To start antihistimine or not....that is the question

[MandCmama]

     M is allergic to just about everything in Pennsylvania, environmental allergy- wise.  He take nasonex daily, and that has pretty much controlled his morning stuffiness and sneezing.  This morning when he woke up i could could hear the two boys giggling in their room.  When I asked what was so funny, M said, "C is just feeling my rash" When I went in to check it out, M had a welt/super hive going all the way around his waist, right where the elastic on his undies had been. If it didn't take me 3 hours to upload a picture onto here, I would! He said it didn't it, but it made ME itch.  Nothing anywhere else.  No other symptoms.  Not even itchy. I didn't give benadryl since it didn't itch and  didn't want to make him drowsy.  I took a picture in case it changed.
     When the allergist's nurse returned my call she said Dr. said it's probably due to his environmentals and start him on Zyrtec, Allegra, or Claratin 1x/daily. (Even though it's only March, we are in crazy full bloom here with temps in the 70's/80's for a couple weeks now)
     I'm not sure what to do...I don't him to take meds that aren't truly necessary.  Does this qualify?  He's not uncomfortable.  Do I wait for that or be proactive?

[GingerPye]

Well, in our house, we'd be crazy not to start antihistamines for the spring allergy season . . .and the fall allergy season, and pretty much all winter for my two kids. 
But an antihistamine is not a big worry like a steroid is (IMO anyway).  If the antihistamine helps, you may be able to eliminate the Nasonex --- or you may have to have him on both.  Just have to see how it goes.

[Mookie86]

Yikes, that's a nasty-sounding hive!

Personally, I consider antihistamines pretty benign.  However, if he's not bothered by his environmental allergies, it doesn't seem necessary to treat it.  If he has asthma, if he has congestion that might turn into a sinus infection, if his eyes are itchy, or if there's any other problematic environmental allergy symptom, then I'd put him on a 24-hour antihistamine.

Years ago, my kids took Nasonex and Zyrtec during pollen season.  We decided to discontinue the Nasonex, and they still did okay.  My thinking was that I knew they needed something during pollen season, but I'd rather have them on an antihistamine than a steroid nasal spray.

May I ask why you decided to approach it differently?  I'm wondering if I overlooked something.

[MandCmama]

Honestly, I haven't really given the Nasonex much thought... Last summer we noticed that every morning when he woke up, he was stuffy and sneezy. We were still months away from seeing the allergist, so I called.  Our allergist was on vacation and another from her group started the Nasonex.  We've seen her since then, and she's aware he's on it.  I never questioned it, b/c when I see her have 50,000 other questions rattling around in brain that are food allergy related, KWIM? And today I called because, again, we're a few months out from our appointment.  I asked the nurse if I should continue the Nasonex and she said yes.  I guess I could do both and then discuss it further with doc in July...

[momma2boys]

I would start them.  Two reasons, easier to get it under control before they are so bad that they are bothering him, and the whole full allergy cup. 

[CMdeux]

I think that I would.

Honestly, I tend to view things from a safety and pharmacological "targeting" standpoint, so my perspective on treating is both conservative

and perhaps more aggressive than some parents who take that outlook on things... (just wanted to explain that-- I'm a NON-drug interventionist in almost all instances, but there are notable exceptions where preventative considerations outwiegh that default stance, and this might be one of them.)

When DD was two, she began having environmental symptoms.  Actually, before then-- at about a year-- but we mostly just managed it without any meds that first year.  Current allergist is a (truly) top-notch pediatric allergist with a specialty in rapid immunotherapy protocols, antibiotic allergies, and in food allergy.  (He's out of Sinai and he's also part of the cohort that includes docs like Wasserman and the desens. group in Conn.)

His take was--

with kids who are multiply food allergic and already have at least one other manifestation of atopy, it is wiser to use the SAFEST medication that keeps things WELL in check (rather than 'symptomatically bearable, mostly') since there was emergent evidence that doing so might do some good in the way of halting the 'allergic march' in those children.  In other words, non-sedating antihistamines to keep inflammatory processes dialed WAY, WAY, WAY back might prevent additional problems like eczema that lichenifies skin, airway remodelling that leads to long-term steroid dependence... and maybe even to additional sensitization (since there is some thought that it's exposure through compromised skin that leads to food sensitization in susceptible individuals).

So we started dosing our then 29lb toddler with 1 tsp of zyrtec syrup daily, split into two doses.  Yes, that is a LOT of antihistamine.  It's half an adult dose.  By the time she was five, she was on an adult dose, and we had added Nasonex and Singulair as well.     The following year, we started on a six-year epic course of allergy shots.

But she was, at the time, a kid who seemed destined for many emergency room visits for asthma and cutaneous infection after infection, not to mention steroids, steroids, steroids. And from a pharmacological standpoint, steroids are the big elephant in the room, by far... we hated using steroid creams on her for her eczema, but nothing else seemed to work for long if she went outside between February and August.    

All that to say-- I feel very differently about non-sedating antihistamines than I do about most meds.  They have been tested, tested, and tested and used so widely that pretty much ALL of the risks are known, including long-term use in kids.  Those risks are really, really, really minimal.  Far less than the risks of airway remodelling or uncontrolled eczema. 

