05/18/2026
Parents,
I am getting more and more calls for children having coughs, runny noses, sore throats and other symptoms. We are thick in the midst of spring allergy season. Currently it is the tree pollen that is causing issues. Soon it will be the grass then weeds.
Allergies effect many of us differently. Most of us will have some element of nasal congestion. For some, this will be very severe. Others will have red, itchy eyes. Some children develop dark circles under the eyes. These are known in the medical business as “allergic shiners”. It is caused by a pooling of blood under the eyes. It is not at all dangerous but cosmetically alarming. A large portion of children exhibit what is known as the “allergic salute”. It is a red, irritated patch under a child’s nose from incessant wiping. Again, it is no dangerous, but looks bad. Some children will develop increasing fatigue and poor sleep. This is a very common symptom of allergies and, actually, one of the most irritating. There are other symptoms as well. A child may develop one symptom, a combination of symptoms, or all of them.
There several different strategies to combat allergies. The first order of business is to determine that allergies are what are causing the difficulties. Allergies do not cause fever but may cause a slightly elevated temperature. They can, however, cause other problems that do create fever: such as ear infections, sinusitis, bronchitis, etc. but they, alone, do not cause fever. There are many clinical features that accompany allergies. If you have any doubt or questions, see your healthcare provider. After a careful history and physical exam, a healthcare provider can determine if allergies are the root of the problem.
Combating allergies is both a very simple process, yet sometimes a difficult one. The first thing is to establish the cause. If you have been fine for months and all of a sudden your eyes are getting red, the need for extensive allergy testing is not present. If it floats, swims, and flies like a duck-it is a duck. No tree pollen, no symptoms, then tree pollen and symptoms, it is the trees. Avoiding tree pollen is very difficult. All of us need to go outside for something. If the cat at your aunt’s house is the culprit, the cat might be avoided. However, if it is trees, no such option exists.
If you are in a situation where the allergen culprit cannot be avoided there are some options available. There are several over the counter medicines that work well. All were once available only via prescription, but several years ago they became over the counter and are easier to obtain.
One of these medicines is loratadine. It is commonly known as Claritin. The medicine comes in a liquid, chewable tablet, and a swallow pill. It is non-sedating and fine for a child to take and go to school. For a child age 2-6 a 5mg dose, once a day is fine. For children age 6 years and up, a 10 mg dose once a day is fine. The generic version that you buy at CVS is just as effective as “Claritin” but a lot cheaper.
Another great medicine is cetirizine. It is commonly known as “Zyrtec”. I feel it works better that loratadine, but it can make a child sleepy. I tend to recommend this medicine at bedtime due to it’s sedating effects. It also comes in a liquid, chewable, and swallow form. For children ages 2-6 years, a 5mg dose is fine. For children ages 6 years and up, a 10mg dose. Again, generic cetirizine works great.
A medicine very similar to Zyrtec is Xyzal. It also works very well and in a similar fashion (meaning it can make a child sleepy). The generic form is called levocetirizine. It comes in a liquid, chewable and swallow form. For children ages 2-5 years, a 1.25mg dose is sufficient. Children ages 6-11 years, 2.5mg and age 12 years and up 5mg. The generic form works as well as the brand name.
Fexofenadine, or “Allegra” is yet another anti-allergy option. it, too, comes in a variety of forms; liquid, chewable, and swallow. It is non-sedating and is fine for a child going to school. A dose for a child 2 years to 12 is 30mg once or twice a day. A dose for a child 12 and up is 60mg once or twice a day or 180mg once a day. Generic fexofenadine is fine.
All of these allergy medicine claim to last for 24 hours. This may be true, but during severe allergy season, I find that these medicines often do not provide the 24 hours of coverage that is heralded. If you are finding that these medicines are not providing 24 hour coverage, talk to your healthcare provider. I have often "bridged" a child with 2 allergy medications: Like loratadine in the morning and cetirizine in the evening.
There are a variety of nasal steroids that were once via prescription only but have recently become over the counter. It is important for a parent to understand that these medicines often take at least 4 days to start working. Perhaps, more importantly, I have yet to meet a child who likes to shove medicine up their nose.
Allergies are a squirrely business. They are often times difficult to treat and manage. I expect to have more information in the coming days. If you have any questions or concerns, please give me a call.
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