This article aims to layout the various allergy medicines that a child may need to take. We look at the types of medications, why and when they are used and any potential side effects.
Allergies in kids are very common. As many as 25% of children may be sensitive to inhalant allergens. Symptoms may include headache, itchy, runny, red eyes, wheezing or cough, nasal congestion and other complaints. Two common syndromes include seasonal and perennial allergy.
Seasonal versions provide cyclic episodes of exposure and symptoms, whereas perennial allergy exposes the child all year long.
To understand how different allergy medications work we should understand the basic allergic reaction causes. An allergen is a foreign protein. When it is inhaled it stimulates mast cells in the body to release their contents. Mast cells dump histamine and other chemicals into the bloodstream that irritate blood vessels, mucous membranes and other tissues.
When the histamine and other chemicals irritate blood vessels they leak fluid into surrounding tissues causing swelling, mucous production and increased tearing and runny nose. The mucous membranes of the nose swell and become congested. It can stimulate wheezing and cough from bronchospasm.
In severe cases, anaphylaxis may result. If your child is at risk, an Epi-pen containing adrenaline should be kept near-by at all times. Your medical team will, of course, advise you on this.
Allergy medication for kids can be divided by where they act. Some are antihistamines, some are leukotriene receptor inhibitors, some are mast cell stabilizers, some simply relieve symptoms like decongestants and then there are steroids.
Each of the various medications can be delivered in different ways. Injection, oral ingestion, inhaled through the mouth or the nose, nose drops and sprays, eye drops and ointments are all vehicles to deliver allergy medicine.
Antihistamines have long been the standard treatment for allergies. It is histamine that is largely responsible for all of the allergic symptoms. There are several histamine receptors that affect symptoms.
- H1 histamine receptors are blocked by diphenhydramine (Benadryl) and loratadine (Claritin). They can produce fatigue and a dry mouth.
- H2 histamine receptors are blocked by fexofenadine (Allegra) and citirazine (Zyrtec) with fewer side effects usually.
- H3 histamine receptors are usually blocked in the stomach to lower gastric acid but theyalso work in allergy. Cimetidine(Tagamet) is an example.
- Topical/skin: Diphenhydramine (Benadryl) cream
- Injection: Diphenhydramine (Benadryl) for injection, hydroxazine (Atarax)
- Eye drop/ointment: Patanol, Zaditor, Alaway, Optivar
- Nasal drop/spray: Astelin, Astepro, Pantanase
- Oral: Benadryl, Zyrtec, Allegra, Claritin, chlorpheniramine, Atarax
2. Leukotriene Receptor Blockers
Drugs in this class are given orally. The leukotriene system is involved in the allergic phenomenon very early on in creating mast cells. When the leukotriene system is interrupted fewer mast cells are made providing less histamine to be released. Less histamine results in fewer symptoms.
Montelukast sodium (Singulair) and zafirlukast (Accolate) are representatives of this class of medication. There are few reported side effects. When starting this medication effects may not be immediately obvious. It takes several days to metabolize the mast cells already in circulation.
3. Mast Cell Stabilizers
Cromolyn sodium prevents the mast cells from releasing their toxic contents. The actually stabilize the cell membranes against stimulation from the allergen. A major indication is to prevent exercise induced wheezing before physical activity. Athletes will spray cromolyn sodium before exercise.
- Nasal spray: NasalCrom
- Respiratory Inhaler: Intal
- Eye drop: Opticrom, Oprex Allergy, Crolom
- Oral: Intercron(available in Europe)
- Leukotriene inhibitors have replaced a large percent of the cromolyn sodium treatment population.
These are vasoconstrictors that relieve some of the symptoms of inhalant allergy. Delivered topically they relieve the congestion that blocks the nasal passages, relieve red eye and dry up secretions. Taken orally they can produce rapid heart rate and increase blood pressure. Over the counter cold and allergy preparations often contain a decongestant with an antihistamine.
- Nasal drop/spray: Oxymetazoline (Afrin), Neosynephrine
- Eye drop/ointment: Visine
- Oral: Pseudoephedrine (Sudefed), phenylpropanolamine, ephedrine, phenylephrine
Steroids can be delivered by mouth, spray, injection, aerosol, drop or cream. They work by preventing the body from making the proteins and cells associated with the allergic reaction. They usually take a day to work.
Steroid medication must be taken consistently and by medical direction. These chemicals control every system in the body. When taking supplemental steroids the body can temporarily suppress its own production. If the extra steroids are stopped suddenly it could create a potentially dangerous drop in levels. Likewise taking too much or taking them too long can produce serious side effects.
- Topical/skin: Hydrocort, Kenalog, Lidex, triamcinolone, betamethasone, Aristocort
- Eye drop/ointment: Decadron, Alrex, AK-Pred, Omnipred, Pred-forte
- Nasal drop/spray: Nasalcrom, Nasacort, Rhinocort, Omnaris, Nasonex
- Respiratory inhaler: Beclovent, Vanceril, Aerobid, Flovent, Pulmacort
- Oral: Prednisone, Predpack, Medrol dosepack, Prelone, Orapred
- Injection: Solumedrol, methylprednisolone
Desensitization – A new option
When allergies or their treatments begin to interfere with the routine enjoyment of life, or if the reactions are severe, desensitization shots can be considered. This involves identification of the exact allergens that cause symptoms. A series of progressively stronger allergen is injected over time to desensitize the individual from the allergy. Eventually the reaction is significantly reduced or eliminated.
The Best Medicine?
The best medicine is avoidance of the allergen. This is seldom easy to accomplish. The choice of allergy medicine for kids depends on the frequency and severity of symptoms. Each compound will work better for some than for others.
Trial and error will determine the best option for your kids.