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The Sneezing Season

Warm weather is a welcome relief to parents and kids who have been cooped up in the house all winter. But for many children, spring also sets off the allergies we call hay fever. "In our house, it's like clockwork," says Janet Coe, of Macungie, Pennsylvania. At the end of March, her 7-year-old daughter, Amber, starts sneezing, sniffling, and coughing. She takes prescription antihistamines to help keep her symptoms at bay until late June, when her allergies taper off. It's a similar story with Coe's two older daughters. "Spring allergies are a nuisance, but they're just part of our lives," she says.

The same is true for millions of other families. It's estimated that up to 40 percent of all U.S. kids suffer from allergic rhinitis, as hay fever is technically called, and the vast majority of these children's allergies are seasonal. In one study, children from families with a strong history of allergies said they were bothered more in the spring than in the fall. "Reactions to ragweed in the fall receive a lot of attention, but trees and grasses in the spring can trigger ferocious allergies," says Laurie Smith, M.D., who chairs the section on allergy and immunology at the American Academy of Pediatrics.

Hay fever is a misnomer, because hay does not cause seasonal allergies. The culprits are plant and tree pollens released in massive quan- tities at certain times of the year and ever-present molds that thrive in warm, moist, and shady surroundings. When tiny pollen grains or mold spores enter nasal passages, the immune system of an allergic child identifies the particles as invading organisms and produces inflammatory chemicals in the body. The result? Congestion, sniffling, sneezing, and itchy, watery eyes.

The biggest springtime allergy offenders are pollens from trees such as oak, ash, elm, hickory, box elder, pecan, and mountain cedar, and grasses such as timothy, johnson, Bermuda, redtop, orchard, sweet vernal, and Kentucky bluegrass. "Trees and grasses can release millions of grains of pollen a day, which can travel for hundreds of miles," says Mark Jacobson, M.D., an allergy and asthma specialist in Hinsdale, Illinois. "Even if you don't have trees in your yard, the pollen is still there." Children who live east of the Rockies tend to get hit the worst, especially from mid-April to early May.

Although allergens are difficult to avoid, there are steps you can take to minimize your child's misery. Our step-by-step guide will help your family survive the season with as few sniffles as possible.

Doctors say that if your child is prone to seasonal allergies, the best way to prevent symptoms from occurring is to avoid the allergens in the first place. Here's what you can do to help.

Get a forecast. The release of pollen from trees and grasses depends on the date, not the weather; this makes the onslaught of allergies predictable. "I live in Baltimore, where maples release pollen on the last day of February or the first day of March and oaks start on April 10 or 11," says Robert Wood, M.D., director of pediatric allergy clinics at Johns Hopkins University Hospital, in Baltimore. "Your local allergist should have the same kind of information for your area, which you can use to plan activities or drug treatment." If you know from experience that maple pollen is a big trigger for your child, for instance, you can limit the time he spends outdoors on the days when that particular pollen count is highest.

Newspapers and weather broadcasts on local television often feature pollen and mold counts. For a four-day allergy forecast in your region, check the Allergy Alert service at www.pollen.com, or call the American Academy of Allergy, Asthma and Immunology at 800-976-5536. Limit outdoor play on high-pollen days. It may seem cruel to make your children come inside when the weather is gorgeous, but this strategy really helps, experts say. Keep your windows closed, especially on nice days, when warm, dry conditions make it easier for pollen to travel on the breeze. (Early morning tends to be a high-pollen time of day.) Be sure to put a clean filter in the air-conditioning system at the start of the season and replace it every two to three months.

Mow your lawn. The height of your lawn doesn't affect the release of pollen, but long grass does provide a shady, wet, more sheltered environment for the underlying soil, where mold grows.

Rake old leaves. Last fall, after you finished raking, a few more leaves fell or blew into your yard, and there they sit, their protected undersides slick with moisture. "Leaves are a huge problem because they provide an ideal place for mold to grow," Dr. Wood says. Rake up the leftovers and put them in the garbage or take them to a recycling dump.

