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Allergic Rhinitis/Conjunctivitis

Allergic rhinitis or conjunctivitis is caused by things that trigger inflammation in the nose or eyes, called allergens. These allergens can be found both outdoors and indoors. When allergic rhinitis is caused by common outdoor allergens—such as mold or trees, grass and weed pollens—it is often referred to as seasonal allergies, or “hayfever.”  Allergic rhinitis or conjunctivitis may also be triggered by allergens that are in your house, such as animal dander (tiny skin flakes and saliva), indoor mold, or the droppings of cockroaches or house dust mites—tiny creatures found in the home.
•   If you have symptoms in spring, you are probably allergic to tree pollens.
•   If you have symptoms in the summer, you are probably allergic to grass and weed pollens.
•   If you have symptoms in late summer and fall, you probably are allergic to ragweed.
•   Dust mites, molds and animal dander (saliva or skin flakes) cause symptoms all year.
Typical symptoms of allergies include clear nasal discharge with sneezing, sniffling, and nasal itching; ear and sinus congestion; headache- particular in the facial area; a tickly or scratchy sensation in the throat; itchy ear canals; hoarse voice; and itchy skin and/or hives.
Fever is NOT a typical symptom, despite the term “hay fever” used to describe seasonal allergies.
 
PREVENTION: the best way to avoid allergies is to avoid or remove the offending substance.
1  For pollen-keep windows shut and use the air conditioner.  Shower immediately upon coming inside from the outdoors.  Use a nasal saline rinse to wash pollen out of the nasal passages, and saline eye wash to clear pollen out of the eyes.  Individual packets of eye saline can be purchased over-the-counter to carry with you to outdoor events.
2  For dust and dust mites- purchase plastic mattress and pillow covers for beds/pillows (available at most home goods stores.)  WET dust in rooms.  Wash bedding regularly, and limit stuffed animals and other dust catchers in the bed area.  Remove old or thick carpeting, and vacuum remaining flooring regularly.  For severe cases, consider a room HEPA filter- a machine that can filter out small particles of dust.
 
ANTIHISTAMINES: these products combat the irritating effects of histamine, a chemical released by the body when reacting to allergens.  There are many over-the-counter products available for use.  Chlorpheniramine and benadryl work well for allergy, but are short-acting and may cause drowsiness.  See the SelfCareNavigator on our website for dosing.
 
Loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra) are longer acting antihistamines now available over the counter that are less sedating and work for 24 hours. They are available in liquid, dissolving tablet, chewable and pill forms. If they do make your child sleepy, try dosing at bedtime.  Store brand loratidine works as well as Claritin at half the price.
 
These products work best IN ANTICIPATION of allergic triggers- once symptoms have begun, histamine has already been released in the body and your child may not fully respond to the anti-histamine.  They should be used daily during allergy season for peak effectiveness, but can be used on an as-needed basis for specific exposures (i.e. exposure to a cat.)
 
Claritin-D and Zyrtec-D are antihistamines paired with pseudoephedrine (Sudafed), a decongestant that helps shrink congested blood vessels in the nose.
 
For EYE symptoms you can purchase over-the-counter Naphcon or Opcon, anti-histamine eye drops or Zaditor, and anti-histamine eye drop that also contains an ingredient to prevent histamine release.
 
If the over-the-counter products are not working for your child, or have significant side effects, schedule a visit for an evaluation by the doctor.  Underlying issues such as sinus infections can be treated, and prescription medications or eye drops can be tried.
 
SINGULAIR:
Singulair is a non-steroidal anti-inflammatory medication that blocks leukotrienes, chemicals that cause inflammation.  Singulair is taken as granules (sprinkled in food), pills or chewables, and is effective for both asthma and allergy symptoms.  This medication should be taken daily throughout the allergy season for peak effectiveness.
 
This medication does not cause drowsiness or jitteriness, and is typically well-tolerated by children ages 1 and older.
 
ANTIHISTAMINE nasal sprays:
Over the counter decongestant sprays such as Neosynephrine and Afrin cannot be used frequently, due to the risk of “rebound” (or worsened symptoms) when discontinued. 
 
Prescription antihistamine sprays such as Astelin, Astepro and Patanase can be used chronically without risk.  They can be particularly helpful in relieving congestion due to cold symptoms and cold weather induced rhinitis, in addition to allergies.
 
STEROID nasal sprays:
Intranasal steroid sprays are one of the most effective treatments for allergic rhinitis, but must be used consistently for best effect.  Dr. Nikki recommends taping the canister to your child’s toothpaste to remind you to use it daily.
 
To use a nasal spray properly, first lean forward (nose towards the toes).  Use the left hand to spray the right nostril, and the right hand to spray the left nostril. Then place the nozzle in the nostril, aiming for the eye on the same side to avoid spraying the septum (middle part of the nose that can develop bleeding.)  
 
Some brands commonly used are Flonase (fluticasone), Nasonex (mometasone), Rhinocort Aqua (budesonide) and Veramyst (fluticasone furoate.)  Both Flonase and Nasonex are now available over the counter- start with one spray in each nostril once a day.