Treating seasonal allergies in teens, kids, and toddlers

As any parent or elementary school teacher will tell you, kids get sick…a lot. It can seem like they are always coughing, sneezing, or wiping a runny nose. It’s easy to write these symptoms off as the latest virus going around at daycare or in class. Or, to worry that it’s COVID-19. However, sometimes these symptoms are a sign of a more chronic problem. 

Seasonal allergies in teens, kids, and toddlers often look like the common cold, but won’t go away without using the correct allergy medicine or allergy proofing your home. 

What are seasonal allergies?

Seasonal allergies, sometimes called hay fever or seasonal allergic rhinitis, are symptoms that happen around the same time of year every year, usually in response to environmental allergens. When you have an allergy to spores or pollen released by plants or dust, your body releases histamines in response to these allergens. This causes the itching, coughing, and congestion that are associated with seasonal allergies. If you or your child experience these symptoms, you are not alone: Hay fever affects approximately 7.7% of adults in the United States and 7.2% of children.

Seasonal allergy symptoms in toddlers and children

Symptoms of seasonal allergies in young children and adolescents may include any combination of the following: 

• Scratchy or sore throat
• Sneezing
• Runny, stuffed up, or itchy nose
• ​Nasal drainage
• Red, irritated, or itchy eyes
• Coughing
• Itchy skin
• Wheezing or trouble breathing (less common)

“Symptoms of seasonal allergies can affect various organ systems,” explains Salma Elfaki, MD, a board-certified pediatrician at Lake Nona Pediatric Center in Orlando, Florida. “Some children can have [a] runny nose, cough, itchy nose. Some patients can also develop itchiness and redness and watery discharge from [their] eyes.” 

These are fairly common symptoms of allergies, but some children will have a more acute reaction. “More severe allergies can cause wheezing and worsening of asthma,” Dr. Elfaki says. “Some children can also develop skin reactions such as eczema or break out in hives (urticaria), which can be mild or very severe.”

If your child is struggling to take a full breath, has difficulty swallowing, or develops a rash or swelling, seek medical help immediately. These could be signs of a severe allergic reaction, similar to what you might expect with food allergies.

How do you know if your child has seasonal allergies?

It’s best to visit your child’s provider rather than self-diagnosing and risking treating your child with the wrong medication. When diagnosing allergies, your child’s healthcare provider will take several factors into consideration:

• Age
• Severity and frequency of symptoms
• Impact of symptoms on daily functioning 
• Associated conditions (such as asthma or eczema)
• Family history
• Past medical history 
• Previous treatment
• Findings on examination

Your child’s provider may suggest allergy testing if your child experiences these symptoms regularly at certain times of year. Allergy testing is usually performed by an allergy specialist by applying allergens to the skin or by running blood tests. 

RELATED: When to allergy test your child

What causes seasonal allergies in kids?

Allergy symptoms occur when your child’s immune system reacts to an allergen (a foreign substance)—such as dust, mold, or pollen—as if it’s a bacteria or virus. Seasonal allergies occur only at certain times of the year, when the allergen that bothers your child is around. According to the American Academy of Allergy, Asthma, and Immunology, common seasonal allergy triggers include:

• Tree pollen
• Grass pollen
• Ragweed
• Mold
• Dust

Though, there are many other plants that can cause allergy symptoms, along with year-round triggers such as pet dander, foods, dust mites, and air pollutants like smoke.

Types of seasonal allergy medicine for kids

“There is treatment available that can help children feel better,” says Kathleen Dass, MD, a physician and the CEO of the Michigan Allergy, Asthma, and Immunology Center. 

There are five main types of over-the-counter allergy medications for children.

1. Oral antihistamines

Exposure to allergens causes the body’s immune system to release histamines, triggering an allergic response. For example, your kiddo might experience a stuffy or runny nose, itchy or watery eyes, sneezing, coughing, a sore throat, or dark circles under their eyes after being exposed to an allergen like pollen or dust mites. 

Oral antihistamines work by blocking histamine receptors, which treats allergic reactions, according to Brian Modena, MD, an allergist and immunologist at Modena Allergy + Asthma in La Jolla, California. He explains that there are four types of histamine receptors in the body (H1-H4); H1 receptors are responsible for allergic reactions. 

