Nasal Allergies (Allergic Rhinitis)

    Nasal allergies ("hay fever") are very common and they may be seasonal or year-round.  The mucous membranes lining the nose and sinuses become inflamed which leads to sneezing, runny nose, cough, itching, clearing of the throat, snoring, mouth breathing, etc.  These symptoms may be constant or on-and-off depending upon what is triggering the allergy symptoms.

Typical irritants include pollen (from grasses, weeds, and trees), dust mites, animal dander, molds, smog, smoke, fumes, weather changes, etc.  We can usually diagnose  nasal allergies by getting a history of chronic nasal symptoms and seeing pale swollen mucous membranes in the nose as well as “allergic shiners” (dark discoloration below the eyes) and the "allergic salute" (a habit of swiping upwards at the nose).

     Treatment involves various oral medications and nasal sprays, but avoiding the offending allergen in the 1st place is best if possible.  Staying indoors is recommended when it is windy or when pollen counts are high.  It helps to have air purifiers in the home as well as changing your air filters regularly, vacuuming frequently, having your air ducts cleaned, removing stuffed animals from your child’s bed, using dust-proof pillows, etc.

    Antihistamines such as Benadryl® help with itching, sneezing, and drip, but they may cause drowsiness.  There are non-sedating antihistamines available: Claritin® is now available over the counter (5mg [1 teaspoon] once daily for kids under 6 years old.  For kids 6 years old and over the dose is 10mg [2 teaspoons or 1 tablet] once daily).  Other non-sedating antihistamines (Allegra®, Zyrtec®, Clarinex®, etc.) are available by prescription.  Oral decongestants such as Sudafed® help with stuffy nose and swelling, but sometimes they make some children wired or cause insomnia.  Over the counter decongestant nasal sprays ) can actually be dangerous and addicting and should not be used for more than a few days!

    Your doctor may also prescribe various steroid nasal sprays to help reduce the swelling and inflammation in the nose.  They are not fully effective until several days after starting them, but they work very well long-term and they should be taken everyday as a daily preventative for many weeks or months.  There is another nasal spray over-the-counter called Cromolyn® (Nasalcrom) which is not a steroid, but it also helps reduce inflammation.  It needs to be taken 3-4 times a day instead of the once-a-day steroid sprays.

    There is also a prescription chewable pill called Singulair® which is also used to treat nasal allergies, and it can be taken alone or in combination with nasal sprays.  There are also various decongestant nasal sprays over-the-counter (i.e. Afrin®) which can be used to treat a stuffy nose, but these can actually be dangerous and addicting and should not be used for more than a few days!

    If your child has tried all or most of the above medications for a significant period of time without any relief, then your child may need to see an allergist for skin testing and may need to have weekly allergy shots.