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Hay Fever

more about Hay Fever


Allergic rhinitis



  • Inhaled allergens (materials that are foreign to the body) such as pollens, molds, or dust trigger an abnormal response by the body's immune system (protective cells and proteins known as antibodies that attack foreign invaders), specifically, IgE antibodies, which attach to mast cells.  Mast cells are specialized cells that release inflammatory products.  These inflammatory products produce the symptoms that occur with allergic rhinitis.  Symptoms occur seasonally or year-round, depending on the allergen.  Some patients will find that their symptoms wax and wane over the course of a year as various plants are in season.  Children, who are reacting to other things in the environment, such as stuffed animals and pets, may find that their symptoms are constant.

  • Nasal congestion
  • Sneezing
  • Watery eyes
  • Eye irritation
  • Eye itching
  • Headaches
  • Pressure in the cheeks
  • Wheezing
  • Impaired sense of smell
  • Sore throat and coughing may occur
  • Wrinkles under the eyes
  • Wrinkles across the nose

  • Pollens
  • House dust
  • Dust mites
  • Mold spores
  • Grasses
  • Ragweed
  • Animal products -- urine, saliva, hair, skin debris

  • Possible findings on examination:
    1. Swollen and pale or purple turbinates (inside the nasal cavity)
    2. Nasal polyps
    3. Tenderness above eyes near bridge of nose or over cheeks.
    4. Wheezing in chest
  • Tests:
    1. Complete blood count
    2. Skin allergy testing
    3. Serum RAST testing

  • Avoid allergens: Several therapies are available, depending upon the age of the child and the symptoms causing the most problems.  This may require removal of pets, carpets, and stuffed animals from the home.
  • For children under 2 years of age, the main medication is an oral antihistamine such as diphenhydramine (Benadryl).
  • For older children, several other therapies are available:
    1. Prescription antihistamines cause less drowsiness, and can be taken less frequently, than their over-the-counter equivalents.  They are best for patients in whom the main problem is a runny nose and postnasal drip.
    2. Inhaled steroids, given by a nasal spray, are useful in children who can cooperate with their use.  They are best for patients in whom the main problem is itchy and watery eyes, headaches, and congestion.  There is some concern that inhaled steroids may decrease the rate of growth in children, but they do not appear to affect the final height they attain.
    3. If your child suffers environmental allergens, keep him/her indoors and use air conditioners or air filters.

      • If caused by animals, keep pets out of the bedroom or remove animal from the home.
      • If caused by mold spores, keep bathroom areas clean of mold and repair all leaks.
      • Use flooring in place of carpets, dust frequently, and using dust-proof material, furniture, and bedding can reduce house dust/house mites.

  • Medications:
    1. Antihistamines -- over the counter such as Benadryl are effective, but tend to cause drowsiness.  Newer prescription medications such as Claritin and Allegra are less likely to cause drowsiness, but are more expensive.
    2. Nasal corticosteroid sprays
    3. Cromolyn sodium nasal sprays
    4. Antihistamine nasal sprays
    5. Decongestants such as pseudoephedrine
    6. Ibuprofen may help with associated headaches.
    7. Prednisone in a tapered dose
    8. Medrol dose pack
    9. Kenalog (Triamcinolone injection) -- corticosteroid injection gives 4-6 weeks of relief, but can have long-term side effects if given too frequently
  • Desensitization therapy also known as "Allergy Shots" -- very small amounts of allergen are injected, slowly increasing the dose over time in order to desensitize the body.

  • Although there is no way to prevent the development of allergic rhinitis, many of the symptoms can be prevented by controlling the environment.
  • The most common things that aggravate allergic rhinitis:
    1. Perfumes and dyes in new clothing; new clothes should always be washed prior to first use to decrease exposure.
    2. Perfumes in clothing soaps: Always use "hypoallergenic" detergents, and do not use fabric softeners.
    3. Stuffed animals
    4. Pet dander
    5. Cigarette smoke, either in the air, or on the clothes of those that smoke
    6. Smog and other airborne pollutants




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