“Histamine, acting on H1 receptors, causes things like hives, itching, flushing, headaches, changes in heart rate, dizziness, fatigue, increased pain, difficulty breathing, abdominal pain or discomfort, diarrhea, and anaphylactic reactions,” Dr. Modena says. 

Two types of over-the-counter allergy medications are used to treat allergic reactions:

First-generation antihistamines such as Benadryl (diphenhydramine) are the oldest and least expensive of their class, but because they cross the blood-brain barrier, they cause side effects like drowsiness, dry mouth, upset stomach, constipation, delirium, dizziness, irritability, poor coordination, and difficulty concentrating, Dr. Modena explains. 

“We don’t typically recommend that children under the age of 6 use first generation antihistamines like diphenhydramine, unless under the consultation and supervision of a physician,” Dr. Modena advises.

Second-generation antihistamine products such as Children’s Allegra (fexofenadine), Children’s Claritin (loratadine), and Children’s Zyrtec (cetirizine) don’t cross the blood-brain barrier, so they don’t have many of the side effects of the first generation H1-antihistamines, Dr. Modena says. 

While certain allergy medicines can mix safely with asthma medications, such as Singulair (which is a prescription medication), it’s dangerous to double up on antihistamines if the first one you try doesn’t relieve symptoms. It’s also important to read the active ingredients of medications so you don’t unintentionally double up. As a rule, parents should make sure that kids only take antihistamines when advised by their allergist or primary care provider, Dr. Modena says, adding that when it comes to the best allergy medicine for kids, it depends on the symptoms being treated.

According to Wendi D. Jones, Pharm.D., a pharmacist with AspenRx Health, combining cold and allergy medications in patients of any age is not recommended. That’s because cold medications often have allergy medications included in their ingredients, and taking them together can result in increased side effects like dryness or drowsiness, not to mention the potential for overdosing, says Dr. Jones. 

2. Corticosteroids

“Infants, toddlers, and younger children have a hard time tolerating a nasal spray, so it is better to use oral antihistamines [for allergy relief], like Allegra, Zyrtec, [or] Claritin (which come in chewable and liquid forms),” Dr. Dass says. “When children are old enough, an intranasal steroid is standard of care to help treat and prevent seasonal allergies.”

Nasal corticosteroids are sprayed into the nose to reduce stuffiness, control a runny nose, and make breathing easier. They act by relieving nasal congestion and reducing swelling in the nasal passages. But while steroid nasal sprays, like Children’s Flonase (fluticasone) and Children’s Nasacort, work for children, Dr. Modena says that these medications should only be given after an examination and discussion with the child’s pediatrician or allergist. 

These medications work better over time, generally after a couple of days, says Dr. Jones, adding that it’s important to only take the amount prescribed.

3. Decongestants

Decongestants, such as Children’s Sudafed (pseudoephedrine), work by helping the body push out extra moisture, explains Dr. Jones. So if you have a stuffy nose, the decongestant will make it run, ridding the sinuses of excess mucus. 

“Pseudoephedrine should be avoided in the very young without explicit medical direction because it can cause heart palpitations and increased blood pressure,” Dr. Jones says. These medications can also make kids hyper.   

Before using decongestants containing pseudoephedrine, check with your child’s healthcare provider; they should not be used at all in young children under 4 years of age. 

4. Cromolyn

Cromolyn is a medication that decreases the body’s allergic response by stabilizing histamine-releasing cells (meaning less histamine is activated), explains Dr. Jones. But unlike antihistamines, nasal Cromolyn doesn’t work quickly; rather, it may take days or weeks to take effect. 

“Cromolyn is commonly used as a preventative for chronic allergies or asthma rather than an immediate help to allergies,” Dr. Jones explains. “It is highly tolerable and works well, but more for prevention and long-term use.”

Just be sure that you are using the version formulated for children, and the appropriate dosage for your child’s age. You should always consult with a healthcare provider before using OTC medications or combining medications for your child. Then, watch for any side effects such as sleepiness, mood changes, headache, stomachache, or bad dreams.

5. Eye Drops

Sometimes, kids get allergic symptoms in their eyes, says Yuna Rapoport, MD, MPH, a board certified ophthalmologist at Manhattan Eye in New York, NY. For allergic conjunctivitis, Dr. Rapport recommends the over the counter eye drops Alaway (ketotifen fumarate) or the prescription drops Pataday (Olopatadine Hcl). “Sometimes dry eye can overlap with allergic symptoms, so it is important to recognize and treat dry eye as well with lubricating drops,” Dr. Rapport says.

