14-Jul-10 10:00 AM EST

Allergies Can Be Serious

What are allergies?

An allergy is a reaction of the protective immune system of your child’s body in response to something that does not usually bother other people. Certain substances, situations, or physical situations can cause this reaction. These irritants can be found indoors or outdoors. An allergy is also called hypersensitivity. Some allergic reactions need immediate attention.

What do I look for to see if my child has allergies?

Each child can show different signs and symptoms of allergies. However, common signs are itchy, watery eyes, itchy nose, sneezing, runny nose, itchy throat, congestion, rashes, or even trouble breathing. Congestion can lead to “allergic shiners” (which are dark circles under the eyes). The “allergic salute” (rubbing the nose upward because it is itchy) is also common in children. This leaves a small crease in the skin of the lower part of the nose. These signs and symptoms may occur during certain times of the year (seasonal allergies), may be constant (perennial allergies), or may show up after your child eats certain foods or is exposed to certain physical situations

How did my child get these allergies?

Allergies may be passed from parent to child through genetics. They may also be caused by exposure to certain substances that your child’s body thinks is a germ. The immune system normally fights germs. However, the defense system is responding to a false alarm in most allergic reactions. Common triggers include: pollen, mold, pet dander, dust mites, cockroaches, cigarette smoke, viruses, bacteria, insect stings, certain foods, medicines, chemicals, and plants.

What is considered a serious allergic reaction?

Although it is not common in the general population, children with severe allergies to insect bites and stings, foods, or certain medications or vaccines can be at risk for anaphylaxis. Anaphylaxis is a sudden, potentially life-threatening allergic reaction. This is a serious reaction that may affect the skin, gastrointestinal system, respiratory system, and / or cardiovascular system. It is considered a medical emergency if two or more of the systems are affected. Common signs and symptoms of anaphylaxis include difficulty breathing, tightness in the throat (feels like airways are closing up on themselves), hoarseness or trouble speaking, wheezing, nasal stuffiness and coughing, nausea, abdominal pain or vomiting, fast heartbeat or pulse, skin itching, tingling, redness, or swelling,

How do I manage my child’s allergies?

To prevent or treat these reactions, make a dedicated effort to avoid the triggers, using allergy medications, or take your child to an allergist. Your child may benefit from allergy shots. For anaphylaxic reactions, use an epinephrine pen (Epi-pen® or Epi-pen Jr®, prescribed by your primary care provider) and call 911.

First, try keeping your child away from things that cause him/her to have allergic reactions. Allergy-proof your house. Here are some tips:

A completely smoke-free environment is best for your child. Even smoking outside or in one particular room is not enough as smoke residue clings to EVERYTHING, including clothing, skin, hair, etc.
Wear a pollen mask when mowing the lawn or cleaning the house—to avoid pollen exposure
Stay indoors in the morning time because this is when the pollen in the air is high—to avoid pollen exposure
Keep windows and doors closed during pollination season—to avoid pollen exposure.

Listen to the local weather report, usually it will tell you when a pollen count outside will be high. You can also check www.pollen.comfor daily reports in your area

Don’t allow animals in the house—Animal dander can cause these reactions.

Change feather pillows, wool blankets and clothing to cotton or synthetic materials

Wash sheets, mattress pad, and blankets weekly in hot water (if possible, wash the curtains on a regular basis)

Remove carpeting, if possible.

Use air filters

Use a dehumidifier to keep indoor humidity low. Dust mites and mold increase in high humidity.

Keep a list of things that trigger an allergic reaction.

Teach everyone caring for your child how to use epinephrine pens and have two epinephrine pens available if your child is at risk for anaphylaxis to certain foods, medicines, vaccines, and other exposures.

In addition to these methods, over-the-counter medications are available that might give your child some relief. To get the maximum benefit from the allergy medicines, your child should be using these medicines everyday. Taking it only as needed will not work as well as taking it everyday. Continue giving the allergy medicines until the allergy season is over for your child or until the doctor tells you to stop giving it.

