Children and Hay Fever

Hay Fever is a condition that can affect everyone, even the children. Although there are many similarities between children and adults in regards to hay fever, the differences are very important to be aware of, especially if you're a parent. 

So what's similar? 

Well, children often have similar presenting symptoms (rhinitis, sneezing, stuffy nose, sore throat etc). Another thing very important to keep in mind is the similarities of the triggers. For children, often triggers include dust, pollen, mold, pet dander and more. Therefore treatment in avoiding these triggers is the same as for an adult. (for more information on this please see previous blog entry). Pharmacological treatment is very similar as well and most of the same medications have indications for children doses on the backs of the packaging. Common medications recommended for children allergy relief include Claritin and Singulair. Keep in mind that it is important to discuss new medications for a child with a doctor and to ensure accurate dosage.

So what is different?

Many children are often predisposed to other conditions, ie asthma and eczema. Therefore hay fever symptoms may often exacerbate the symptoms of these conditions. This could be especially dangerous with asthma because inadequate oxygenation may occur.

Also, children are at a higher risk for otitis media, also known as a common ear infection. This occurs from the congestion in the sinus passageway. The reason that children have a higher risk of this is because of the passage (Eustachian tube) connects into the nasal passageway. In younger children the tube in more horizontal as opposed to the more diagonal route of an adult Eustachian tube. As a result, it is easier for it to become infected and inflamed.

Lastly, because the development of a child is crucial and much of this is done at school, it is important to address the symptoms of hay fever in a child. Not only are the symptoms bothersome, but also it can actually impede in the learning process and worsen attention. Hay fever can even decrease self-esteem with the constant concern about how their symptoms are affecting their schoolwork and it’s affect on the body.

Final Notes

Like all hay fever sufferers, it is important to address the symptoms and take care of them. With children these this need even increased. Make sure if you think your child has hay fever visit your doctor to have him/her evaluated and see what treatment is appropriate.  

Check out http://www.keepkidshealthy.com/welcome/commonproblems/hayfever.html

When to see a doctor

When to see a doctor

When starting to experience symptoms, questions generally arise about what’s causing this and what can be done to help. Or it could just be that you have had these symptoms for a while now and you just are tired of it. It seems that with a condition like hay fever you don’t necessarily need to see the doctor until you choose to. What may be some things to prompt you though?

One reason to see a doctor is if your hay fever is disrupting your quality of life. This can include a variety of things such as missing work or school, not getting enough sleep, or even just getting in the way of your favorite activities.

Another reason that you should see a doctor is for possible complications or exacerbations of other conditions commonly associated with hay fever. The most common are sinusitis, nasal polyps, asthma, and eczema.

       

     Sinusitis- an inflammation of the sinuses that is associated with infections that can either be bacterial, fungal, or viral. Symptoms are similar to that of the common cold that don’t reside or even worsen after 5-7 days. This can include loss of smell or taste, nasal congestion, headache, sore throat, nasal discharge, fever and fatigue

Sinusitis X Ray

     

    Nasal Polyps- inflammation of tissue lining the nasal passageway causing sac-like growths. Symptoms include similar feelings of a having a persistent cold (up to months or years), mouth breathing, nasal obstruction, loss of smell, runny nose.

Nasal Polyps

    Asthma- a condition where the airways of the lungs can become swollen and narrow, or bronchoconstriction. The most common symptoms are chest tightness, wheezing,  shortness of breath, and coughing. Depending on severity of symptoms, asthma can lead to an emergency situation and you must seek help immediately. 

Bronchiole- Normal vs Asthmatic

    

   Eczema- a hypersensitivity reaction on the skin resulting in itchy and/or scaly rashes.  Symptoms include skin changes resulting in blisters with oozing and crusting, ear discharge/bleeding, itchiness, skin color changes, skin redness/inflammation around blisters, and thickened or leather-like areas on the skin.

