic
Solution 3
years of age and above: 1 drop once a day, every 24 hours.
Flonase® Allergy Relief
Nose Spray 2-11 years of age (use Children’s Flonase): 1 spray
per nostril per day. 12 years and above: 2 sprays per nostril.
Flonase Sensimist
Allergy Relief Nose Spray 2-11 years of age (use Children’s
Flonase Sensimist): 1 spray per nostril once a day. 12 years of age and above:
2 sprays per nostril once a day.
Nasacort Allergy
24-Hour® Nose Spray 2-11 years of age: 1 spray per nostril once a day. 12 years of age and
above: 1-2 sprays per nostril once a day.
Rhinocort (budesonide) Allergy
Spray 6-11
years: 1 spray per nostril; 12 years of age and above: 1-2 sprays per nostril
once a day.
Astepro
Allergy Nose Spray 6-11
years of age: 1 spray per nostril every 12 hours. 12 years of age and above: 2
sprays per nostril every 12 hours.
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