Allergy Medications & Children

Allergy Medications Children

Summary

Allergy medications can be a source of great relief for children who suffer from moderate to severe allergies. Many over-the-counter and prescription medications are available in formulations specially designed to treat a child’s symptoms, including itchy eyes, runny nose and breathing difficulties.

However, parents and physicians need to consider many variables when deciding whether or not an allergy medication should be given to a child. For example, some over-the-counter antihistamines may help soothe a child’s itchy nose, but can also cause sedating side effects that are severe enough to impair academic performance at school.

Parents should always consult with a physician in formulating a plan to treat their child’s allergies. No allergy medication – over-the-counter or prescription – should be given to a child without first consulting a healthcare professional.  

About children and allergy medications

Allergy medications are available in many formulations to help soothe a child’s allergy-related symptoms. Pills, syrups, nasal sprays, inhalers, eye drops and creams are just some of the methods used to deliver these treatments.

Many children benefit from these medications, which can treat itchy eyes, runny nose, breathing difficulties and other symptoms. However, parents and physicians must weigh whether medication is truly the best approach to treating a child’s symptoms.

For example, it may be possible to treat the symptoms of some children simply by reducing their exposure to certain allergens. In such cases, a prescription for an antihistamine or a course of expensive, time-consuming allergy shots (immunotherapy) may be unwarranted.

However, in other cases, allergy medications may be the best way to reduce a child’s symptoms. Parents should never give any over-the-counter or prescription medication to their child without first consulting a physician. Allergy medications can interact with other medications the child may be taking, and side effects of these drugs can be more severe for children than they are for adults. Physicians can determine if the medication is safe for the child, and at what dose.  

Many allergy medications are available in doses appropriate for children. As a child enters adolescence, adult dosages of medications may be more appropriate for their needs.

Some allergy drugs are to be taken after symptoms appear (called “reliever” medications), while others are taken regularly as a preventative measure to ward off future reactions (called “controller” medications).

Various drugs treat different aspects of an allergic reaction. Sometimes, the drugs may be used in combination to treat various symptoms.

Physicians consider a number of factors when selecting allergy medication for a child, including:

  • Child’s age
  • Child’s overall health
  • Child’s medical history
  • Severity of child’s allergic reactions
  • Child’s tolerance for medications
  • Other medications the child is taking
  • Parent’s personal preferences

A child may need to use more than one type of allergy medication before the most effective form of treatment is found.

Antihistamines & children

Antihistamines are “controller” drugs that block the action of histamine, a chemical released during allergic reactions. Histamine contributes to symptoms such as sneezing, runny nose and itchy eyes. 

There are several side effects to consider before giving a child an antihistamine. These include:

  • Drowsiness. Antihistamines can make many children sleepy. This can affect a child’s performance in school.

  • Hyperactivity or jitters. Some children react to antihistamines with varying types of restlessness. Concerned parents should contact their child’s physician to arrange for a dosage or medication change.

  • Seizures. This condition is more likely to occur in children who take antihistamines than in adults. If a child experiences convulsions, parents should alert their child’s physician immediately.

  • Nightmares and irritability. These symptoms may appear in varying degrees in some children. Concerned parents can consult with their child’s physician to change drugs or dosage.

Oral histamines are often the first choice for treating children with allergic rhinitis. Over-the-counter oral antihistamines cause drowsiness in many children, and excitability in a small percentage. For this reason, it may be best to restrict a child’s use of over-the-counter antihistamines to bedtime (unless, of course, the child is among those who become excitable after antihistamine use).

Newer prescription antihistamines do not cause drowsiness in most children and may be a good alternative to the sedating over-the-counter (OTC) medications. Examples of antihistamines given to children include

TypeBrandGeneric
OTC controllersBenadryl
Claritin
Alavert
diphenhydramine
loratadine
loratadine
Prescription controllersAllegra
Zyrtec
Astelin
fexofenadine
cetirizine
azelastine

Allergy medications often combine antihistamines with decongestants. Popular choices include:

TypeBrandGeneric
OTC relieversActifed
Claritin D
pseudoephedrine
triprolidine
Prescription relieversAllegra D
Zyrtec D
fexofenadine
pseudoephedrine
cetirizine
pseudoephedrine

Decongestants & children

Decongestants are “reliever” drugs that treat symptoms of nasal congestion by constricting blood vessels in the nose. This decreases tissue swelling in the nose and opens the airways.  

Decongestants can be effective in clearing up a child’s allergy-related congestion, but only as a short-term solution. It is critical to limit a child’s use of decongestants to no more than three consecutive days. Long-term decongestant use results in “rebound effect,” which will actually make congestion worse (rhinitis medicamentosa).

