Pediatric Allergy Medications Explained

by Dr. Christopher Chang, last modified on 1/8/23.

Anti-Histamines • Steroid Nasal Sprays • Anti-Histamine Nasal Sprays • Dymista • Singulair • Saline Flushes
Vitamin D • Nasal Decongestants • Mucinex • Cromolyn Nasal Spray •Taking More than One Medication

Introduction:

Although there are surgical procedures to help reduce some of the symptoms of allergies such as turbinate reduction and adenoidectomy in kids, the mainstay of allergy symptom treatment is medications whether elixirs, pills, or nasal sprays. If you are wondering WHAT allergy medications should be taken for specific allergy symptoms, click here for more information.

There is plenty of information on the internet on the science of how allergy medications work as well as all the different types of medications available. The purpose of this webpage is to explain how allergy medications work in layperson terms without going too much into the science. Not mentioned on this webpage is the use of acupuncture or acupressure to help with allergy symptoms. Click here to read more about this method of treatment. In order to learn what steps you can take to improve the air quality in your home in order to minimize allergy symptoms and the need for medications, click here. Information regarding allergy shots can be found here.

ANALOGY: The scientific analogy I will use in this webpage is a water balloon and will be contained inside a box like this. The water balloon is analogous to the mast cell which is responsible for allergic symptoms. To prevent an allergic reaction, you do NOT want the water inside the balloon from getting out. The water is the chemicals that causes a person to sneeze, have a runny nose, etc. You can also watch a video explaining the difference between allergy medications here.

Anti-histamines:

(starting from 6 months old)

Anti-histamines in essence blocks the pollen or other allergic substances from causing an allergic reaction (watch video). Such anti-histamines include allegra, zyrtec, claritin, benadryl, xyzal, etc. Pretty much common knowledge there... BUT...

Generally speaking, taking a benadryl at bedtime and zyrtec in the morning (both meds are over-the-counter) will take care of most kids with allergy flare-ups. If the benadryl causes a paradoxical effect of making a child stay awake, one can given zyrtec (or other anti-histamine) once in the morning AND again at bedtime. However, if once a day suffices, there is no need to add the second dose.

Please note that allegra is the ONLY anti-histamine that does not cause drowsiness. All other anti-histamines may cause drowsiness as a side effect.

Xyzal (levocetirizine) dosing is as follows:

Adults and children 12 years of age and older: 5mg once a day
Children 6 to 11 years of age: 2.5mg daily.
Children 6 months to 5 years of age: 1.25mg daily

Allegra (fexofenadine) dosing is as follows:

Adults and children 12 years of age and older: 60 milligrams (mg) two times a day, or 180 mg once a day.
Children 6 to 11 years of age: 30 mg two times a day.
Children 4 to 6 years of age: Use and dose must be determined by your doctor.
Children and infants up to 4 years of age: Use is not recommended.

Zyrtec (cetirizine) dosing is as follows:

Adults and children 6 years of age and older: 5 - 10mg daily.
Children 2 to 6 years of age: 2.5mg 1-2 times a day.
Children and infants up to 2 years of age: Use is not recommended.

Claritin (loratidine) dosing is as follows:

Adults and children 6 years of age and older: 5mg 1-2 times a day
Children 2 to 6 years of age: 5mg daily.
Children and infants up to 2 years of age: Use is not recommended.

Benadryl (diphenhydramine) dosing is as follows starting from 12 months of age:

Children 100+ pounds: 25 - 50mg every 6 hours
50-99 pounds: 25mg every 6 hours
25-49 pounds: 12.5mg every 6 hours
20-24 pounds: 10mg every 6 hours (basically 4ml of the elixir)

ANALOGY: Anti-histamines prevent a needle from popping a water balloon. Explanation of the analogy provided here.

Steroid Nasal Sprays:

(starting from 2 years old)

Steroid nasal sprays available over-the-counter (Nasacort, Flonase, Sensimist, Nasonex) all work by decreasing the overall reactivity of a child's nose to pollen and other materials they are allergic to. It works best when used in a preventative manner and as such, should be used DAILY whether a child is having symptoms or not. It does not work quite as well when used only when having problems.

ALSO, it is very important to understand that it takes daily use for about 2 weeks before it starts working, though some kids may find symptom improvement after only a few days.

Another area of concern for parents is the fact that it is a "steroid." The good news is that nasal steroids do NOT have the bad side effects one hears about in the news. In fact, they are so safe they can be used daily for years, even from the age of 2 years (watch video of kids using allergy nasal sprays). Also, they are NOT addictive unlike OTC nasal decongestant sprays (afrin, zicam, etc) which should not be used for more than 3 days.

It is totally understandable that kids hate the idea of nasal sprays and it may be very difficult to persuade them to start using it willingly. But, for those who have sino-nasal allergy symptoms, steroid nasal sprays work BETTER then oral medications.

In kids starting at 2 years old, steroid nasal spray dosing is 1 spray in each nostril daily.

