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.
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.
HOME CARE ADVICE
- Reassurance:
- 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.
- Antihistamines:
- 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
- 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.
- 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.
- 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.
- Expected Course: Since pollen allergies recur each year, learn to control the symptoms.
- 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.
REFERENCES
- Mahr T, Sheth K. Update on allergic rhinitis. Pediatr Rev. 2005; 26(8):278-283.
- Meltzer EO. Treatment options for the child with allergic rhinitis. Clin Pediatr. 1998; 37:1-10.
- Naglerio RM. Allergic rhinitis. N Engl J Med.1991;325:860-869.
- Nash DR. Allergic rhinitis. Pediatr Ann. 1998;27:799-808.
- Rooklin AR and Gawchik SM. Allergic rhinitis - It's that time again. Contemp Pediatr. 1994;11(4):19-41.
- Schoem S, Josephson GD, Mendelson LM, Wohl DL. Why won’t this child’s nose stop running? Contemp Pediatr. 2002;19(12):48-63.
- 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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