While antihistamines often make children drowsy, decongestants are a stimulant and are likely to have the exact opposite effect. Decongestants can sometimes make children jittery because the drug is closely related to adrenaline. In particular, small children and infants are susceptible to this effect.

Since decongestants are chemically related to adrenaline, they can also raise blood pressure. This is not a major concern for children who have healthy hearts. However, the stimulant effects of this medication may cause sleeplessness or irritability in many children.

Pseudoephedrine is found in many decongestants advertised as “non-drowsy.” It is more likely to cause side effects in infants than in older children and adults. Newborns and infants born prematurely are especially at risk. Although regular, short-acting decongestants that contain this chemical can be given to infants and small children (with the dosage approved by a physician), long-acting decongestants are not recommended for children under 12. Most physicians agree that children under the age of six months should avoid taking decongestants.

Phenylpropanolamine is an ingredient previously found in decongestants that is no longer used. The drug is associated with a low risk of hemorrhagic stroke (bleeding into the brain or into tissue surrounding the brain) in women. However, some older medications may contain this drug, and it should not be taken without consulting a physician beforehand.

Decongestants are available in topical forms and oral preparations. Topical decongestants (eye drops and nasal sprays) are likely to provide a child with a better combination of relief and fewer side effects than oral decongestants. Because these medications are delivered in a concentrated form to the specific area they are targeted to treat, the amount of decongestants passed into the rest of the child’s body is reduced. This helps limit side effects. However, children using nasal sprays or eye drops need to be carefully supervised. Children may be tempted to overuse these medications, leading to rebound congestion.

Examples of over-the-counter (OTC) and prescription decongestants given to children include:

TypeBrandGeneric
OTC relieversSudafed
Afrin
Otrivin
Clear Eyes
Visine
pseudoephedrine
oxymetazoline
xylometazoline
naphazoline
tetrahydrozoline
Prescription relieversAllerestnaphazoline
Prescription controllersNaphconnaphazoline

Antihistamine/decongestant prescription and OTC medications combine the effects of these two drugs. Popular choices include:

TypeBrandGeneric
OTC relieversActifed
Claritin D

pseudoephedrine triprolidine
loratadine pseudoephedrine
Prescription relieversAllegra D
Zyrtec D

fexofenadine pseudoephedrine
cetirizine pseudoephedrine

Anti-inflammatories & children

Anti-inflammatories are “controller” medications that inhibit allergic reactions and reduce nasal swelling. They often are prescribed as a nasal spray when used to treat allergies. Some of the more popularly prescribed anti-inflammatories are corticosteroids, cromolyn sodium (a mast cell stabilizer) and nonsteroidal anti-inflammatory drugs (NSAIDs).

Corticosteroids are used to treat the most severe forms of allergic rhinitis, especially if antihistamines fail to provide relief. Corticosteroids decrease inflammation in nasal passages during an allergic reaction. These drugs are not the same as the anabolic steroids used by some athletes to enhance muscle size and strength.

Physicians are often reluctant to prescribe corticosteroids to children, for a number of reasons, including:

  • Children and teenagers who take corticosteroids can experience slowed growth, particularly if the medication has been taken for a long period of time. This is due to the medications interference with the function of the adrenal gland.

  • Corticosteroids have a range of side effects that tend to be more pronounced in children than in adults. These are rare, but may include:
    • Memory problems
    • Anxiety and depression
    • Hallucinations

  • Children who are using corticosteroid drugs and contract certain infections (e.g., measles, chickenpox) may experience more severe infections. To avoid this, a physician may recommend vaccinations for some types of infection or suggest an alternative treatment, if appropriate.

Children may receive corticosteroids in nasal spray or inhaler form, but only when absolutely necessary. An injection of corticosteroids is often given to young children who have a hard time swallowing the foul-tasting liquid form of the medication. Some children vomit after taking the liquid form. The effectiveness of a corticosteroid injection is comparable to the liquid form. Examples of corticosteroids given to children include:

TypeBrandGeneric
Prescription controllers/relieversFlonase
Rhinocort Aqua
Nasocort AQ
Nasonex
fluticasone propionate
budesonide
triamcinolone acetonide
mometasone

Patients who are nearing the end of systemic corticosteroid therapies must gradually taper off the drug to allow the adrenal glands to resume their normal rate of cortisol (a steroid hormone) production. Symptoms that can occur during this transition period include fatigue, weakness, depression and muscle and joint pain.

