Options for Allergies

I want to like Spring–I really do. The sunshine is radiant, the flowers are blooming, and there are baby chicks at Tractor Supply. You couldn’t ask for much more. But for allergy sufferers (like me), springtime can be miserable. Fortunately, the possible solutions for allergy sufferers have never been better. Here’s a quick overview of your options (roughly in order of preference):

  1. Do nothing: As much as doctors get accused of throwing medicines at everything, symptoms don’t always need medication. Just like many other conditions, there is a huge spectrum of symptom severity with allergies. Some people will have some mild sneezing and runny nose only after extended outdoor excursions on days with heavy pollen. For those people, it’s probably not worth the expense, hassle, or minimal risk of a daily medication. Just “dealing with it” may be all that’s necessary.
  2. Minimize exposures: Allergies are triggered by allergens; if there’s no exposure, there will be no symptoms. I’m not saying you should lock your kids in the house until June, but there’s something to be said for eliminating unnecessary exposures. Keep the windows in your house and car closed to keep pollen out (indoor allergens are another topic, and I’ll cover them later). Try to discourage your kids from rolling around in the grass, and when they come back inside, have them bathe and change clothes. It’s easy to follow pollen counts online and know which days are the most likely to cause symptoms. (If looking it up is too much of a hassle, the general rules are that every plant/tree has a peak time of year, wind makes pollen go airborne, and rain rinses it out of the air.) Avoiding outdoor activities on days with high pollen counts can do a lot to minimize suffering.
  3. Nasal rinses: This is an ancient practice that has been shown to have benefit in relieving both allergies and cold symptoms. (I’m not opposed to all alternative treatments, just the ones that don’t work.) Nasal rinses are a great way to remove allergens that have already found their way into the nasal passages before turning to medical management. I have to admit, this was a tough one for me to embrace (personally), but now it’s the first thing I do after being outside during allergy season. Essentially, it involves some method of sending a stream of saline solution up one side of your nose and out the other. The traditional method is the neti pot; I prefer a plastic squeeze bottle. Either choice will likely be a tough sell for young children. You can buy individual packets to mix with water or mix your own. For the sake of liability, everyone recommends using boiled or distilled water; this is based on two extremely unfortunate Louisianans that used tap water containing amoebas. Again, exceedingly rare…just keep your neti pot clean, and don’t squirt amoebas up your nose.
  4. Nasal steroids: When symptoms are bad enough to need a daily medication, I prefer to start with nasal steroid sprays. While it takes a few days for them to start working, these medicines have been shown to work better than oral antihistamines, as they do a better job reducing overall inflammation. The side effects (if any) are pretty minimal–usually just dryness inside the nose or very mild nosebleeds, and the doses are low enough that they don’t tend to cause the problems we associate with systemic oral steroids. As of a couple years ago, some of them (Flonase, Rhinocort, Nasacort) are available over the counter. They’re not cheap, but they may save you the hassle and cost of an office visit. Giving these medicines may be a struggle at first, but most kids get used to nose sprays pretty quickly.
  5. Antihistamines: These are what most people think of as “allergy medicine.” While they aren’t quite as effective as nasal steroids, they act more quickly and usually work well. They’re better-suited to every-now-and-then use. They also tend to be less expensive, and until recently, they were one of the few over-the-counter options. Benadryl (diphenhydramine) is an old-school (first-generation) antihistamine that still works fantastically for allergies, but its sedating properties make it a poor choice for school days, family activities, or pretty much any situation when you might want your kids to be awake. You also have to give it four times a day, which is a hassle, and–let’s face it–never actually happens. If your child has bad allergy symptoms and trouble sleeping, it’s a great option; otherwise, not so much. Fortunately, there are other choices. The second-generation antihistamines were created to address allergy symptoms while eliminating many of the side effects–most notably, sedation. Claritin (loratidine) and Zyrtec (cetirizine) are both non-drowsy, once-daily medicines that are available in generic forms over the counter and are approved for use in children. Allegra (fexofenadine) is even less likely to make kids sleepy, but it has to be given twice a day. All three of these medicines do the same thing, but different ones may work better in different individuals. If one doesn’t work, try another.
  6. Eye drops: For those people whose only symptom is itchy, watery eyes (or whose only remaining symptom after using some of the treatments above is itchy, watery eyes), antihistamine eye drops can be a great choice. There’s very little risk of side effects, and the medication goes right where you need it. There are several options available over the counter; my favorite is Zaditor, which works almost as well as the prescription-only alternatives. Eye drops are another treatment that can be difficult for young children (and many adults), but if you can get them in, they’re very effective.
  7. Immunotherapy: This is essentially re-training your immune system to stop over-reacting to certain allergens. There’s really no reason that you need to sneeze when exposed to birch pollen, and that’s the root problem with allergies–over-reacting to something that isn’t harmful. In people with allergies, starting with very small doses and gradually increasing the exposure can teach the immune system to stop over-reacting and correct the root of the problem. Unfortunately, it can also trigger a life-threatening allergic reaction, so this is best done under the supervision of an allergist. Allergy testing (more on this later) is often misunderstood and over-utilized, but in this case, it is necessary to determine which allergens should be used to desensitize an individual. Immunotherapy is expensive and requires frequent office visits, but it can be very effective and even life-changing for some people. Until very recently, immunotherapy was synonymous with shots, but in 2014, the FDA approved the first oral immunotherapy medication. There are a few of these available now, and more in the development stage. Their use is limited for now, but an end to allergy shots may be in sight (although I have a feeling that an orally-dissolving tablet containing cockroach poo may be poorly received).

