Hay Fever (Nose Allergies)

HAY FEVER (NOSE ALLERGIES)

DEFINITION

  • An allergic reaction of the nose (allergic rhinitis).
  • An itchy nose and clear discharge is common

Symptoms

  • Clear nasal discharge with sneezing, sniffing, and nasal itching
  • Eye allergies (itchy, red, watery and puffy) are commonly associated
  • Ear and sinus congestion may also be associated
  • A tickling, scratchy sensation in the back of the throat can be associated
  • Itchy ear canals, itchy skin, and hoarse voice are also seen
  • Symptoms occur during pollen season
  • Similar symptoms during the same month of the previous year
  • No fever

Causes

  • Hay fever is an allergic reaction of the nose and sinuses to an inhaled substance, usually a pollen.
  • Grass, tree and ragweed are common pollens
  • Allergens from cats and other animals

See More Appropriate Topic (instead of this one) If

  • Doesn't look like hay fever, see COLDS.
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WHEN TO CALL YOUR DOCTOR

Call your doctor within 24 hours (between 9am and 4pm)if:

  • You think your child needs to be seen.
  • Lots of coughing.
  • Sinus pain around cheekbone or eyes (not just congestion) and not relieved by antihistamines

Call your doctor during weekday office hours if:

  • You have other questions or concerns.
  • Hay fever symptoms interfere with sleep or school after taking antihistamines for 2 days.
  • Diagnosis of hay fever has never been confirmed by your doctor.
  • Year-round symptoms of nasal allergies.

Parent care at home if:

  • Hay fever and you don't think your child needs to be seen.
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HOME CARE ADVICE

  1. Reassurance:
    2.  
    • Hay fever is very common, occurring in 15% of children.
    • Nose and eye symptoms can be brought under control by giving antihistamines.
    • Because pollens are in the air every day during pollen season, antihistamines must be given daily.
  2. Antihistamines:
    3.  
    • Give antihistamines continuously during pollen season (continuously is the key to control).
    • Chlorpheniramine (e.g., chlortrimeton) products are effective and don't need a prescription. Any antihistamine you have will do, but some may cause more drowsiness.
    • See dosage charts for chlorpheniramine or benadryl.
    • The bedtime dosage is especially important for healing the lining of the nose.(Benadryl is a good choice for bedtime)
    • Long-acting products (less dosages per day) and combination antihistamine-decongestant products (less sedating) may be more helpful.
    • Loratadine: Newer antihistamine that causes less sedation and lasts 24 hours (over-the-counter in 2003).
      • Dosage: 10 mg tablet once daily in morning (orally dissolving tablet also available)
      • Indication: weight over 66 pounds (30 kg) AND drowsiness from Benadryl or chlorpheniramine interferes with school
      • Limitation: doesn't control hay fever as well as older antihistamines.
      • Cost: store brand usually costs half the Claritin brand
  3. Benadryl: If the runny nose and itchy eyes are out of control and your child is taking long-acting antihistamines, give 1 dose of Benadryl (see dosage table) to stabilize your child.
  4. Eye Allergies:
    • For eye symptoms, wash the pollen off the face and eyelids.
    • Then apply cold compresses.
    • Antihistamine-vasoconstrictor eye drops (no prescription needed) are sometimes needed, but oral antihistamines usually control eye symptoms.
  5. Wash Off Pollen:
    • Remove pollen from the nose with nasal washes (using warm tap water) whenever needed.
    • Instill 2 or 3 nose drops in each nostril followed by blowing the nose. Repeat until open. 
    • Remove pollen from the hair and skin with hair washing and a shower, especially before bedtime.
  6. Expected Course: Since pollen allergies recur each year, learn to control the symptoms.
  7. Call Your Doctor If:
    • Symptoms aren't controlled in 2 days with continuous antihistamines
    • Your child becomes worse

And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. Mahr T, Sheth K. Update on allergic rhinitis. Pediatr Rev. 2005; 26(8):278-283.
  2. Meltzer EO. Treatment options for the child with allergic rhinitis. Clin Pediatr. 1998; 37:1-10.
  3. Naglerio RM. Allergic rhinitis. N Engl J Med.1991;325:860-869.
  4. Nash DR. Allergic rhinitis. Pediatr Ann. 1998;27:799-808.
  5. Rooklin AR and Gawchik SM. Allergic rhinitis - It's that time again. Contemp Pediatr. 1994;11(4):19-41.
  6. Schoem S, Josephson GD, Mendelson LM, Wohl DL. Why won’t this child’s nose stop running? Contemp Pediatr. 2002;19(12):48-63.
  7. Solomon WR. Nasal allergy: More than sneezing and a runny nose. Contemp Pediatr. 1999;16(8):115-137.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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