Eczema lesion on hand

On your visit…

Make sure you list your symptoms which includes ones that are old and new. Tell your doctor about lifestyle changes you had to make in order to accommodate these symptoms and what you have done to help alleviate. Make sure to include all medications (OTC, prescription, and even herbal remedies). Depending on severity and types of symptoms you may have allergy skin testing or even see a ENT (ear nose and throat) specialists. Also, make sure to write down questions you might have prior to your visit and don’t be afraid to ask. 

Allergy Skin Tests

Allergy Skin Tests

With hay fever, the most common thing you are told is to avoid your triggers. But what if you don’t know what the triggers, how are you supposed to avoid them? How do you find out what they are?

Allergy skin tests are designed to help expose whether or not a suspected allergen is actually what is causing the allergic reaction. To gather information on what could be a possible suspected allergen is through the medical history.  During the medical history some questions that may be asked include: How long have you had the allergy? Where do you live? How long do the symptoms last for? Where do you work or what are some environmental exposures?

After gathering the information, the suspected allergen will then be introduced in one of three ways- a skin prick test, skin injection test, and patch test.

            Skin Prick Test- is done with a lancet injected different allergens. The results usually come in about 15 minutes. It can be done with as many as 40 different substances to see if the allergies are from pollen, mold, pet dander, dust and even food allergies. If a skin prick test is positive, there will be a skin response This could be a raised, red itchy lump- somewhat like a mosquito bite.

            Skin Injection Test- a test that, like the skin prick, injects a small amount of allergen extract into your skin. The difference is that instead of a lancet, it is used with a needle to be a little deeper as an intradermal test. In about 15 minutes, there will be signs of an allergic reaction- this test isn’t very common for hay fever like the skin prick test, but more for allergies to venoms or specific medications.

            Patch Test- tests to see if there is an allergic reaction by not injecting an allergen, but instead applying it to a patch, which will be placed on the skin. Like the injection test, this isn’t very common for hay fever, but more for contact dermatitis, such as latex or preservative allergies. The patch will be worn for 2 and irritation will indicated a positive test.  

All of these tests are used in order to pinpoint what your allergies are in order to avoid them. This means may not be necessary for everyone, but more for those who really need to know, are more susceptible, and have very severe allergies. Talk to your doctor about if this interests you to see when/how you can receive this testing. 

Immunotherapy- A Medication Alternative

Immunotherapy- The Medication Alternative

Pills aren’t working? Are those alternate therapies not doing the trick? Or are you just sick (physically and mentally) of your symptoms being so intense and irritating every day or allergy season?

These are just some of the reasons why many patients venture to the care and treatment of hay fever through immunotherapy.

What even is immunotherapy though?

Immunotherapy is treatment targeted often to type I hypersensitivity, which uses desensitization therapy. Also, usually works best with hay fever patients. How it works is through the involvement of environmental control of external allergens in addition to the titrated pharmacologic exposure to them as well. With environmental control, a plan has to be made to decrease the exposure to the specific allergen(s). The pharmacologic desensitization process involves injections of the allergen (antigen) regularly through a course of time. This usually will last anywhere from months to years depending on the extent and progress. Throughout the time period, the dosages of allergen will be increased as tolerated. This will hopefully cause a change in the immunoglobins so that there will be an increase of IgG and IgA blocking antibodies as opposed to the abundance of IgE..

However immunotherapy doesn’t always work and may not be a complete treatment to allergy symptoms.  Also it has been reported that the relief to certain grasses and pollens usually last about 4-5 years.

Some considerations before getting involved

If you are thinking about getting immunotherapy keep a couple of things in mind. Such as the commitment it will take -the years of having to come in for the shots. Also it is an expensive process- you must weigh the costs of this with the costs of the medications you normally use.  Immunotherapy is not a definitive treatment and does not yield the same results for everyone.  Age is an important consideration- immunotherapy shots are usually not given to children under five and to older adults (65+ depending on medical status). Lastly, there are some medication conditions that may be present to prevent you from receiving immunotherapy. These include immunodeficiency diseases, recent heart attack or unstable angina, current use of beta blockers. 

Remember if you are considering this to ask your physician about any concerns or questions you may have. 

Some of the Meds

Treatment

How do these medications work?

