Patient Education

Allergies

Millions of Americans have pollen allergies, an unusual sensitivity to substances that are normally harmless. The most common allergy symptoms include sneezing, runny nose, nasal congestion, watery and itchy eyes and a scratchy throat. If you suspect your child has pollen allergies, here are some tips to minimize exposure:

  • Pollen is at its highest levels in late evening and early morning. Avoid going outside during peak levels. Also keep your windows closed as much as possible, especially during those hours.
  • Check the weather network for forecasts of local pollen counts and if you can, avoid going outside on a day when the pollen count is high (especially a dry, windy day.)
  • Keep the windows closed in your home and car, using air conditioners when possible. Air conditioning recirculates indoor air, instead of outside air which carries pollen.
  • Have someone kill weeds by cutting them or using weed killers.
  • Use HEPA filters in the home, including HEPA air filters and vacuum cleaners. HEPA stands for High Efficiency Particle Arrester, which is a type of filter designed to absorb most particles floating in the air.
  • Do not hang your laundry out to dry. Pollen collects on the clothing/sheets and increases pollen exposure inside your home.
  • If your child spends time playing outside, wash their hair before they go to sleep. Pollen settles on the scalp/hair and then falls on their pillows when they lay down.

If your child continues to experience symptoms, you may need to consider medication. In the past several years many of the common antihistamines used for allergies have gone over-the-counter (OTC). As a result, there is no longer any medical reason for patients to routinely request a prescription for an oral allergy medication. If you have tried one of the medications for 1-2 weeks without result, then you should give a different medication a trial. Sometimes patients will find that one medicine works well for a few years and then their body seems to build up a "tolerance" and that medicine no longer controls symptoms. In this case, patients often find relief with a different class of antihistamine. Many of these antihistamines also come in combination with decongestants. If your child is experiencing significant congestion you may want to try a combination product initially, but we recommend using a straight antihistamine for daily control during the allergy season. Ask your pharmacist for assistance if you are having difficulty choosing the right medicine for your child. 

Flonase is now Over The Counter (OTC) and approved as a safe/effective allergy treatment for children 4 years of age and older. It can be used alone or in combination with an antihistamine for maximum allergy relief. During peak allergy seasons, many patients require both medications for control. In addition to nasal symptoms, many times Flonase is also helpful for itchy eyes. Be sure to read instructions on how to use Flonase correctly. Other approved intranasal sprays include Nasacort (approved for use in children 2 and older), and Rhinocort (approved for use 6 and up).

Benadryl (Diphenhydramine), one of the oldest and most effective antihistamines, comes as 12.5 mg/tsp or 12.5 mg chewable tabs, and as 12.5 OR 25 mg tabs/capsules. It can be used for allergies, to dry up a runny nose, or for itching and hives. Benadryl usually makes children sleepy, but in about 5% of patients causes a "paradoxical" reaction and makes them hyperactive. (Don't try it for the first time when you are boarding an airplane with a toddler, in case they happen to be one of those 5%.) Benadryl should be given every 6 hours as needed. Since the medicine may make your child sleepy, some people try to use a slightly lower dose during the day, with the full dose given at night.

    Benadryl
 Weight  Dose in mg  Liquid  Chewable
 10-14 lbs  6.25 mg  ½ tsp  
 15-20 lbs  9.375 mg  ¾ tsp  
 21-25 lbs  12.5 mg  1 tsp  1 tablet
 26-30 lbs  15.625 mg  1¼ tsp  1¼ tablet
 31-35 lbs  18.75 mg  1½ tsp  1½ tablet
 36-40 lbs  21.875 mg  1¾ tsp  1¾ tablet
 Over 40 lbs  25 mg  2 tsp  2 tablets
 Over 12 yrs  25-50 mg  2-4 tsp  2-4 tablets

 

The most common “new generation” OTC antihistamines are Loratadine (Claritin and Alavert) and Cetirizine (Zyrtec) and Fexofenadine (Allegra). For more information, see doses below or go to their respective websites.

Loratadine (Claritin/Alavert)
 Age  Syrup 1mg/1ml  5 mg chew or
oral dissolving tabs
 10 mg tablets
 Under 2 yrs  Not recommended  Not recommended  Not recommended
 2-5 yrs  1 tsp once daily  1 tablet once daily  Not recommended
 6+ yrs  2 tsp once daily  2 tablets once daily  1 tablet once daily

 

Cetirizine (Zyrtec) - may make tired, consider giving at bedtime
 Age  Syrup 1mg/1ml  5 mg chew or
oral dissolving tabs
 10 mg chew/swallow tabs
 Under 2 yrs  ½ tsp once daily  Not recommended  Not recommended
 2-5 yrs  ½ to 1 tsp once daily  ½ to 1 tablet once daily  Not recommended
 6+ yrs  2 tsp once daily  2 tablets once daily  1 tablet once daily

 

Fexofenadine (Allegra)
 Age  Dose in mg Children's Liquid Dose  Children's Tablet Dose  60 mg 12 hour Tablets 180 mg 24 hour Tablets
 Under 2 yrs Not recommended Not recommended  Not recommended Not recommended  Not recommended 
 2-6 yrs  30 mg 1 tsp every 12 hours  1 tablet every 12 hours  Not recommended   Not recommended 
 6-12 yrs  30 mg 1 tsp every 12 hours 1 tablet every 12 hours    Not recommended    Not recommended 
12+ yrs 60 mg 2 tsp every 12 hours 2 tablets every 12 hours 1 tablet every 12 hours 1 tablet every 24 hours


For patients whose allergy symptoms are mostly eye symptoms (itchy, watery eyes), consider using Zaditor drops, which are now OTC as well. The usual dose is 1 drop in each eye every 12 hours as needed.

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