Cromolyn sodium is a type of mast cell stabilizer commonly prescribed in nasal spray, oral or inhaled forms for the treatment of allergies and asthma. These medications prevent mast cells from bursting and releasing histamine and other chemicals that cause the symptoms of an allergic reaction. Cromolyn sodium is not as effective as corticosteroids in treating severe allergies. However, it is considered extremely safe. It is often prescribed to treat less severe allergies in children as young as 2 because it has very few side effects.

Some forms of cromolyn sodium and their safe age of use include:

  • Cromolyn (inhalation) solution has been safely tested in children as young as 2, and the cromolyn inhalation aerosol has been tested in children as young as 5.

  • Cromolyn (nasal spray) has been safely tested in children as young as 6.

  • Cromolyn (oral) has not been thoroughly tested in young children, though it is frequently used in children as young as 2, and can be used to treat children younger than 2 in severe cases.

Depending on the judgment of the physician, mast cell stabilizers can be prescribed to children younger than the ages indicated. This class of drugs is often more suited to use in young patients because of the mild and relatively low number of side effects associated with their use. Cromolyn sodium medications include:

TypeBrand
Prescription controllersCrolom
Intal
Opticrom
Over-the-counter (OTC)controllersNasalcrom

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications commonly used to reduce pain and inflammation. While these drugs are often the first choice for treating pain and inflammation, they should be used with caution for people with asthma, since they can trigger an asthma attack in susceptible individuals.

Other medications & children

Other treatments available to help control allergy symptoms include:

  • Epinephrine. This is an emergency drug used to treat severe asthma attacks or allergic reactions. In rare cases, children exposed to an allergen will experience a potentially life-threatening reaction called anaphylactic shock that involves difficulty breathing and a drop in blood pressure. An injected dose of epinephrine is necessary to reverse the symptoms.

    A physician may prescribe an emergency allergy kit for children with a history of allergic reactions involving two or more body systems (anaphylaxis). While anaphylaxis can be mild, it can also progress quickly into anaphylactic shock. For people prone to anaphylaxis, it is not possible to predict whether a reaction is likely to be mild or life threatening. Allergy kits contain a dose of epinephrine that can be self-injected, or injected by a parent or other caretaker.

    Examples of auto-injector epinephrine medications (all prescription relievers) include:
    • EpiPen
    • EpiPen Jr.
    • Ana-Kit
    • Ana-Guard

  • Leukotriene modifiers. These relatively new medications are designed to prevent asthma attacks, but may also be used to prevent symptoms of some allergic conditions (e.g., allergic rhinitis). They target leukotrienes, which are chemicals that inflame the lining of airways and cause symptoms such as wheezing and shortness of breath. Children 12 months and older can be prescribed leukotriene modifiers. Some studies have indicated that these prescription drugs may be more effective when combined with antihistamines, thereby shutting down two major chemicals in airway constriction, histamines and leukotrienes.

    It should be noted that leukotriene modifiers have not been found to be as effective as inhaled corticosteroids, and that there is not yet a body of evidence to conclusively state that leukotriene modifiers are an effective means of treating allergic rhinitis by themselves. Parents are encouraged to discuss the risks and benefits of leukotriene modifiers use with their child’s physician.

  • Anti-IgE antibody. Medications that disrupt the sequence of events that causes an allergic reaction – known as the allergic cascade. They are taken through an injection every two to four weeks and work by stopping the release of histamine, which causes allergy symptoms.

    Anti-IgE antibody medications are still new in the United States and are currently approved by the U.S. Food and Drug Administration only for use in patients over the age of 12. Some physicians may prescribe this type of medication to children under 12, but there is currently no clinical data available on the safety of such use. Parents should feel free to discuss the risks and benefits of this type of treatment with their child’s physician.

While not medication, allergy shots (immunotherapy) are another form of allergy treatment. During this treatment, low doses of an allergen are periodically injected into a patient over a period of months or years to increase the patient’s tolerance to the allergen. This reduces symptoms brought on by an allergic reaction. Typically, allergy shots are recommended after use of medications has failed to control symptoms, or to prevent cases of whole-body allergic reactions known as anaphylaxis.

Questions for your doctor

Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Patients may wish to ask their child’s doctor the following questions regarding allergy medications and children:

  1. Is my child a candidate for allergy medication?
  2. What are my child’s medication options?
  3. Will my child need allergy medication for the rest of his or her life?
  4. Under what circumstances should I give my child allergy medication?
  5. How effective are the allergy medications you have recommended?
  6. What side effects may occur in my child?
  7. What if I am unhappy with the side effects I see in my child?
  8. Is the allergy medication likely to interfere with my child’s performance in school?
  9. Will my child’s allergy treatment plan change as he or she gets older?
  10. Under what circumstances should I contact you before giving my child allergy medication?
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