I always feel a special empathy for my young patients with allergies because my own allergies were so bad. Even worse, I've now passed them on to my children. At least they have lots of company: Research suggests that nearly half of all children in the U.S. have some kind of allergy.
Seasonal allergic rhinitis usually develops after a few years of exposure to an outdoor allergen, so it's uncommon in children younger than 2. (However, children can develop allergies to year-round indoor triggers like pet dander and dust mites before age 2.) The typical age for diagnosis is around 4 to 6 years old. Symptoms—including sneezing; stuffy or runny nose; cough and scratchy throat due to postnasal drip; puffy, watery, itchy eyes, mouth, or skin—peak in late childhood and adolescence, and then improve during adulthood.
All this experience as a patient, parent, and pediatrician has armed me with some insider tips that you might not have heard before, even if you have plenty of experience with allergies in your family.
1. Your kid should start taking meds earlier in the year than you may think.
If your child has seasonal allergies, he should ideally start the medicines at least two to three weeks before the beginning of the season (which depends on his specific allergy) and continue them through the end. If your child has allergies year-round, talk to his doctor about keeping the medicines going all year rather than waiting for symptoms to flare up.
Most allergy medicines are far more effective at preventing symptoms than they are at treating them once they start. That's because the runny nose, stuffiness, itching, sneezing, and watery eyes result from a whole cascade of events in the immune system, and once it gets going it's hard to stop. Corticosteroid nose sprays, available over-the-counter, are the most effective type of medicines for allergies (for children 2 and older); they prevent the cascade by decreasing the immune system's response to antigens like dust mites and pollen.
Antihistamines can help relieve symptoms during an attack, but they are even more effective if they're in the bloodstream before the attack starts. Allergy medicines, which may either be prescribed or bought over-the-counter, are often given once a day—which means they need about five days to reach their full strength and another five to wear off completely. Oral antihistamines relieve many allergy symptoms (including sneezing and itchy eyes) by blocking histamine, the chemical "culprit" in the body, but they don't relieve nasal congestion.
2. Pollen counts don't tell the whole story.
If your child has had allergy testing, the results will be much more useful than relying on monitoring the overall pollen count. If she's not allergic to ragweed, for example, then a high ragweed count shouldn't keep her off the playground.
Children who only have allergies in certain seasons are likely allergic to pollens or mold spores that appear at specific times of year. Doctors can perform skin and/or blood tests to help you learn which types of pollen cause your child's flare-ups, and you can monitor pollen counts to know when to start medicines and, on the worst days, when to limit your child's time outdoors. As a general rule, trees pollinate in the spring, grasses bloom in mid- to late spring or early summer, and weeds in the late summer or early fall. In colder climates, mold spores are a summer to early-fall phenomenon, but in warm places (like North Carolina, where I live), they can remain airborne year-round.
Many weather services report overall pollen levels or levels of specific allergens such as ragweed, the most common cause of hay fever. The National Allergy Bureau, a service of the American Academy of Allergy, Asthma, & Immunology, provides reports on pollen from specific species of trees, weeds, and grasses around the country—as well as mold-spore counts—at aaaai.org.
3. Winter has a big effect on allergies.
Cold winter weather is a blessing for many kids with seasonal allergies, who can count on a break until at least February. A warmer winter can cause plants to pollinate early, meaning sufferers' symptoms start up sooner than usual. A rainy spring can also promote rapid plant growth and lead to an increase in mold, with effects that last well into the fall. Rain can wash away pollen, but the relief is only temporary since pollen counts can rise rapidly following wet weather.
Other weather clues that may help you to head off your child's worst symptoms: Warm, windy days generally lead to a high pollen count, whereas calm days can leave all that pollen on the ground rather than flying into your child's nose.
4. Kids ages 5 and older can try a new treatment.
When I was a child one of the only things that helped my allergies was getting "allergy shots," properly called immunotherapy or AIT. Even today, shots are usually given one or two times every week or month for three to five years and act much like a vaccine, offering exposure to increasing levels of the substance you're allergic to so your immune system adapts and becomes less reactive. Injections were the only form of immunotherapy approved for children in the U.S. until April 2014, when the FDA approved the first of three oral immunotherapy agents.
This form of daily immunotherapy has been popular in Europe, where children apparently hate shots just as much as they do here. Absorbed under the tongue, the tablets contain an extract of grasses or ragweed. In order to benefit from the therapy, children need to be at least 5 years old and have a positive allergy test for a pollen allergy that can cause sneezing, runny or itchy nose, and watery eyes. One caveat: Due to the (rare) possibility of symptoms of a serious allergic reaction, your allergist must observe your child for at least 30 minutes after the first dose, and afterward your allergist should prescribe an epinephrine auto-injector in case of emergency.
5. Honey may help—but there's no proof.
Some parents swear by local honey as an all-natural immunotherapy. (It's safe for kids 12 months and older.) If regular exposure to allergens is how immunotherapy strengthens a patient's immune system, shouldn't a tasty substance laden with pollens from your local area have the same effect?
Unlike immunotherapy, honey doesn't contain consistent levels of pollen. There are few scientific studies of honey and allergies, and the ones that exist have conflicting results. Research has shown that any honey works as well as medicine for cough (given by teaspoon on an as-needed basis), but the jury is still out on whether local honey reduces allergy symptoms in children. That said, it has to be the yummiest unproven therapy out there.