Hay Fever (Nasal Allergies)

DEFINITION

  • An allergic reaction of the nose (allergic rhinitis)
  • An itchy nose and clear discharge is common

Symptoms

  • Clear nasal discharge with sneezing, sniffing, and nasal itching
  • Eye allergies (itchy, red, watery and puffy) are commonly associated
  • Ear and sinus congestion may also be associated
  • A tickling, scratchy sensation in the back of the throat can be associated
  • Itchy ear canals, itchy skin, and hoarse voice are also seen
  • Symptoms occur during pollen season
  • Similar symptoms during the same month of the previous year
  • No fever

Causes

  • Hay fever is an allergic reaction of the nose and sinuses to an inhaled substance, usually a pollen.
  • Grass, tree and ragweed are common pollens
  • Allergens from cats and other animals

See More Appropriate Topic (instead of this one) If

  • Doesn't look like hay fever, see COLDS

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Lots of coughing
  • Sinus pain around cheekbone or eyes (not just congestion) and not relieved by antihistamines

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Hay fever symptoms interfere with school or normal activities after taking antihistamines for 2 days
  • Diagnosis of hay fever has never been confirmed by your doctor
  • Year-round symptoms of nasal allergies

Parent Care at Home If

  • Hay fever and you don't think your child needs to be seen

HOME CARE ADVICE FOR HAY FEVER

  1. Reassurance:
    • Hay fever is very common, occurring in 15% of children.
    • Nose and eye symptoms can be brought under control by giving antihistamines.
    • Because pollens are in the air every day during pollen season, antihistamines must be given daily.
  2. Antihistamines:  
    • Give antihistamines continuously during pollen season (continuously is the key to control).
    • Chlorpheniramine (e.g., chlortrimeton) products are effective and don't need a prescription. Any antihistamine you have will do, but some may cause more drowsiness.
    • See dosage charts for chlorpheniramine or benadryl.
    • The bedtime dosage is especially important for healing the lining of the nose. (Benadryl is a good choice for bedtime)
    • Long-acting products (less dosages per day) and combination antihistamine-decongestant products (less sedating) may be more helpful.
    • Loratadine: Newer antihistamine that causes less sedation and lasts 24 hours (over-the-counter in 2003).
      • Dosage: 10 mg tablet once daily in morning (orally dissolving tablet also available)
      • Indication: weight over 66 pounds (30 kg) AND drowsiness from Benadryl or chlorpheniramine interferes with school
      • Limitation: doesn't control hay fever as well as older antihistamines.
      • Cost: store brand usually costs half the Claritin brand
    • Benadryl: If the runny nose and itchy eyes are out of control and your child is taking long-acting antihistamines, give 1 dose of Benadryl (see dosage table) to stabilize your child.
  3. Eye Allergies:  
    • For eye symptoms, wash the pollen off the face and eyelids.
    • Then apply cold compresses.
    • Antihistamine-vasoconstrictor eye drops (no prescription needed) are sometimes needed, but oral antihistamines usually control eye symptoms.
  4. Wash Off Pollen:  
    • Remove pollen from the nose with nasal washes (using warm tap water) whenever needed.  
    • Instill 2 or 3 nose drops in each nostril followed by blowing the nose.  Repeat until open.  
    • Remove pollen from the hair and skin with hair washing and a shower, especially before bedtime.
  5. Expected Course: Since pollen allergies recur each year, learn to control the symptoms.
  6. Call Your Doctor If:
    • Symptoms aren't controlled in 2 days with continuous antihistamines
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 7/15/2007

Last Revised: 8/5/2007

Content Set: Pediatric HouseCalls Online

Copyright 1994-2007 Barton D. Schmitt, M.D.