Dr. Sears advises: a daily “nose hose” and “steam clean” is a must for clearing stuffy nasal passages.
- A “nose hose” and “steam clean” – flushing the nose two or three times a day with nasal saline spray and gently blow the nose. Facial steamers are a good alternative to the spray. Steam your child’s nose and gently blow for ten minutes twice a day. Nasal washing clears the allergens out of the nose and relieves congestion. If using a medicated nasal spray as discussed below, be sure to do nasal washing prior to using the medication. This increases the effectiveness of the medicine. (For detailed instructions click on Nose Hose and Steam Clean)
- Medications – allergy medications can be useful for temporarily relieving symptoms during flare-ups or for continuous use during allergy season. Your child may need an allergy medication every night for a week or two. Or, your child may need a medication every morning for two or three months only during allergy season. These are common situations where allergy medications can be used safely and effectively. We do not recommend they be used continuously for several months or more without the supervision of a doctor.
- Antihistamines – these work by blocking the action of histamine as described in the beginning of this discussion. They treat the itchy, sneezy, runny nose, itchy watery eyes, and itchy throat. They can also help with nasal congestion. Antihistamines are available in liquid, chewables, and pills.
- Over-the-counter antihistamines – common brands include Benadryl, Dimetapp, and Chlortrimeton. Try several different brands to see which one works best for your child. They are generally safe for children 6 months and older. They last 6 – 12 hours.
- Prescription antihistamines – common brands include Claritin, Zyrtec, and Allegra. Some of these are now approved for children as young as two years old. These prescription medications generally last 24 hours. We suggest you try over-the-counter medications first and then talk to your doctor about these prescription medicines if needed.
- Side effects – include headache, dry mouth, drowsiness, and upset stomach. A few children can act hyperactive from these medications. In general, the new prescription medications (also known as “non-sedating” antihistamines) seem to have fewer side effects than the over-the-counter ones, but this varies from person to person. If drowsiness is the only side effect, try taking it only before bed. Often the drowsy effect wears off by morning, but the antihistamine action can last 24 hours.
- Decongestants while these drugs do nothing to fight the histamine effects of allergies, they can improve nasal congestion associated with allergies. They are especially helpful in conjunction with an antihistamine when the major allergy symptom is nasal congestion. Decongestants come as a separate medication or in combination with an antihistamine. Over-the-counter decongestants are virtually the same as prescription ones. Side effects are rare but include jitteriness and hyperactivity.
- Combination antihistamine/decongestants – the above prescription antihistamines also come combined with a decongestant. You can also purchase over-the-counter combinations as well.
- Nasal sprays – These are sprayed directly into the nose and help prevent the immune cells in the nasal lining from reacting with the allergens. Because they usually take one or two weeks to start working, they shouldn’t be used only one day here and there as this isn’t effective. Three types of nasal sprays are:
- Antihistamine nasal spray – there is only one on the market right now, available only by prescription, called Astelin. In 2000, it became approved for use in children as young as 5 years. It works well, and has the benefit of acting directly in the nose, compared to oral antihistamines. It can be used safely for many months at a time with very few side effects.
- Steroid nasal sprays – the word “steroid” commonly makes a parent shudder at the thought of giving it to their child. But these steroids are different than the “body building” ones taken by weightlifters. This steroid also stays in the nasal lining. Very little of it is absorbed into the body. They are currently approved for children as young as four years, but this age gets younger every year. Available only by prescription, they come either as wet sprays or dry aerosols. If your child hates one kind, switch to the other. Some common brand names include Flonase and Beconase.
- Side effects – include nasal irritation and dryness, nosebleeds, sore throat, cough, and headache.
- An additional side effect has been noted over the past few years. Very rarely some children have been found to slow their rate of growth while taking steroid nasal sprays. Generally their growth speeds up again when taken off the medication. Studies have shown that the steroid has no effect on eventual adult height. While this side effect is very rare, it needs to be considered when deciding to use a steroid nasal spray. For moderate to severe allergies that don’t improve with other measures, using a steroid nasal spray probably is worth this tiny risk.
- Cromolyn nasal spray – this acts like antihistamine spray. They are less effective than nasal steroids and Astelin, yet unlike steroids, they can be used daily for many months without harm. Side effects are transient stinging and sneezing.
- Decongestant nasal spray – this isn’t actually an allergy spray. It is very effective at temporarily relieving severe nasal congestion, but does not prevent allergy symptoms. It is available over-the-counter as neo-synephrine. Warning – do not use more than 3 days at a time or your nose may become dependent on it to stay clear, or a “rebound” effect may occur whereby the nasal membranes become more swollen.
Allergy prevention is usually the best long-term treatment for allergies. But when the above preventative measures aren’t enough, or if your child’s allergies are only occasional and not worth tearing the house apart trying to prevent them, then allergy medications can be a great benefit.
There are essentially two different ways to use allergy medications – preventative treatment and as-needed treatment.
- Preventative medications are used even when your child is well in order to prevent flare-ups.
- As needed medications are used only when your child is having symptoms.
Deciding which medications to use and when to use them can be confusing. The following are several different allergy scenarios. Decide which one fits you child best, and consider following that suggestion. Of course, be sure to do the nasal washings twice a day.
- Occasional symptoms – your child is generally well most days out of the month, but seems to have 3 or 4 random days where her allergies flare up. Try an over-the-counter antihistamine that works with minimal side effects. Have this handy to use only on those few days when it is really needed. If several different over-the-counter medications haven’t worked well for your child, ask your doctor for a prescription antihistamine.
- Symptoms lasting several weeks, but only every few months – your child seems well most of the year, but has flare-ups every few months that last for several weeks. This generally doesn’t warrant any preventative medications. What works well is when you notice one of these long flare-ups starting; give your child a daily dose of an antihistamine that works well for her. After 2 or 3 weeks when you see the symptoms subsiding, take her off the medication.
- Seasonal symptoms only – your child is well all year around, except for every spring (or other season) it hits – three long months of allergy symptoms that affect her almost every day. This is the time to use daily preventative therapy. You have three options:
- Daily antihistamine
- Daily nasal spray with an antihistamine as needed on worse days
- Both antihistamine and nasal spray daily
We suggest trying the first two options. If the symptoms don’t subside after two weeks, then try the third option. Remember, it often takes the nasal spray one or two weeks to start working. Use the antihistamine as well until the nasal spray kicks in, then try coming off of the antihistamine.
- Persistent symptoms that never end – if this describes your child, and you’ve tried many of the allergy prevention steps but they don’t seem to work, your child may need daily preventative therapy. Try the options as discussed immediately above under seasonal symptoms. Once you’ve found a combination that effectively alleviates your child’s symptoms, leave her on this regimen for 2 or 3 months. Then try to wean her off the medications. You may find she stays well for some time afterwards.