Spring in Cleveland is one of the most enjoyable times of the year. Now that Daylight Savings Time begins in the beginning of March, it seems that the whole world is beginning to emerge from winter just a little earlier. The birds are chirping a little earlier in the morning, kids are beginning to stay up a little later playing outside and the trees seem to have gotten the memo as well, beginning to bud in mid March. People are smiling a lot more and even though there is often a late spring snow storm, it seems like it just can’t hurt us as much as those mid January blizzards.
But with spring comes spring time allergies. For those of us who suffer from the runny nose, congestion, eye drainage and coughing spells, spring is no time to picnic. Fortunately, the treatment of springtime allergies has improved drastically over the past few years. There is no need to suffer and many of the medications are now more easily available over the counter.
Understanding the science behind allergy symptoms: The basic mechanism which accounts for the aforementioned allergy symptoms is histamine release. Allergens like tree, weed and plant pollens attach to receptors in the eyes, nose and lungs, causing the release of histamine. With histamine release, blood vessels become more leaky which explains the runny nose and eye drainage as well as the nose congestion. Histamine also causes airways to become more irritated and this accounts for the cough and the wheezing (allergic people are much more likely to wheeze than the general population). There are two basic approaches to dealing with histamine release. 1) Antihistamines are like mitts. They catch the histamine molecules and prevent them from doing their dirty work. They are inexpensive and easily available over the counter. But they are not foolproof. When there is an overwhelming allergy attack, even the most effective antihistamine is overwhelmed. 2) Medications like singulair prevent the release of histamine. They take longer to take effect and are only available by prescription but can be a helpful addition in the treatment of seasonal allergies.
Non pharmacologic approaches to allergies: The most effective treatment is always prevention. Many allergic responses are immediate. The child plays outdoors on the day that the grass was cut and immediately suffers from runny nose, watery eyes, nasal congestion and a cough. But there is also a delayed response coming 6-8 hours after the irritation. Since we cannot keep our children in a bubble, it is helpful to keep windows closed at night and use air conditioning whenever possible. This protects the child from night time exposure and allows recovery from the effects of histamine release. Washing hair at night prevents allergens in the hair from becoming embedded in the pillows and again, protects the child from 24/7 exposure. Similarly, children with significant seasonal allergies who play baseball or soccer, benefit greatly from a shower immediately after the game.
Treatment of mild allergy symptoms: For treatment of runny nose, eye discharge and nasal congestion, start with loratadine (Claritin and generics) or cetirizine (Zyrtec and generics) because they both work effectively without making your child sleepy. There is no reason to spend extra money on brand name antihistamine medications. The dose for both is 1 teaspoon (5 mg) once a day for children from 2-6 years and 2 teaspoons (10 mg) once a day for children over 6 years. Anyone over 6 months can use 10 mg reditabs (melt in your mouth for loratadine) or 10 mg chewables (for cetirizine – unfortunately, these taste terrible) or 10 mg swallowable tablets (for both). Diphenhydramine (Benadryl and generics) is the oldest and best know of the antihistamines and also the most effective. However, 10% of people who use diphenhydramine, suffer from sleepiness which is particularly annoying in school age and adolescent children (90% do not however). The dose is 1 teaspoon or chewable (12.5 mg) for 20 pound children (about 1 year of age), 2 teaspoons or chewables (25 mg) for 40 pound children, 3 teaspoons or chewables (37.5 mg) for 60 pound children and 4 teaspoons or chewables (50 mg) or 2 swallowables for children over 85 pounds. We often recommend giving diphenydramine at night to help children suffering from more significant allergies.
Treatment of moderate to severe allergies: When antihistamines are not effective, the next step is usually to begin Singulair which has been shown to prevent the release of histamine. When used in combination, Singulair and antihistamines can really reduce the symptoms of moderate to severe allergies. If your child is experiencing these more intense symptoms, please schedule an appointment to determine if this more intensified program can be helpful.
Treatment of allergy symptoms in infants and young children: We believe that even infants can manifest the symptoms of allergies. If the parents are suffering in April and May and the child is congested, it is certainly possible that the child is suffering from the same seasonal allergies. Unfortunately, there is no medication that is safe for use under 6 months. In the 6-24 month age child, however, please schedule an appointment to see us if you suspect that your child is suffering from seasonal allergies.
Treatment of watery eyes: For many years, the mainstay of treatment was 1-2 drops of opcon A drops, (an antihistamine eye drop) given 3-4 times a day in each eye. The benefit of opcon A has been that it is inexpensive and available over the counter. The downside has always been that it causes a burning sensation and has to be given multiple times during the day. Over the past 2 years, ketotifen (Zatidor and generics) has become available without prescription and has become the treatment of choice. The dose is 1-2 drops to each eye twice a day for as long as symptoms persist.
Treatment of nasal congestion: Unfortunately, there is no product available without a prescription that effectively treats just the nasal congestion. Nasal steroids (Flonase, Nasonex, Rhinocort Aqua and others) are the mainstay of therapy for this problem because they stabilize the nasal passageways and prevent the impact of histamine. If your child is suffering from significant nasal congestion, please schedule an appointment to evaluate if he/she is a candidate for a nasal steroid.
Treatment of cough: When OTC antihistamines are ineffective, often it means that the allergies are more significant and are causing mild wheezing (see link to wheezing). When your child is coughing, especially at night, the treatment is usually a combination of bronchodilators that open up the airways (albuterol and brand names) and inhaled steroids (Flovent, Azmacort and others) which are available only by prescription. Please schedule an appointment for us to evaluate the best combination of medications to help your child.