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DEAR MAYO CLINIC: For years, my son, now 14, has had seasonal allergies, but he’s never been formally tested. Every spring, he takes an over-the-counter antihistamine each morning, and his symptoms always have gone away for the most part. This spring, that’s not the case. He’s constantly complaining about itchy eyes and feeling stuffy. Should he try a different medication, or is it time to see his health care provider?
ANSWER: When antihistamines are not enough to control seasonal allergy symptoms, it is a good idea to see your primary care provider. He or she can do an evaluation and recommend other medications that may help. If symptoms persist, make an appointment for your son with a pediatric allergist.
Seasonal allergies, also called “hay fever” or “allergic rhinitis,” flare up for many people in the spring when blooming trees release pollen — a common allergy trigger. Symptoms of seasonal allergies include a runny nose; nasal congestion; watery, itchy and red eyes; and sneezing. Using an over-the-counter antihistamine to combat seasonal allergy symptoms is a good first step. When that medication effectively controls symptoms, no further medical testing or evaluation is needed. The duration of seasonal allergy symptoms varies; it may be years or lifelong.
When an antihistamine does not adequately relieve seasonal allergy symptoms, there are other treatment options. For example, nonprescription nasal steroid sprays, such as Flonase, may reduce nasal inflammation and runny nose. But they do not work right away. It can take up to six weeks to receive the full benefit of such medications. If your son is having a tough time managing his symptoms, he might not want to wait that long. His primary care provider may be able to offer alternatives that will offer relief more quickly.
A prescription medication called montelukast (Singulair) often can relieve nasal congestion, runny nose and sneezing. This drug works by blocking symptom-causing chemicals in the body known as leukotrienes. Typically, montelukast is used along with an antihistamine and a nasal steroid spray.
In addition to medication, there are some self-care steps you can take to reduce allergy symptoms. During spring and summer, use air-conditioning at home and in the car rather than leaving windows open. Do not hang laundry outdoors where pollen can stick to it.
Although it won’t keep symptoms from coming back, your son may receive temporary relief from nasal congestion by rinsing his nasal passages with sterile saline to flush out mucus and allergens from his nose. Squeeze bottles and neti pots designed for this purpose are available at most pharmacies.
If your son continues to struggle with symptoms despite using a combination of allergy medications, a consultation with a pediatric allergist would be in order. An allergist can conduct testing to pinpoint the specific allergens that are causing your son’s symptoms.
Once the allergens have been identified, immunotherapy may be recommended if his symptoms do not improve with a combination of antihistamines, intranasal sprays and montelukast. Immunotherapy involves administering small amounts of allergen that triggers an immune response but not enough to cause an allergic reaction. Over time, the dose of allergens in the immunotherapy is increased, so the body gets used to the allergen exposure. This process is called “desensitization.” The immune system builds up tolerance to the allergens, and allergy symptoms begin to diminish. Allergy shots are continued once a month for several years.
Traditionally, shots have been used to deliver immunotherapy for allergies. But recently the U.S. Food and Drug Administration-approved sublingual tablets (different from sublingual drops) that can be taken orally have become available for allergen immunotherapy. The way they work is similar to allergy shots. But, unlike injections, they do not require an office visit for every dose. Patients usually take the first tablet at the allergist’s office. After that, the tablets are taken at home. — Dr. Anupama Ravi, Pediatric Allergy and Immunology, Mayo Clinic, Rochester, Minnesota
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