Anything that limits the use of other drug classes-- especially other immune modulators like steroids (even applied locally-- though to be sure, local > systemic application there, so inhaled or topical or nasal = okay whereas oral steroids are bad, bad news)...  anyway, anything that limits drugs in OTHER classes is a good thing when it comes with such low risks.

My personal order of aversion, from least to greatest is:

• second-gen antihistamines (zyrtec, claritin, allegra)


• first gen (sedating) antihistamines (diphenhydramine/benadryl, atarax, chlorpheniramine, etc)
• mast cell stabilizers (cromolyn sodium-- brand Nasalcrom-- I like this MUCH better than nasal steroids in terms of safety)

and these are about even, actually--

• leukotriene inhibitors (singulair)
• locally applied steroids (nasal/Nasonex-Flonase, inhaled, topical creams)

anything beyond this is on our personal "REALLY try-to-avoid" list--

• oral steroids


• calcineurin inhibitors (there are some eczema meds that are in this category... protopic, elidel, etc.)  Macrolides which are immmunosuppressants and have not-yet-fully elucidated pharamcology.

PS.  We've definitely noticed that there is a difference in DD's threshold dose for her food allergens when she's on a daily antihistamine versus not, too.  It doesn't buy her much in the way of margin for error, really (she's still awfully sensitive) but it's a quality of life thing that means the difference between hives EVERY time she goes to the movies, the library, etc. versus every second or third trip.  YK?

[YouKnowWho]

Could it be that he could only need them twice a year - maybe for a few weeks.  DH is affected at the end of the spring bloom and then again when ragweed rears it's ugly head.

I hear you on the daily meds, I do.  Having said that, allergy medication for both boys and DH means less illnesses and/or asthma flares.  So the daily med (Zyrtec for all before bed) frustrations for us, definitively outweighs the thought of a daily med.  For us, we are lucky in that it's generally just two months out of the year (March/April and August/September).  We stop dosing towards the end and see if it they can make it without.

Listening to DS1 cough and seeing DS2 helpless in bed (the kid who never stops moving and quit napping at a year old has spent two days having long naps, high fever and strep), reminds me that I stupidly made their allergist appt, not realizing that our pollen levels would reach nearly 10K this week.  So while we usually hit the Zyrtec when pollen levels start climbing above 200, they were off it when it hit the 3000 mark this weekend and it shows. 

[GoingNuts]

I would start them.  Two reasons, easier to get it under control before they are so bad that they are bothering him, and the whole full allergy cup.

Took the words right out of my mouth.  They are much easier to control before they get away from you.  Once they do, you're just playing "catch up".

That's how it works around here, anyway. 

[candyguru]

I would start them.  Two reasons, easier to get it under control before they are so bad that they are bothering him, and the whole full allergy cup.

Took the words right out of my mouth.  They are much easier to control before they get away from you.  Once they do, you're just playing "catch up".

That's how it works around here, anyway. 

During much of the year, we also give our 4 year old a daily antihistimine (due to pollen and leaf mould).  We usually give her cetirizine syrup (2.5 ML or 5ML a day).    We have also given her desloratadine (Aerius) syrup (2.5 ML a day) as cetirizine syrup is not available  in Canada (my high school friends who live in Seattle now are bringing a few bottles during their visit next month). 

Both cetirizine and desloratadine (NOT at the same time, of course) work very well in controlling her environmental allergies (sinus, sneezing, etc) and her itchy skin.

Just this morning, she had a runny nose, stuffy, sneezing etc and I gave her 2.5 ML desloratadine syrup and she has been fine the remainder of the day... allergy symptoms gone.  I also had to take a cetirizine pill today (Reactine, 10 mg).  Lots of tree pollen out there this time of year.

[MandCmama]

Thank you, all, for your input! I did start him on the cetirizine today. I was surprised to see the tablets are no longer an option ( a couple years ago c was on it and absolutely rejected the liquid. We had to quarter it, crush it and hide it, lol). I guess it never came back after the recall?

[CMdeux]

We buy tablets at Costco.  Check around for generic?  They are really tiny-- DD has no trouble taking them even without water. 

[candyguru]

Thank you, all, for your input! I did start him on the cetirizine today. I was surprised to see the tablets are no longer an option ( a couple years ago c was on it and absolutely rejected the liquid. We had to quarter it, crush it and hide it, lol). I guess it never came back after the recall?

I see that CVS has children's chewable cetirizine tablets 5mg.

http://www.cvs.com/CVSApp/catalog/shop_product_detail.jsp?filterBy=&skuId=688425&productId=688425&navAction=jump&navCount=3

[Mfamom]

everyone here is like wow, its only march (this was a few weeks ago) and my allergies killing me.  I think people don't realize that some pollens come out as soon as end of January.  People seem to wait too long to start taking something then, they are a mess and full allergy cup like others said.

[GoingNuts]

My allergies often start mid-late February; this year they never totally stopped.  And man oh man, they went into overdrive yesterday! 

[candyguru]

I think people don't realize that some pollens come out as soon as end of January.

Maybe this year ...  but in a normal year, it is -15C and we are buried under 20cm of snow in late January (here in Canada)  haha

Though by late Feb we can have snow mould depending on the weather