ALLERGIES
Allergic rhinitis is an inflammation of the nasal
membranes and
eyes caused by sensitivities to certain particles in the environment,
such as pollen and molds (spring and fall) or dust mites and animal
dander (all year round). The symptoms of allergic rhinitis are a runny
or stuffy nose, sneezing, itching of the eyes, nose, or throat, and
sometimes headache and fatigue.
Allergen
Avoidance
The first step in treatment is to help your child avoid the
allergens causing the problem. Dust mites, mold, and pets are the major
indoor allergens. Concentrating on eliminating allergens from the
bedroom is often an effective first step, since children spend eight to
twelve hours each day in the bedroom.
Pollen
counts are the highest
between 5 a.m. and 10 a.m., so
keep your child's bedroom window closed at night during pollen season.
It is also helpful to keep car windows closed to avoid pollen blowing
into children's faces while driving in the car. Because children spend
at least one third of their day in the bedroom, it is worth trying to
keep the bedroom as pollen-free as possible. Don't bring
anything
in to the bedroom that might carry pollen from outdoors. This
might include removing coats, hats, and even shoes before the child
returns to the bedroom. Don't let pets that have been outside
bring pollen in to the bedroom. Consider wahsing your child's
hair before bed to avoid bringing pollen from outside into the bedroom
and on to the pillow.
Dust mites
are microscopic organisms which live in
bedding, rugs, and upholstered furniture. They survive on human and
animal skin cells, fabric fiber and food crumbs and thrive when the
humidity rises above 50%. The most effective way to decrease your
child's contact with dust mites is to cover the bedding, mattresses and
box springs in air-tight vinyl or nylon cases that zip shut. Also,
remove drapes and upholstered furniture and wash linens, area rugs and
stuffed animals frequently using water hotter than 130 degrees. Cold or
warm water does not kill dust mites. Other effective control measures
are to remove bedroom carpeting, avoid wool blankets and use synthetic
pillows (not down or feathers).
Mold
grows where humidity is high. In addition to the above
measures, use chlorine bleach to reduce mold growth in bathrooms,
cellars and other damp areas. Pets with fur or feathers should be given
away, but if this is not possible at least do not let them in the
child's bedroom. A weekly bath will decrease the amount of allergen a
furry animal sheds. Outside the problem is usually pollen.
Medications
Medications can help relieve many of the symptoms of
allergies. Antihistamines taken by mouth can help control
runny
nose, stuffy nose, sneezing, and itchy
eyes. Older antihistamines (like Benadryl)® have the side
effect
of making the child
sleepy, but the newer antihistamines do
not have a sedating effect. Anti-inflammatory nose sprays can also be
very helpful for nasal symptoms and have minimal or no side effects,
but they are not very effective against itchy, red, or watery eyes.
Eye drops do
help to minimize redness, itching, and tearing of the eyes without
causing burning or irritation. It is generally a good idea to take
allergy medication regularly during your child's allergy season, rather
than only when symptoms are present. Speak with your child's doctor for
more information on these medicines.
Oral Medications
Most
of the newer, non-sedating oral antihistamines are now available over
the counter without a prescription. They all last 24 hours,
and
are intended to be used once daily. Unfortunately, they are
no
longer covered by almost all insurance companies. We
recommend
Claritin®, or its generic equivalents loratadine and Alavert®, as a
first
choice in this category. Occasionally patients find that
Zyrtec®
works a little better, but it also has a higher risk of causing
sedation. These medications are both available without a
prescription.
Eye Drops
Zaditor®
is a new allergy eye drop that is available without a prescription.
It is similar to Patanol®, which has been available by
prescription for many years. Many find that Zaditor® works
better than Patanol®.
Nose Sprays
Steroid nose sprays are generally more effective than oral
medicines for nasal congestion, runny nose, and sneezing, and begin
working more quickly also. Unfortunately, they all require a
prescription, but fortunately this also means that they are often
covered by health insurance. If your child is taking an oral
medication such as Claritin® or Zyrtec® and is not getting as much
relief as you would like, adding a nose spray is a good next step.
Please call our office to discuss.
Allergists
Occasionally, environmental controls
and medications will not
relieve symptoms, so your pediatrician may refer you to an allergist
for your child. Allergists usually try some skin testing to diagnose
the offending agents and then may start a series of desensitizing
injections ("allergy shots".) We generally resort to allergy testing
and possible shots only when the above efforts fail. Fortunately, this
happens infrequently. Allergy shots are not useful for food allergies.
With the correct treatments, most children will be able to
find relief from allergy symptoms and be able to function happily.
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