Seasonal Allergies: The Runny Nose And Itchy Eyes

I noticed just this week that I am beginning to see a bump in the number of kids coming into my office with seasonal allergies. Seasonal allergies can range from a slight nuisance to completely miserable. Allergies can cause a runny, itchy nose, watery eyes, and sneezing. Since allergies tend to have a genetic component, be on alert for symptoms in children if either parent suffers from allergies.

How does my doctor know if my child has allergies?

1. Your doctor will ask lots of questions about your child’s symptoms, triggers, and environmental influences. She will determine if the story of symptoms is consistent with allergies.
2. Physical exam findings can include some or all of the following:
   1. Dennie’s line (a Dennie-Morgan fold to be exact): A small fold or line in the skin just below the eye caused by swelling from allergies.
   2. Allergic shiners: Dark circles (purple-grey discoloration) under the eyes caused by the accumulation of blood or fluid that happens with chronic nasal congestion.
   3. Allergic salute: The action of wiping the nose with the palm of the hand in an upward movement (called a “salute” due to the unintentional gesture). Technically, it can also be a back and forth rubbing of the nose with the back of the hand.
   4. Transverse nasal crease or groove: A white little line or crease seen across the bottom third of the nose; usually caused by the allergic salute (see above).
   5. Nose exam: The nasal turbinates (fleshy, little protrusions on the inside of the nose) will classically be pale and boggy (vs. when sick they are typically very red and inflamed).
   6. Red, watery eyes (your doc will examine them and help distinguish allergic red eyes from infectious red eyes).

What to do about allergies?

1. Oral medications: It is reasonable to do a trial of the counter medications first (e.g., Zyrtec, Allegra, Claritin). If your child is under 3 years, you should probably consult with your doctor first to determine need for meds, dosing, and which one. (Note: I intentionally didn’t mention Benadryl. While it works, it tends to be a really sedating antihistamine, making it a poor long-term option).
2. Symptom specific medications: If the problem is only itchy eyes, you may want just an allergy eye drop. The same holds true for the nose. If the symptoms are runny nose only, you may want an allergy nose spray. Most of the best symptom specific medications available are by prescription only, so make an appointment with your doctor for those.
3. Change bath time to nights instead of morning. It helps to wash all the pollen off the body and hair before sleeping.
4. Saline nose spray: This can help break up thick mucus if your child isn’t old enough to effectively blow her nose (especially important to get as clear a nose as possible before using any medicated nasal sprays).