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Summer Allergies
By Brian W. Donnelly, M.D.

Brian W. Donnelly, M.D.Summertime brings vacation, and happiness for most kids. But for kids who are allergic, June through September can mean annoyance, or even misery.

Symptoms of allergies include sneezing and runny nose. The eyes can be itchy and watery. Nasal congestion and cough afflict some children. Others can suffer headaches from sinus pressure. The profuse production of mucus can trigger nosebleeds in some patients, sometimes from irritation, and sometimes from the patient's fingernail – what has been labeled "digital manipulation." Patients who suffer from allergic asthma can have cough, wheezing, shortness of breath and chest tightness.

Just as with spring allergies, pollen is the typical trigger of summer allergies. Tree pollens dominate during the spring, and are usually finished by the beginning of summer. Grasses and weeds then take over. Timothy, red top, sweet vernal, bluegrass, orchard, and Bermuda are the most common grass allergens. Ragweed, cockleweed, pigweed, sagebrush, and tumbleweed are the popular weed offenders. Ragweed pollen can travel hundreds of miles, so, if you are allergic, you can run, and even relocate, but you cannot hide.

Dust mites also peak during the summer months. They thrive in warm, humid temperatures and make their homes in beds, carpets, and other fabrics. This should not be overlooked by the allergy sufferer.

There are a few different approaches to treatment. Avoiding the allergen is ideal, but not always feasible. Having access to an air filtered room some refuge. Nasal irrigation is an option. Over the counter remedies include decongestants and antihistamines. Decongestants come in oral and intranasal versions. Both can provide short-term relief, but neither should be used for prolonged periods.

Antihistamines also come in oral and intra-nasal forms. The two types of oral antihistamines are short-acting and long-acting. The classic short-acting antihistamine is diphenhydramine. Its classic side effect is sedation, or drowsiness. This can interfere with staying awake in the classroom, or with driving an automobile. Long-acting antihistamines are much less likely to cause sleepiness, and their effect can last up to 24 hours. Examples of these are cetirizine, loratadine, and fexofenadine. All of these are available in a liquid, making them a nice option for children. The intranasal antihistamine option currently requires a prescription.

Another intranasal option is cromolyn sodium. This medication is very good at preventing nasal allergies when used faithfully three times a day, but does not provide quick relief. The other options to squirt up there are the glucocorticoid-type steroids. There is one over the counter option (Nasocort), and several prescription alternatives. These can be used once a day, and most people get relief within a few days of usage.

If a patient has mostly (or only) itchy, watery eyes, eye drops are an option. Ketotifen is available without a prescription, and there are a few other options that your physician can offer.

If allergy symptoms are severe enough, combining intranasal steroids and oral antihistamines is often the most effective option. If that is not effective enough, there are more prescription options. Allergy specialists can perform skin testing to help isolate the offending agent(s). Immunotherapy (allergy shots) can then mitigate the patient's allergic response and, hopefully, lead to a drastic reduction in medication usage.

Dr. Donnelly is a Board Certified pediatrician and shareholder at Pediatric Alliance. For more information, visit www.pediatricalliance.com or call (412) 364-5834.

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