Spring allergies

Spring is here!

For those who don’t suffer from seasonal allergies, it’s an amazing turning point. The weather is beautiful, flowers are blooming - all is good.

But for those with hayfever or whose atopic symptoms are triggered by pollen, it can be a really uncomfortable few weeks.

Here is some helpful information about seasonal allergies in all its variations (allergic rhinitis, allergic conjunctivitis, eczema, asthma, and more). If you’re looking for a more practical post about treatment options, check out this post.

AND be sure to check out my free download in the guides section that lists 10 things you can do for allergies that aren’t medication.

Why do allergies happen?

Allergies occur when our immune system overreacts to triggers such as pollen. We develop antibodies called Immunoglobulin E, which then trigger a cascade that includes histamine release from mast cells… leading to those typical allergy symptoms you know and hate.

Allergies absolutely have a hereditary component, and they like to travel alongside other “atopic” conditions such as atopic dermatitis, asthma, and food allergies. But it IS possible to develop allergies even without a known family history.

Allergy symptoms

Symptoms vary by person and can change over time. Here are the most common:

• Nasal congestion/runny nose

  • Allergic rhinitis is the term we use to describe this symptom.

• Sneezing

• Headaches & sinus pressure

• Sore or itchy throat (often worst in the morning)

• Rashes including worsening eczema or hives.

• The “allergic salute”

  • This is something kids with allergies do all the time — they rub the nose upwards  (usually with the heel of their hand) as a way to relieve itching and to help remove mucus so they can breathe more easily (because pushing upwards opens the nostrils wider). It often leads to a crease or even a line/change in pigmentation across the top of the nose (“nasal crease”)

• Itchy, watery, puffy or red eyes

  • Allergic shiners are the darker puffy areas that some children develop around their eyes

• Cough or wheezing

• Fatigue (which may be related to the fact that these symptoms often interfere with restful sleep).

What causes allergies?

It is theoretically possible to be allergic to anything. But the most common causes of environmental allergies in children include:

• dustmites

• mold

• pollen (trees, weeds, grasses)

• pets

• cockroaches

The most common times of year to develop allergy symptoms are spring and fall.

Treatment:

Most allergy medications are available over the counter, and when used consistently, they can be very effective. I find that parents often dismiss allergy symptoms as not a big deal, and avoid treating them, but the truth is that these symptoms can have a tremendous impact on quality of life. Since there are many options, so this warrants an entire post of its own.

The Pediatrician Mom Tip: It can take up to 2 weeks of consistent use to see the full effect from some of these preventive/controller allergy medications.

Things to avoid:

I do not recommend nasal decongestants, cough suppressants or expectorants in kids (eg afrin, sudafed, dimetapp, mucinex). We also do not recommend Benadryl anymore.

These medications can cause side effects including drowsiness, upset stomach, seizures, increased heart rate, & even death.  Some cause worse rebound symptoms (such as Afrin) if used for more than 3 days. None have really been shown to be all that helpful in kids.

What can I do apart from medications?

The best way to avoid allergy symptoms is to minimize exposure to the triggers. Check out the free download in the guide section for a list of practical ways to do this!

When to consult the allergist

This is not a comprehensive list. In general, always err on the side of calling your pediatrician if you have any concerns about your child. There is a lot to be said for a parent’s gut instinct, and I promise: your pediatrician would rather you called!

In most cases, a general pediatrician can handle standard allergy symptoms. We bring in allergists in unusual circumstances, when routine interventions are not working, or when allergies are so severe that they are disrupting day to day life. Immunotherapy (allergy shots) can be helpful in these situations.

FAQs

Can infants get seasonal or environmental allergies?

Environmental allergies are a result of exposures within the environment, so it is rare for young infants under age 1 to develop them. However, it is not impossible.

Dust mites, pets, and mold are more likely than pollen to trigger allergies in babies. This is because they are more likely to have sustained exposure to these indoor allergens.

Infants do often have rhinitis (or nasal congestion) for other reasons, but it is not necessarily allergic rhinitis. However, it can be hard to tell, especially for those who are in daycare and have frequent upper respiratory infections, so infants are often misdiagnosed as having environmental allergies.

Do you recommend Benadryl for allergies?

Benadryl (or Diphenhydramine) is called a 1st-generation antihistamine. It is no longer favored as a first-line treatment option for allergies. This is because it doesn’t last as long as newer medications, and because it more easily crosses the blood-brain barrier which means more possible side effects. 2nd generation antihistamines are more effective, longer-lasting, and cause fewer side effects.

I’ve heard raw local honey can be helpful. Is this true?

I’m a big fan of honey. And it does help for coughing — but for allergies? No.

There aren’t many studies. In one RCT (PMID: 11868925) people who had scratch-test confirmed allergies received either placebo, local raw unfiltered honey, or national pasteurized honey. There was NO significant difference in symptoms. In another (PMID: 21196761), patients with birch pollen allergies were given either NO honey, REGULAR honey, or BIRCH POLLEN honey. ONLY the group taking birch pollen honey showed an improvement in symptoms.

This makes sense because regular honey does not contain the right allergens.

Remember: bees make regular honey from FLOWER NECTAR NOT pollen. The pollen that causes seasonal allergies primarily comes from trees, grasses & weeds — not flowers. Yes, some of their pollen may end up in the honey due to wind transfer, but this amount is inconsistent & small. In allergy shots, exposure happens carefully, consistently & with gradually increasing amounts. NOT safe to do on your own: could trigger a severe reaction. There is one study (PMID: 24188941) which found that a honey dose of “1g/kg weight” daily for 8wks may be helpful for symptoms compared to placebo. That is a LOT of honey (1 tbsp honey is ~21g = 17g of sugar).

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Seasonal allergies can be disruptive and frustrating, but the medications effective. The key is consistency and starting them early in the season.

I hope this post gives you a better understanding of environemtna allergies, as well as some actionable tips to help keep those allergy symptoms at bay!

Stay tuned for tomorrow’s post. I promise it’ll be helpful.