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Hay Fever

One of the most common presentations of allergies in children involves the nose and eyes. The clinical condition involving nasal symptoms is called “rhinitis” and allergic involvement of the eyes is called “conjunctivitis”.
According to the American Academy of Allergy, Asthma and Immunology (AAAAI), allergic rhinitis affects about 40 million people in the U.S., including up to 40% of children. With the onset of spring and fall, many children begin to exhibit symptoms of seasonal allergic rhinitis, or hay fever due to exposure to outdoor allergens, such as tree pollens, grasses and weeds.

What causes hay fever?

  • Seasonal allergic rhinitis, or hay fever, is caused when a person’s immune system mistakenly identifies an allergen (e.g., pollen) as an intruder, much like bacteria or viruses.
  • Once the body has identified a particular allergen as an intruder, it produces antibodies specific to that allergen.
  • In the future, when that allergen enters the allergic person’s body, it attaches to the antibodies and triggers the release of histamine and other chemical mediators of inflammation. This release of histamine and other chemical mediators is what causes allergy symptoms.

How often can hay fever occur?

  • Constant exposure for the allergic individual can cause daily symptoms, resulting in what your physician would diagnose as “persistent, chronic, or perennial allergic rhinitis”.   Allergens responsible for these chronic symptoms may include house dust mites, mold spores, cockroach allergen, feathers, or indoor pets.
  • Symptoms of allergic rhinitis can also be acute or intermittent, presenting only when one is exposed to a relevant allergen. It is not uncommon for a cat allergic individual to have an acute episode of allergic rhinitis  when they enter into the home where a cat resides.
  • Seasonal allergic rhinitis, as its name implies, will manifest itself usually during the pollen seasons, most typically in the spring and fall. Exposure to tree pollens is generally responsible for late winter and springtime symptoms and grass pollens are generally the cause of springtime and early summer symptoms. Flare ups in the fall are typically due to weed pollens and high mold spore exposure.
  • Different people are allergic to the pollen of different plants, but people whose bodies develop allergies to one plant are very likely to develop allergies to others as well.

Can hay fever run in families?

  • Allergic rhinitis does run in certain families and are more common in children that have asthma or eczema.
  • It is also more common in children that are exposed to second hand smoke, air pollution and pets.

What are the signs and symptoms of hay fever?

  • sneezing
  • runny nose
  • nasal congestion
  • watery eyes
  • itchy nose, eyes, ears and throat
  • headache
  • ear and facial pain
  • “allergic salute” - a common habit of children which consists of rubbing their nose upward. This is usually because the nose is itchy and this practice can lead to a small crease in the skin of the lower part of the nose.
  • “allergic shiners” - dark circles under the eyes caused by nasal congestion (see photo called Allergic shiners)

How else can allergic rhinitis adversely affect my child?

  • According to the Pediatric Allergies in America survey, which is the largest and most comprehensive national survey of parents of children under the age of 18 who suffer from allergic rhinitis, and presented at the AAAAI 2008 Annual Meeting in Philadelphia, allergies do interrupt a child’s productivity, sleep cycle and daily functioning.
  • More than 500 parents who had a child with allergies were interviewed about severity and effects of allergies on their child’s life, and their responses were compared to more than 500 parents of children without allergies.Some of the major findings include:
  • Allergy symptoms are interfering with children’s sleep. 40% of parents indicated that their child’s allergies interfere a lot or somewhat with their sleep.
  • Allergy symptoms are limiting children’s activities. Twice as many parents (21%) said allergies limit their children’s activities, compared with only 11% of parents whose child did not suffer from allergies.
  • Allergy symptoms interfere with children’s education. 40% of parents of children with allergic rhinitis report their condition interferes with their performance at school compared to only 10% of parents of children without allergic rhinitis.

How does one make the diagnosis?