Reduce pollen cling. Like a fine household dust, pollen clings to clothes, skin, and just about anything else it lands on. (Oak pollen, for example, forms a yellowish powder that you may notice dusting parked cars in springtime.) To keep it off your child, avoid hanging clothes, towels, or sheets outside to dry. Have your child wear sunglasses or eyeglasses outdoors to help keep pollen away from her eyes, and when she comes in, use a damp washcloth to wipe her face, especially around her eyes. Just before bedtime, have your child take a bath or a shower. "Otherwise, she'll go to bed with a head full of pollen, which she'll react to all night long," Dr. Wood says.

Despite your best efforts to reduce her exposure to pollen, your allergic child will inevitably experience some sneezing and sniffling during the spring months. Your doctor may not need to prescribe medication if these over-the-counter measures provide enough comfort.

Try antihistamines. Antihistamines remain the most popular and least expensive line of defense against allergies. They don't prevent an allergic reaction but counter the effects of histamine. (Most allergy drugs are formulated in doses for children as young as 3, which is generally the earliest that allergies begin in kids.) Although antihistamines can provide relief from sneezing, itching, runny nose, nasal congestion, and eye irritation, however, they're often sedating, a side effect you may not want for your child, especially if he's in school. Conversely, they can cause hyperactivity in some kids.

Consider cromolyn. Cromolyn sodium, a nasal spray that until recently was prescription only but can now be bought over the counter in a children's formula, inhibits the release of histamine from special cells called mast cells. Each dose blocks a reaction for about four hours. Knowing in advance when allergies will strike can help: For cromolyn to be fully effective, doctors often advise giving it to your child regularly for one to two weeks before allergy season. "It can also be helpful taken just before your child is exposed to an allergen on an as-needed basis," Dr. Smith says.

Avoid decongestant sprays. Giving your child a nasal spray to relieve stuffiness is acceptable for short-term relief as long as you don't use it for more than a day or two. "If you use them longer than that, they can cause a rebound effect, in which the congestion becomes even worse," Dr. Smith says. Because seasonal allergies tend to last weeks or months, not days, Dr. Smith is cautious about recommending them at all. Oral decongestants don't pose a rebound problem, but they also don't address sneezing and itching and can make some children hyperactive.

If preventive measures and over-the-counter remedies don't give your child relief, your doctor can prescribe a stronger medication. After taking an in-depth history of your child's allergy patterns, she may recommend one of the following treatments:

Nonsedating antihistamines. A number of prescription antihistamines now on the market control the effects of histamine without making kids sleepy or lethargic. They're also convenient: You need to give these formulas to your child only once a day, making them easier to deal with than over-the-counter antihistamines, which typically must be administered every four hours.

Nasal steroids. Nasal cortico-steroid sprays fight allergies on several levels, reducing inflammation and mucus output and cutting back the number of histamine-producing mast cells. Although there has been concern in the past that steroids could affect children's growth if they were absorbed into the body, nasal sprays keep the drug localized in the nose, and the doses -- which have been approved for kids as young as 3 -- are extremely low. "We're confident that low doses, especially when used only on a seasonal basis, are okay," Dr. Wood says, although the drug can cause a mild burning sensation that some kids don't like.

Allergy shots. If your child suffers from limited seasonal allergies only, injected immunotherapy is usually not needed. With this treat- ment, children receive increasingly concentrated doses of the allergen they react to, which over time produce changes in the immune system (for example, reducing the numbers of antibodies that attack the allergen) and make the body less reactive.

The good news for any child with spring allergies is that there's an end in sight. Your child's symptoms should clear up by May, although some cases can last until mid-July. "Unfortunately, however, if your child reacts in the spring, you can probably look forward to hay fever in the fall as well," Dr. Wood says. "Allergic people tend to react to more than one trigger." But even if your child's symptoms do return in autumn, you'll have a smart treatment strategy already in place.