There are, of course, other options that I have intentionally left out. The ones I discussed are the big ones, most of which can be obtained over the counter, and some combination of which will be enough to make allergy symptoms tolerable, or even non-existent, for the majority of kids. If you’re interested in reading more, the American Academy of Allergy, Asthma, and Immunology pretty much covers them all in a comprehensive, slightly-outdated, and somewhat dry 84-page document.

As I was working on this post, I solicited questions from readers on my Facebook page. Here are some answers to questions I received (if I didn’t answer them above):

  1. How do I know symptoms are caused by allergies (vs. a cold)? It can be tricky to know whether a child’s runny nose or congestion is caused by allergies or a viral infection. Here are a few things that would make me lean more towards allergies: itchy eyes or nose, symptoms that get worse with exposures to pollen/pets/other triggers, symptoms that last longer than a couple weeks, or a family history of allergic diseases (yep, it’s probably your fault).
  2. When are allergies worth treating? The answer to this one really depends on your child’s symptoms and your philosophy about giving medicines. I guess my answer would have to be: when they bother you (or your child) enough to make it worth it. Like any other medical treatment, it’s a matter of benefits vs. risks/costs. For most of the treatments I discussed, the risks are quite low, but the cost and hassle of giving a medicine every day are very real considerations. It may be that your child can get by using a medicine only on rare occasions, or with daily use only during a bad season. But if she is miserable every day, it’s probably worth it to start a daily treatment to prevent symptoms.
  3. What can I do about the cost of daily allergy medicines? Depending on your insurance plan, you may be better off asking your doctor for a prescription, even for medications that are available over the counter. If you’re stuck paying out of pocket, remember that generic forms are cheaper and work just as well. If the dose is right and you can teach your child to swallow a pill, those are a lot less expensive than liquids–and everything is cheaper than the chewables. Finally, don’t forget your typical bargain-shopping tricks: watch for coupons, shop sales, and buy in bulk.
  4. Are there any complications from long-term daily use of allergy medicines? As a whole, the medicines I mentioned are quite safe. Antihistamines have been used for years and really have no long-term effects. Steroids have awful side effects when given orally in large doses for long periods of time–but the low doses delivered directly to the nasal tissue are far less concerning. The most significant long-term effect of prolonged nasal steroid use is slowing of growth, which is estimated to reduce growth by an average of 1/8 inch during a year of continuous use at the highest dose. It’s all about balancing risks and benefits, but if that 1/8 inch matters, you might try shopping for taller shoes.
  5. What alternative treatments are available for allergies? The most effective is nasal irrigation or rinsing, as I discussed above. Eating raw, local honey has been touted as a treatment for allergies, and it even makes sense–it would essentially be a “natural” form of immunotherapy. But plants that are pollinated by bees tend to have heavy pollen that falls to the ground (thus the need for bees), while grasses and trees, which cause allergy symptoms, tend to have lighter pollen that goes airborne all on its own. It might work, if you could train the bees. There are a handful of herbal treatments that have shown some effectiveness in small studies in adults. But they haven’t been studied in kids, and they are not entirely benign (natural≠safe). There’s also the very real possibility with herbal supplements that the contents won’t match the label. And as I’ve said before, don’t waste your money on homeopathy.

In summary, the allergy medicines I discussed above are some of the best-studied medicines we have. If the symptoms aren’t bad enough to treat, that’s great–don’t treat them. But if you’re going to treat your child’s allergies, do it with something that works and that we know is safe.

As always, your comments are welcomed (even if you happen to disagree). I'll get back to you as soon as I can. Please try to keep it civil--I reserve the right to delete comments that are offensive or off-topic.

One thought on “Options for Allergies

  1. Thanks for the tips for dealing with spring allergies. For me, the only symptom I really have is the red, itchy eyes. I like your idea of using some antihistamine eye drops, so I will go out and get some soon.

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