  • Based on the history and physical examination, your pediatrician can make a clinical diagnosis of hay fever. They may then elect to give your trial of the basic medications used for treatment.
  • An allergist can also help your child with the immediate symptoms of seasonal allergic rhinitis. And, more importantly, an allergist can identify the pollens to which your child are allergic and then design an effective treatment program to eliminate or minimize their allergies in the future.
  • If the medical history suggests allergic rhinitis, an allergist is likely to perform allergy testing in order to confirm the diagnosis, identify the offending allergen(s), and ascertain the severity of the allergy.
  • The preferable testing method by most allergists is skin testing. This method allows the testing of multiple allergens with the results being available immediately. Alternatively, similar results can be obtained through a blood test called RAST or ImmunoCap.

What treatment options are available?

  • Once the relevant allergens have been identified, a comprehensive treatment plan will be recommended. Treatment options fall into three categories: environmental control, pharmacotherapy, and immunotherapy. One, two, or all three of these options may be recommended, depending on multiple factors such as the severity and chronicity of symptoms, results of past treatment, and the effect that these symptoms have on one’s quality of life.
  • Environmental control: one needs to minimize exposure to allergens to which he/she is sensitive.  As simple as this is conceptually, it may be quite difficult, if not impossible, to implement in many cases. The classic case is the child who is cat-allergic and lives in a home with a cat. Removing the cat from the home can in some cases be curative, but, in reality, there is often great resistance to the recommendation to remove the cat from the home due to the attachment a family develops with a pet, and the resultant emotional issues that can ensue.
  • Pharmacotherapy: there are many medicines available which are quite effective in minimizing or eliminating the symptoms of allergic rhinitis. These generally fall into the categories of 1) the newer, non-sedating antihistamines, such as Allergra, Claritin, Clarinex and Zyrtec and 2) steroid nasal sprays, such as Nasonex, Flonase, and Nasacort.
  • Immunotherapy, or desensitization, is the only treatment that addresses the actual cause of the problem.

Once the cause of the rhinitis has been identified, your allergist will recommend a treatment plan designed to minimize or eliminate your child’s rhinitis and/or conjunctivitis symptoms.

How can exposure to pollen be minimized?

According to The Allergy and Asthma Center in Atlanta, pollen is the most difficult airborne allergen to avoid, but there are still a number of things that you can do to minimize your exposure to pollen.

Here are some tips from the Center at www.allergyinatlanta.com.

In your home:

    • Avoid open windows, attic fans, or any other unfiltered openings for pollen to get into your home. Instead, run your central air or a window unit for air circulation and filtration.
    • Replace your furnace filters or washelectrostatic filters regularly to help clean pollen out of the air. You can also use vent filters on the room vents to catch anything that might have made it by the furnace filter or pollen and other allergens that may have already settled in your air ducts.
    • Run a HEPA air cleaner in your bedroom to help eliminate the pollen that makes its way into your home.
    • Do not dry your clothes on an outside line where they can collect pollen. Instead dry them in a vented dryer.
    • Outdoor pets are covered in pollen. Wipe or brush them down when you let them indoors and bathe them frequently. You should also avoid letting them track pollen onto your bed.

When working outdoors:

    • Avoid work like mowing the lawn or raking leaves, which stir up even more allergens than are already airborne. If you cannot avoid yard work, wear a pollen mask.
    • Take a shower when you come inside to remove pollen from your hair and skin and irrigate your close to remove pollen from your nasal passages.
    • Your clothes and shoes collect pollen when you go out. When you get home leave your shoes by the door and change clothes as soon as possible. This cuts down the time you spend in contact with pollen and the amount of pollen that you bring into your home.

When you are going out:

    • Keep car windows and sunroofs closed and the air on re-circulate when traveling in your car to prevent pollen from making its way in.
    • Keep in mind that pollen is at its worst on windy days, because the wind stirs even more pollen and it travels further. And, pollen is at its best after a prolonged rain, because the rain washes the pollen out of the air.