Antihistamines, such as children’s loratidine (Claritin®) or cetirizine (Zyrtec®)—help with itch, watery eyes and runny nose.
Nasal sprays such as nasal saline—help clear out the nose
Oral nasal decongestants—help the stuffy nose
Table 1. Antihistamines, nasal sprays, and decongestants for kids

Antihistamines	Approved Ages
Benadryl® (diphenhydramine)	Ages 6 and older
Claritin® (loratadine)	Ages 2 and older
Zyrtec® (cetirizine)	Ages 6 and older

Nasal Sprays	Approved Ages
Little Noses Saline Spray/Drops	All ages
Baby Simply Saline Nasal Drops	All ages
*Little Noses Decongestant Drops	Ages 2 and older

*Oral Decongestants	Approved Ages
*Children’s PediaCare Decongestant	Ages 2 and older
*Children’s Sudafed	Ages 2 and older

*Speak with your child’s pharmacist or pediatrician to make sure your child will benefit from the decongestants before using any of these products.

Check with your child’s pharmacist or pediatrician before giving any of these

medications to your child to make sure you give the right dose

Table 2. Common over-the-counter and prescription medicines used to treat allergies.

Antihistamine (Oral Formulations)	Approved Ages	Dosage Forms	Drowsiness
Allegra^® (fexofenadine)	Seasonal Allergic Rhinitis: ≥ 2 yrs	Generic Tablets: 30mg, 60 mg, 180 mg Allegra ODT: 30 mg (only approved for ≥ 6 yrs of age) Allegra Capsule: 60 mg Allegra Suspension: 30 mg/5 mL Allegra Tablets: 60 mg, 180 mg	1.3%^a
Benadryl^® (diphenhydramine) *many other generic forms available	Allergic Rhinitis: ≥ 6 yrs	Generic Capsules and Liquid Benadryl Liquid and Perfect Measure: 12.5 mg / 5 mL Benadryl Fastmelt Tablets: 12.5 mg Benadryl Tablets, Liquid Gels, Quick Dissolve Strips, Kapgels: 25 mg	Most Sedating; May also potentially cause opposite effects, i.e. excitation^b
Clarinex^® (desloratadine)	Perennial Allergic Rhinitis: ≥ 6 months Seasonal Allergic Rhinitis: ≥ 2 yrs	No Generic Available Clarinex ODT: 2.5 mg, 5 mg (safety and efficacy have not been established for ≤6 yr old) Clarinex Syrup: 0.5 mg/mL (safety and efficacy have not been established for ≤6 months old) Clarinex Tablet: 5 mg	9.1%^c
Claritin^®/Alavert^® (loratadine) *many other generic forms available	Seasonal allergic rhinitis: ≥ 2 yrs	Generic Tablets and Syrup Claritin Syrup*: 5 mg/ 5 ml Claritin Chewables: 5 mg Claritin Tablets, Liquid Gels, Reditabs: 10 mg (only approved for ≥ 6 yrs of age) Alavert Tablets: 10 mg (only approved for ≥ 6 yrs of age) Alavert Orally Disintegrating Tabetls: 10 mg (only approved for ≥ 6 yrs of age)	8%^d
Xyzal^® (levocetirizine)	Perennial Allergic Rhinitis: ≥ 6 months Seasonal Allergic Rhinitis: ≥ 2 yrs	No Generic Available Xyzal Solution: 0.5 mg/mL Xyzal Tablet: 5 mg	3%^e
Zyrtec^® (cetirizⁱne) *many other generic forms available	Perennial Allergic Rhinitis: ≥ 6 months Seasonal Allergic Rhinitis: ≥ 2 yrs	Generic Tablets, Syrup, Chewables Zyrtec Tablets, Liquid Gels: 10 mg (only approved for ≥ 6 yrs of age) Zyrtec Chewables: 5mg, 10 mg (10 mg only approved for ≥ 6 yrs of age) Zyrtec Perfect Measure: 10 mg (only approved for ≥ 6 yrs of age) Zyrtec Syrup*: 5 mg/ 5 mg	5 mg = 1.9%^f 10 mg = 4.2%^f
Antihistamine (Nasal Sprays)	Approved Ages	Dosage Forms	Drowsiness
Astelin^® (Azelastine)	Perennial Allergic Rhinitis: ≥ 12 yrs Seasonal Allergic Rhinitis: ≥ 5 yrs	No Generic Available Astelin Ready Nasal Spray: 137 mcg/actuation	11.5%^g
Astepro^® (Azelastine)	Perennial Allergic Rhinitis: ≥ 12 yrs Seasonal Allergic Rhinitis: ≥ 12 yrs	No Generic Available Astepro Nasal Spray: 205.5 mcg/actuation
Patanase^® (Olopatadine)	Seasonal Allergic Rhinitis: ≥ 12 yrs	No Generic Available Patanase Nasal Spray: 0.6%	in poisoning^h
Antihistamine (Opthalmic Solutions)	Approved Ages	Dosage Forms	Drowsiness
Optivar^® (Azelastine)	Allergic Conjunctivitis: ≥ 3 yrs	Generic Opthalmic Solution: 0.05% Optivar Opthalmic Solution: 0.05%
Pataday, Patanol^® (Olopatadine)	Allergic Conjunctivitis: ≥ 3 yrs	No Generic Available Pataday Opthalmic Solution: 0.2% Patanol Opthalmic Solution: 0.1%
Leukotriene Modifier	Approved Ages	Dosage Forms	Drowsiness
Singulair^® (Montelukast)	Perennial Allergic Rhinitis: ≥ 6 months Seasonal Allergic Rhinitis: ≥ 2 yrs	No Generic Available Singulair Granule Packets: 4 mg/packet Singulair Chewable Tablets: 4 mg, 5 mg Singulair Tablet: 10 mg	in overdoseⁱ