As stated before, the most common medications used for hay fever are antihistamines, mast cell stabilizers, intranasal corticosteroids, leukotriene receptor antagonists LTRAs and decongestants.

Antihistamines: There are two type of antihistamines which are classified in first generation (sedating) and second generation (non sedating). Common first generation antihistamines are azataine (Optimine), brompheniramine (Dimetane) and diphenhydramine (Benadryl). Common second generation antihistamines are loratadine (Claritin), centirizine (Zyrtec), dexofenadine (Allegra), and desloratadine (Clarinex). Both generations work by binding with the Hò receptors on target cells thus blocking the binding of histamine. Second generation agents have a decreased attraction for the receptors in the brain, which makes them preferable with the less sedating side effects. http://www.claritin.com http://www.benadryl.com

Mast cell stabilizers: The most common use of this is seen as a nasal spray, or cromolyn spray known as NasalCrom. Recall in a previous entry the physiologic process about how mast cells degranulate resulting in the histamine release? Mast cell stabilizers inhibit this degranulation in the first place of these sensitized mast cells. Medications like NasalCrom have minimal side effects, besides occasional nasal irritations however it is important to start treatment regimens prophylactically. This includes 2 weeks before the allergy season or 15 minutes before exposure to a specific allergy, such as a dog. http://www.nasalcrom.com/

Intranasal Corticosteroids: The primary corticosteroids used for hay fever come in the form of nasal sprays. Some of the common medications include budesonide (Rhinocort), ciclesonide (Omnaris), and mometasone (Nasonex). These work by being a locally used corticosteroids for the nasal passageways. Corticosteroids work by inhibiting the inflammatory response- thus decreasing the symptoms that go along with hay fever. Like the mast cell stabilizers, there is just minimal nasal burning or stinging and it should be started 2 weeks before the allergy season. However, because corticosteroids work by surpressing the immune system the body is at risk for increased risk for infections, such as Candida Albicans (a fungal infection where white patches will appear in the mouth and tongue). Also it is to be used on a regular basis, not just as needed. http://www.nasonex.com/nasx/index.jsp http://www.omnaris.com/

Leukotriene Receptor Antagonists (LTRAs): The most common LTRA is montelukast (Singulair). This works by antagonizing or inhibiting leukotriene activity. Normally when leukotrienes are released, they cause a slow-reacting substance of anaphylaxis (SRS-A) leading to many of the respiratory symptoms. These include narrowing of airway and increased edema in the airway. By inhibiting these to be released, these symptoms are able to be avoided.  Unlike many of the other medications listed here, there are many side effects that go along with the use of LTRAs. These include from a range of headaches, and dizziness to altered liver function tests. Therefore it is important to monitor liver function, take on an empty stomach, and not be be used for acute attacks of symptoms. Also, medications such as singular are more common for chronic respiratory conditions such as asthma. This would not be a first round choice for those with hay fever especially with just mild to moderate symptoms. http://www.singulair.com/montelukast_sodium/consumer/asthma/asthma-medication/index.jsp

Decongestants: Perhaps with the antihistamines and intranasal corticosteroids, decongestants are a very popular choice for hay fever, especially for those who have a little more severe sinus/nasal symptoms. The most common decongestant is pseudoephedrine (Sudafed). These decongestants can also be recognized for being added to other medications with the addition of a “D” to the name. Ex: Claritin D. These work by stimulating adrenergic receptors on blood vessels causing them to constrict. As a result congestion decreases from the reduced nasal edema and rhinorrhea. Because it acts on the adrenergic receptors some side effects are from the cardiovascular system such as increased blood pressure, increased heartbeat and excitation/irritability. Another important thing to keep in mind with decongestants is that you have to buy them from the pharmacy counter and purchases marked through your driver’s license. Why? The key ingredient in these decongestants (ephedrine or pseudoephedrine) is used in the production of meth. http://www.sudafed.com/

If you have any questions about what medications you should be taking or about any of the side effects make sure to talk to your doctor and pharmacist. Also check out www.rateadrug.com to evaluate your treatments. Also use it to read about other people’s questions or input on medications you may be taking or thinking about taking.