ANALOGY: Steroid nasal sprays decrease the number of water balloons and makes them smaller. Explanation of the analogy provided here.

Astelin, Astepro, and Patanase (Anti-Histamine Nasal Spray):

(starting from 2 years old)

These are the only anti-histamine nasal sprays out on the market. Astepro is the only that is available over-the-counter. There's really not much difference (I believe) among these sprays other than the smell and taste after use. All anti-histamine nasal spray dosing for kids is 1 spray in each nostril twice a day.

Astepro which is the only over-the-counter anti-histamine nasal spray is given starting from 2 years old.

Astelin is given starting from 5 years old.

Patanase is given starting from 6 years of age.

ANALOGY: Anti-histamines prevent a needle from popping a water balloon. Explanation of the analogy provided here.

Dymista (Anti-Histamine & Steroid Combo Nasal Spray):

(starting from 6 years old)

Dymista is the only nasal spray that contains both an anti-histamine and a steroid. Based on the active ingredients, it essentially is flonase (steroid nasal spray) and astelin (anti-histamine) nasal sprays merged into one. Dosing starting from 6 years old is 1 spray in each nostril twice a day

ANALOGY: Anti-histamines prevent a needle from popping a water balloon. Steroid nasal sprays decrease the number of water balloons and makes them smaller. Explanation of the analogy provided here.

Singulair (Leukotriene Inhibitor):

(starting at 12 months old)

Singulair (montelukast) is a unique medication that works by preventing the overall production of chemicals that leads to allergy symptoms whereas anti-histamines tries to prevent the release of those same chemicals. There is no other medication like singulair for allergies and is in a class of its own. Although some kids may find benefit with this medication alone, for the majority, it works best when taken in conjunction with an anti-histamine. Zyflo and Accolate are other leukotriene inhibitor medications mainly used to treat asthma.

Singulair dosing in kids as follows:

Adults and children 15 years of age and older: 10mg once a day
Children 6 to 14 years of age: 5mg daily.
Children 1 to 5 years of age: 4mg daily

ANALOGY: Singulair prevents water from being made inside a water balloon. Explanation of the analogy provided here.

Saline Flushes:

Saline flushes, quite simply, is giving a child's sino-nasal passages a good shower... just like taking a shower or bath to keep a body clean. By regularly performing saline flushes, it prevents pollen and other irritating allergens from settling in a child's nose and causing problems. Many kids have found that by performing saline flushes, their need for medications decreases if not altogether stops. Watch a video to watch kids performing sinus rinses.

It is recommended to perform such saline flushes with the Neilmed Sinus Rinse kit 1-2 times a day, especially after playing outdoors. Generally speaking, kids from the age of 5 years old can perform without difficulty. Kids younger than 5 years of age should use a saline nasal spray followed by bulb suctioning. Sinus irrigation devices also exist for greater ease, but are much more expensive.

ANALOGY: Saline flushes removes anything from the environment that may cause a water balloon to pop. Explanation of the analogy provided here.

Vitamin D:

Vitamin D has been found to help treat as well as prevent allergies by making the cells that produce allergy less active. Typically, the recommended dose of Vitamin D3 is 1000U daily for children.

ANALOGY: Taking Vitamin D is like decreasing the production of balloons by a balloon factory. Explanation of the analogy provided here.

Nasal Decongestants:

(starting at 4 years old)

There are 2 different types of nasal decongestants... nasal spray (Afrin, Zicam, etc) and pill (Sudafed) formulations. These medications alleviate the symptom of the "runny nose" and are NOT specific to allergies only, but also colds and other viral illnesses that cause a nose to run. In essence, nasal decongestants work by causing the blood vessels that go to the sino-nasal mucosal lining of your nose to squeeze shut... in essence, a chemical "tourniquet" is placed. When this happens, the reduced blood flow to your nose reduces the swelling and the drippiness of the nose.

That's why some people's blood pressure increases when taking this medication! The heart is trying to pump the same volume of blood, but through smaller blood vessels resulting in increased blood pressure.

Another potential harmful side effect and even addiction occurs with nasal spray decongestants (not with pills like sudafed). This "addiction" is called rhinitis medicamentosa which is a medication rebound phenomenon. If nasal spray decongestants are used daily for more than 4 days, one slowly becomes dependent on this medication in order to breath through the nose. Why? Well, remember that nasal decongestants places a "tourniquet" on the blood vessels going to the nose. Over time, the lining of your nose becomes starved for food and oxygen which only blood can provide, so when the decongestant wears off, the cells are screaming for blood and the vessels respond by becoming quite enlarged. Unfortunately, this causes your nose to become VERY stuffy... leading one to use the spray again... and again... and again. Once this happens, it becomes very difficult to stop using the spray and with any addiction, quitting is a very uncomfortable process complete with withdrawal affects. See your doctor for help if this happens to you.

In the end, our recommendations to patients are NOT to take any nasal decongestants unless the nose is dripping excessively. OR, if you do use, to try to avoid taking daily for a prolonged period of time, especially decongestant nasal sprays (no more than 3 days).

