Hay Fever (Allergic Rhinitis)

McKesson Clinical Reference Systems: Pediatric Advisor 2002.1

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What is hay fever?

Hay fever is an allergic reaction of the nose (and sinuses) to pollen or another substance in the air.

Symptoms include:

a clear nasal discharge
an itchy nose with sneezing and sniffing
itchy, watery eyes (eye allergies)
sometimes, sinus or ear congestion.

Hay fever is the most common allergy. More than 15% of people have it.

What is the cause?

Although pollen is usually the cause of hay fever, it can also be caused by animal dander or something else your child is allergic to. This allergic sensitivity is often inherited.

During late April and May the most common pollen causing hay fever is from trees. From late May to mid-July, the pollen is usually from grass. From late August to the first frost, the leading cause of hay fever is ragweed pollen.

How long will it last?

This is a chronic condition that will probably recur every year during pollen season, perhaps for a lifetime. Therefore, it is important to learn how to control it.

How can I take care of my child?

Oral antihistamine medicine
The best drug for hay fever is an antihistamine. It will relieve nose and eye symptoms. Your child's antihistamine is __________________________________. Give ___________________every ________ hours.
Symptoms clear up faster if antihistamines are given at the first sign of sneezing or sniffing. For children with daily symptoms, the best control is attained if antihistamines are taken continuously throughout the pollen season. For children with occasional symptoms, antihistamines can be taken on days when symptoms are present or expected.
The main side effect of antihistamines is drowsiness. If your child becomes drowsy, switch to a combination product that contains an antihistamine with a decongestant (such as pseudoephedrine). If your child remains drowsy, continue the drug, but temporarily decrease the dosage. Your child should become tolerant of the regular dosage in 1 to 2 weeks. Newer prescription antihistamines cause much less drowsiness and are FDA approved for use in children over age 6.
Prescription steroid nasal sprays for prevention
If not helped by antihistamines, severe hay fever can usually be controlled by steroid nasal sprays. Allergy shots are usually not necessary.
These prescription nasal sprays must be used when the nose is not dripping. Give your child an antihistamine to stop the dripping before you use the spray. Your child's nasal spray is _______________________________. Give ______ puff(s) in each nostril _______ times per day every day. Nasal sprays do not help eye symptoms. Therefore they are usually used along with oral antihistamines.
Pollen removal to decrease symptoms of hay fever
Pollen tends to collect on the exposed body surfaces and especially in the hair. Shower your child and wash his hair every night before he goes to bed. Your child should avoid handling pets that have been outside and are probably covered with pollen.
Prevention of hay fever symptoms
Your child's exposure to pollen can be reduced by not going on drives in the country and by not sitting by an open car window on necessary drives. He should stay away from someone cutting the grass during pollen season. When it is windy or the pollen count is especially high, he should stay indoors. Close the windows that face the prevailing winds.
If your child's hay fever is especially bad, consider taking him to an air-conditioned store or theater for a few hours.
Avoid feather pillows, pets, farms, stables, and tobacco smoke if any of them seem to bring on symptoms of nasal allergy.
Eye allergies associated with hay fever
If your child also has itchy, watery eyes, wash his face and eyelids to remove pollen. Then apply a cold wet cloth to the eyelids for 10 minutes. An oral antihistamine will usually bring the eye symptoms under control. If not, put 1 drop of long-acting vasoconstrictor eyedrops (a nonprescription item) in the eyes every 8 to 12 hours for a few days. Ask your pharmacist to recommend a reliable product.
Common mistakes
Vasoconstrictor nosedrops or nasal sprays usually do not help hay fever because they are washed out by nasal secretions as soon as they have been put into the nose. Also, if they are used for more than 5 days, they can irritate the nose and make it more congested.

When should I call my child's health care provider?

Call during office hours if:

Your child's symptoms are not controlled in 2 days with antihistamines.
Your child develops sinus pain or pressure.
You have other concerns or questions.