As spring approaches adults and children alike will begin suffering from seasonal allergies. Allergic Rhinitis is the most common form of environmental allergies. The diagnosis in adults and older children is straight forward . Symptoms include itchy nose, runny nose, nasal congestion, and sneezing. Younger children can have a variety of symptoms . Some of these signs include:

• Chronic Cough
• Frequent Sneezing
• Itchy Nose
• Runny Nose
• Bad Breath
• Recurrent Sore Throats
• Recurrent upper respiratory infections
• Hyper nasal speech
• Fatigue
• Decreased appetite

Untreated Allergic Rhinitis can cause a variety of problems including Conjunctivitis, Sinusitis, Asthma exacerbations, Eczema, Otitis Media (Ear infections), Obstructive Sleep Apnea, Speech Impairment, and reduced quality of life.

There are several methods for treating allergic rhinitis appropriate for pediatric patients.

Nasal Medicines

Nasal medicines are used 1-2 times daily. They usually take several days to achieve their maximum effect. They have virtually no systemic side effects but can sometimes have local side effects (irritation, nose bleeds). Nasal medicines need to be used daily and before symptoms begin to have the maximum effect.

• Nasal Steroids (Flonase, Rhinocort, Nasonex...etc)
• Nasal Mast Cell Stabilizer (NasalCrom)
• Nasal Anti-Histamines (Azelastine, Levocabastine)

Oral Antihistamines

Antihistamines are the main class of medicine used for systemic allergies. Oral anti-histamines work systemically and can have systemic side effects (drowsiness, hyperactivity). Oral anti-histamines (especially the sedating type) can have quick relief, but still work better when taken daily. Several antihistamines can be found over the counter like Claritin and Benadryl.

• sedating (i.e. Benadryl, Brompheniramine)
• non-sedating (Claritin, Allegra)

Leukotriene Inhibitors

Leukotriene inhibitors are used only for patients with asthma. Recent studies have shown that some Leukotriene Inhibitors improve the symptoms of Allergic Rhinitis. They are not as effective as the nasal steroids or oral anti-histamines, but have the added benefit of improving Asthmatic symptoms. These medicines include:

• Montelukast (Singulair)
• Omalizumab (Xolair)