*May be marked as a solution

a: In patients 6 months to 5 years of age.¹

b: Most sedating antihistamine but it may cause excitation in children²

c: In patients 6-11 months old with syrup vs placebo (9.1%, 8.1%).³

d: In clinical trials versus placebo (6%) (no specific information regarding pediatrics); effect was dose-related⁴

e: In children.⁵

f: Somnolence rates in patients 6-11 years of age vs placebo (1.3%); patients 6-24 months, somnolence rate was about the same as placebo. ⁶

g: Up to 11.5% somnolence.⁷

h: Somnolence in mild to moderate poisoning.⁸

i: Drowsiness reported with overdose.⁹

References for Table 2:

sanofi-aventis U.S. LLC. Allegra (fexorendadine) tablets, ODT (orally disintegrating tablets) and oral suspension [product information]. Bridgewater, NJ: sanofi-aventis U.S. LLC; 2007.
Diphenhydramine. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically.
Schering Corporation. Clarinex (desloratadine) tablets, syrup, Reditabs [product information]. Eden Prairie, MN: Schering Corporation; 2005.
Loratadine. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically.
Levocetirizine. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically.
McEvoy GK, ed. AHFS Drug Information 2009. Bethesda, MD: American Society of Health-System Pharmacists, Inc; 2009.
MedPointe Healthcare Inc. Astelin (azelastine) nasal spray [product information]. Somerset, NJ: MedPointe Pharmaceuticals; 2006.
Olopatadine. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically.
Merck Sharp and Dohme Corp. Singular (montelukast) tablets, chewable tablets, and oral granules [product information]. Whitehous Station, NJ; Merck & Co., INC; 2010.

Table 2 Constructed by Amanda Jensen, Christina Christopher, and Michelle Eykamp (PharmD Candidates at time of development) and Lynnette Sever, PharmD, PGY1 Pharmacy Resident at time of development.

General References:

Tietze KJ. Disorders Related to Cold and Allergy. In: Berardi RR, McDermott JH, Newton GD, et al. eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 14th ed. Washington, DC: APhA; 2004: 240-245.

Allergy. National Institute of Allergy and Infectious Diseases. URL: http://www.nlm.nih.gov/medlineplus/allergy.html. Accessed: July 14, 2010.

Serious allergic reactions (Anaphylaxis). KidsHealth. URL: http://kidshealth.org/parent/medical/allergies/anaphylaxis.html. Acccessed July 14, 2010.

Allergy-proof your house. URL: http://www.mayoclinic.com/print/allergy/HQ01514/METHOD=print. Accessed: July 14, 2010.

All about allergies. KidsHealth. URL: http://kidshealth.org/parent/medical/allergies/allergy.html. Accessed: July 14, 2010.

Allergy treatment guide. Keeping Kids Healthy. URL: http://www.keepkids.healthy.com/welcome/treatmentguides/allergy.html. Accessed: July 14, 2010.

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For additional information on this InfoSheets and Tools article, please contact:

Catherine Revzon

Source: Original author: Former TTUSHC-SOP student

KidsMeds