For regular (short-acting) sudafed oral dosage form (capsules, oral solution, syrup, or tablets)

Adults and children 12 years of age and older: 60 milligrams (mg) every four to six hours. Do not take more than 240 mg in twenty-four hours.
Children 6 to 12 years of age: 30 mg every four to six hours. Do not take more than 120 mg in twenty-four hours.
Children 4 to 6 years of age: 15 mg every four to six hours. Do not take more than 60 mg in twenty-four hours.
Children and infants up to 4 years of age: Use is not recommended .

ANALOGY: Decongestants is damage control after a water balloon has already popped. Explanation of the analogy provided here.

Mucinex:

Mucinex (also known as Robitussin or guaifenesin) does not help with allergies directly. All mucinex does is thin out secretions so it is easier to cough/spit up. It basically makes thick, sticky secretions less so. That's it. Nothing more. It does NOT work if not taken with plenty of water, so remember to drink a large glass of water with this medication. Often, mucinex is combined with sudafed (ie, Mucinex-D) which is a nasal decongestant and people often erroneously attribute symptom improvement to the mucinex when in actuality, it may be the nasal decongestant ingredient of the medication. LOOK at the list of ingredients if you are not sure! For more information on mucinex (appropriate and inappropriate uses), click here.

Mucinex dosing in kids:

Adults and children 12 years of age and older: 600mg 1-2 tabs every 12 hours.
Children 6 to 11 years of age: 5–10mL elixir every 4 hours.
Children 4 to 5 years of age: 2.5–5mL elixir every 4 hours.
Children and infants up to 4 years of age: Use is not recommended.

ANALOGY: Mucinex is damage control after a water balloon has already popped. Explanation of the analogy provided here.

Cromolyn Nasal Spray: (NasalCrom)

(staring at 2 years old)

Cromolyn nasal spray known over-the-counter (no presciption needed) as NasalCrom is a mast cell stabilizer. What this means is that it does what an anti-histamine does, but by a different method. An anti-histamine prevents the stuff a kid is allergic to from attaching to a mast cell causing it to rupture. A mast cell is the culprit cell that causes an allergic reaction. NasalCrom stabilizes the mast cell's membrane to point that it will not rupture, even if it is supposed to.

The downside of this medication is that it works best when given 30 minutes BEFORE a person gets exposed to their allergies.

Starting from 2 years of age, dosing is 1 spray every 6-8 hours.

ANALOGY: Cromolyn nasal spray makes the water balloon's skin tougher so it is harder to pop in the first place. Explanation of the analogy provided here.

Can I Take More than One Medication?

YES! In fact, for many kids with particularly very bad allergies, they do need to take an anti-histamine, steroid nasal spray, singulair, astelin, and perform saline flushes to keep their symptoms under control. These medications work synergistically and do not interfere with each other. The best way to think about taking all these medications is by comparing it to the military.

Astelin is the air force.
Singulair is the navy.
Steroid nasal spray is the marines.
Anti-histamines is the army.
Saline flushes are the factories that produce military hardware.

ANALOGY: These meds work synergistically to prevent a water balloon from popping. NasalCrom makes the water balloon's skin thicker so it is harder to pop. Anti-histamines prevent a needle from touching the balloon's surface. Singulair decreases the amount of water inside a water balloon. Steroid nasal sprays decreases the number of water balloons present. Saline flushes cleans the environment of anything that might pop a balloon. Explanation of the analogy provided here.

Though they each try to get your symptoms under control, they do it by different mechanisms which when taken altogether, can work even better than by itself. So, using the table below, a patient can generally take one medication from each column at the same time (but not more than one medication contained within a column unless directed by your doctor). For example (highlighted in RED), a patient can choose to take allegra, nasonex, singulair, patanase, nasalcrom, and saline flushes all at the same time.

Anti-Histamine Pill	Steroid Nasal Spray	Anti-Histamine Nasal Spray	Leukotriene Inhibitor	Saline	Cromolyn Nasal Spray	Vitamins
*Allegra* (fexofenadine) Zyrtec (cetirizine) Xyzal (levocetirizine) Clarinex (desloratidine) Caritin (loratidine) Benadryl (diphenhydramine)	Nasacort AQ Rhinocort AQ Flonase (fluticasone) Veramyst *Nasonex*	*Patanase* Astelin Astepro Rhinolast	*Singulair* Accolate Zyflo (asthma)	*Saline Flushes*	*NasalCrom*	Vitamin D3

Not sure what multiple types of allergy medications should be taken for your specific symptoms? Check out this webpage that tries to come up with the right combinaton for you!

Indeed, it is not fun to take medications daily, and for those kids, allergy testing followed by receiving allergy shots or drops may offer relief by building up a body's tolerance to the point that their allergies may be "cured". At the very least, a child's dependence on allergy medications may drastically decrease.

Along with medications, environmental control is very important to prevent exposure to whatever is triggering allergies in the first place. Click here for more information.

Check out our online store on allergy products here.