RELATED: Mixing allergy medication

Immunotherapy

For severe allergies, “allergy shots are helpful and can help you outgrow the allergies,” explains Dr. Dass. “We usually do not start allergy shots until the child is at least 5 or 6 years old to help prevent allergies. Further, by controlling allergies, you could potentially help your child’s eczema and help prevent asthma from developing.”

Children’s allergy medicine dosage

The following dosage chart is based on the manufacturer’s instructions for each of these Food & Drug Administration (FDA)-approved medication:

Best allergy medicine for kids
	Children under 2	Children 2-6	Children 6-12
Children’s Allegra (30 mg / 5 ml)	Ask a healthcare provider	5 mL every 12 hours; no more than 10 mL in 24 hours	5 mL every 12 hours; no more than 10 mL in 24 hours
Children’s Claritin (5 mg / 5 ml)	Ask a healthcare provider	5 mL; no more than 5 mL in 24 hours	10 mL; no more than 10 mL in 24 hours
Children’s Zyrtec (5 mg / 5 ml)	Ask a healthcare provider	2.5 mL every 12 hours; no more than 5 mL in 24 hours	5-10 mL; no more than 10 mL in 24 hours
Pataday (0.2% ophthalmic solution)	Ask a healthcare provider	One drop per affected eye once per day, no more than twice a day (every 8 hours)	One drop per affected eye once per day, no more than twice a day (every 8 hours)
Alaway (0.025% ophthalmic solution)	Ask a healthcare provider about use in children younger than 3	Children 3-6:  One drop per affected eye once per day, no more than twice per day (every 8 hours)	Children 3-6:  One drop per affected eye once per day, no more than twice per day (every 8 hours)
Cromolyn (100mg/5ml)	Ask a healthcare provider	One ampule 4 times per day, taken 30 minutes before meals and at bedtime	One ampule 4 times per day, taken 30 minutes before meals and at bedtime
Children’s Nasacort	Do not use	1 spray per nostril daily	1-2 sprays per nostril daily
Children’s Sudafed (15 mg/5 mL)	Do not use	Children younger than 4 should not use.  For children younger than 12 years old, discuss with their healthcare provider before using.	For children younger than 12 years old, discuss with their healthcare provider before using.

Preventing allergies in kids

The best way to stop seasonal allergies is to prevent symptoms before they start. 

• Close windows and keep kids indoors when pollen counts are high. 
• Use a HEPA filter to help reduce allergens within your home.
• Try natural remedies like a neti pot or cold compress to make symptoms more bearable.
• Shower after being outdoors to remove pollen, dust, and spores.
• Reduce carpets and rugs in the home.
• Focus on good nutrition (plenty of fresh fruits and vegetables) to keep allergies at bay, advises Dr. Jones. 
• Consult with an allergist about immunotherapy, Dr. Modena suggests.

If your child lives with seasonal allergies, it’s important to communicate with your provider to determine the most effective treatment plan. With the right medication and preventive measures, you kids can spend more time playing, and less time stuck inside. 

What to ask a healthcare provider

Parents should ask their child’s healthcare provider the following questions about a child’s allergies and medication, advises Jones:

• How much allergy medication should my child take?
• What kind of medication would work best in this situation?
• What should I know about this medication’s frequency, timing, side effects, and cost?
• What ingredients should my child avoid and how can I read nutrition labels?
• Should my child avoid any medications or vaccines? 
• What about allergy treatments like allergy shots for insect stings or peanuts?

Any allergy that affects a child’s breathing is an emergency, says Dr. Jones. It’s possible to have a local reaction to a bee sting that may itch, swell up, turn red, and last for days, but if it doesn’t migrate to other parts of the body, it’s not an emergency. However, if your child is stung and immediately has itching, redness, or swelling away from the sting, it’s important to watch what happens.

If swelling in other areas (such as the mouth, eyes, ears, etc.) occurs, then that sting should be considered life-threatening, urges Dr. Jones. You should call 911. These symptoms could signify anaphylaxis, a severe and potentially life-threatening allergic reaction that often requires the administration of epinephrine, a drug used to treat allergic reactions in an emergency setting.